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Dr Sudhir Kumar MD DM🇮🇳 Profile picture
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Jan 11 • 10 tweets • 3 min read
Intravenous #thrombolysis (IVT) may be safe in patients taking direct oral anticoagulants (DOACs)

1. DOACs, including apixaban, dabigatran and rivaroxaban, have emerged as the primary #stroke prevention option in patients with nonvalvular atrial fibrillation (AF).
#neurotwitter
2. Every sixth patient with stroke otherwise qualifying for intravenous thrombolysis has a prescription for DOACs. Guidelines recommend the exclusion of patients with recent ingestion of DOACs (within 48 hours previously) from receiving IVT should they have an ischemic stroke.
3. This recommendation to exclude patients on DOACs from receiving IVT is based on the presumption of an increased risk of symptomatic intracranial #hemorrhage (sICH), but data to support or refute this presumption are lacking.
4. In a recent study, the risk of sICH in patients with recent ingestion of DOACs receiving IVT as treatment for acute ischemic stroke was compared with that in controls not taking DOACs.
5. The study included 33 207 patients with acute ischemic stroke receiving IVT (832 who had taken a DOAC and 32 375 controls who did not take DOAC).
The median NIHSS score was 9 (5-16).
6. Overall, 1345 patients (4.1%) developed sICH within 36 hours after IVT administration. The unadjusted rate of sICH was 2.5% in patients taking DOACs compared with 4.1% in control patients using no anticoagulants.
7. After adjustment for stroke severity and other baseline sICH predictors, patients with recent ingestion of DOACs who received IVT had lower odds of developing sICH.
8. The unadjusted rate of any ICH was 18.0% in patients taking DOACs compared with 17.4% in control patients who used no anticoagulants. After adjustment, there was no difference in the odds for any ICH between the groups.
9. The rates of functional independence and death were similar in both groups (those receiving DOACs and controls).
Ref: jamanetwork.com/journals/jaman…
10. Conclusion
*Patients receiving direct oral anticoagulants (apixaban, rivaroxaban or dabigatran) should be considered for intravenous thrombolysis (case-by-case basis).
*Guidelines need to be revised in the coming months/years to include the above.
#MedTwitter

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More from @hyderabaddoctor

Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 12
Woman in whom #migraine #headaches were triggered by financial dependence on husband

1. 35-year old Mahima- "Dr, my husband locks entire cash in a safe and takes the keys to office. I have no back account, so can't use UPI on mobile. I can't even buy a chocolate for my son."
2. Mahima had been consulting me for three months for frequent headaches, which were suggestive of migraine.
She was properly following my prescription, however, she still used to get 2-3 episodes of #headache every week.
I enquired with her about possible #stressors.
3. She had no interpersonal issues with in-laws or other family members and had no problems in marital life.
She was a housewife and had no source of income. She was dependent on husband for every expense, including buying small gifts for her son and even for emergency expenses.
Read 8 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 11
#Indian patients with ischemic #stroke are 19 years younger than British

1. In a recently published research paper, the mean age of ischemic stroke patients in India was only 52 years as compared to 71.5 years in #British.
Ref:doi.org/10.1111/ene.15…
#MedTwitter #neurotwitter
2. Even among British, Stroke patients of South Asian ethnicity were 9 years younger as compared to White British.
*Ethnicity is an independent predictor of early age of stroke onset.
3. Risk factors such as hypertension, atrial fibrillation, ischemic heart disease, alcohol use & obesity contributed to strokes occurring at younger age in Indians.
Consuming carbohydrate-rich diet and lack of physical activity were other risk factors for stroke among Indians.
Read 4 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 11
#PhysicalActivity and #brain health in patients with atrial fibrillation

1. Vascular brain lesions, such as ischemic infarcts, are common among patients with atrial fibrillation (AF) and are associated with impaired cognitive function.
#MedTwitter #neurotwitter #dementia
2. In a recent study, effects of physical activity and regular exercise on brain infarcts, brain volume and cognition were looked at.
Reference: doi.org/10.1111/ene.15…
3. In AF patients, regular exercise was associated with a lower prevalence of ischemic infarcts and of moderate to severe white matter disease, with larger brain volume, and with better cognitive performance.
Read 4 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 10
Common Medical #Prescription #Errors

1. Medical errors are unfortunately common, and they can cause patient harm as well as increased healthcare costs. The idea of this post is not to find fault but to caution healthcare professionals (HCPs) so that these errors can be reduced.
2. In an Indian study, out of the total 24,572 medication orders in ICU, 2,624 had prescription errors (PEs), an error rate of 10.7%.
7.2% PEs did not result in patient harm and 3.5% PEs required interventions and/or resulted in patient harm.
#MedTwitter
3. In Emergency department setting, the prescription error rate was 16.5%. Ref: doi.org/10.1016/j.ajem…
Read 10 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 10
Runners, take it easy, if you aren't able to match your pre-covid level performance

1. #running, like every #PhysicalActivity, got severely impacted during #COVID19 pandemic. Several runners couldn't keep to their training and as a result, aren't able to match pre-covid fitness.
2. Finishes in #endurance and #ultra endurance #running (UER) decreased significantly during the pandemic, with an almost 11-fold decrease in endurance running and 5-fold decrease in UER.
This resulted in lesser opportunities for #Training.
Ref: doi.org/10.3390%2Fmedi…
3. Covid-19 lockdown has negatively impacted the fitness level
The COVID-19 lockdown reduced 1000 meter running and pull-up performances by 11% and 24% respectively, among Chinese college men.
Ref: doi.org/10.3390%2Fijer…
Read 8 tweets
Dr Sudhir Kumar MD DM🇮🇳 Profile picture
Jan 10
Only about 40% of people completely recover their #smell >2 years after smell loss due to #Covid_19 infection

1. In a recent study, data was collected from about 1000 people who suffered loss of smell due to covid 19 infection >2 years ago.
#MedTwitter
doi.org/10.1016%2Fj.am…
2. After 2 years, 7.5 % percent continued to report no recovery.
Most (92 %) reported some recovery – either complete recovery (38%) or partial recovery (54 %).
3. Recovery in smell functions was greater in people aged 40 or less.
Subjects under age 40 reported complete recovery at a higher rate (46%) than those over 40 (33%; p = 0.001).
Read 5 tweets

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