Tranexamic acid (TXA) has been held as something of a wonder drug. It’s cheap, largely demonstrated to be safe and has been given a role in a number of settings. The 2013 CRASH-2 trial showed improved survival in trauma with bleeding, and thus became one of the most widely cited publications in traumatology and emergency medicine. Several… Continue reading TICH-2: No Benefit From TXA in ICH. What Now?
Crash-2 showed that TXA reduced mortality due to bleeding and all-cause mortality in trauma patients with extra cranial bleeding. The Crash-3 trial will provide reliable evidence about the effect of TXA on mortality and disability in patients with TBI. the effect of TXA on the risk of vascular occlusive vents and seizures will also be… Continue reading Crash-3 has enrolled 9653 patients!
There´s a paucity of guidelines and recommendations on diagnostic pathways in patients on warfarin who sustain head injuries. This article by Alrajhi et al from 2015 (J Emerg Med) looked at an historical cohort of patients on warfarin admitted for either minor (Glasgow Coma Score 13-15, with loss of consciousness, amnesia, or confusion) or minimal (Glasgow Coma Score… Continue reading To CT or not CT? Intracranial Haemorrhage in Patients on Warfarin
Published in NEJM 2016, the Antihypertensive Treatment of Acute Cerebral Hemorrhage II (ATACH-II) trial compared two BP-management regimes in intracerebral haemorrhage patients with hypertension (SBP>180 mmHg): Intensive lowering to SBP 110-139 mm Hg. vs. standard treatment to within the 140-179 mm Hg range. The trial was discontinued early after an interim analysis showed no difference between the groups in… Continue reading ATACH II Trial – No Benefit From Aggressive BP-lowering in ICH
Transfusing thrombocytes to patients taking anti-platelet therapy who develop an intracerebral hemorrhage seems to confer harm, according to the authors of the PATCH trial (abstract). Published recently in the Lancet by Baharoglu et al, this multicentre RCT included 190 patients in order to determine whether platelet transfusion reduces extent of haemorrhage, thereby improving outcome, in ICH associated with… Continue reading PATCH – Trial: Platelets in ICH Harmful
On behalf of our colleague Dr. Ann-Christine Lindroos of Töölö Hospital in Helsinki, Finland we´d like to solicit your opinion on the discontinuation of anticoagulant medication in neurosurgical practice. We´d love to hear from as many of our colleagues as possible. Feel free to comment below and share your institution´s policy with NeuroScand users. In Dr. Lindroos´own… Continue reading Anticoagulants and Neurosurgery – What´s Your Policy?
A Statement for Healthcare Professionals from the Neurocritical Care Society. Read more here. Best regards, Riikka Takala.