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Half-Dose DOACs Cut Bleeding, Thrombus Risk Post-Watchman LAA Closure
https://www.medscape.com/viewarticle/960974

Oct 15th, 2021 - In a potential case of "less is more," an antithrombotic regimen with only short-term antiplatelets and long-term reliance on direct oral anticoagulants (DOACs) — but at half the standard dosages — led to an almost 90% drop in risk of thromboembolic and major bleeding events after transcatheter left-atrial appendage (LAA) closure, in an observational study. Meanwhile, the long-term half-dose DO...

New FDA Guidance Aims to Cut Sodium in Processed Foods
https://www.medscape.com/viewarticle/960788

Oct 13th, 2021 - The US Food and Drug Administration (FDA) has issued voluntary, short-term sodium reduction targets for food manufacturers, chain restaurants, and food service operators for processed, packaged, and prepared foods, with an eye toward reducing diet-related conditions such as heart disease and obesity. According to the FDA, more than 70% of total sodium intake is from sodium added during food man...

Key Takeaways From the Latest Stroke Guidelines
https://www.medscape.com/viewarticle/956496

Oct 13th, 2021 - This transcript has been edited for clarity. Dear colleagues, I am Christoph Diener from the faculty of medicine at the University of Duisburg-Essen in Germany. This month I would like to report on several new publications from the European Stroke Organisation on the management and prevention of stroke. Managing Blood Pressure in the First 24 Hours The first study deals with the management of b...

Rivaroxaban's Single Daily Dose May Lead to Higher Bleeding Risk Than Other DOACs
https://www.medscape.com/viewarticle/960710

Oct 12th, 2021 - A study that compared three types of direct oral anticoagulants (DOACs) found that rivaroxaban was associated with a much higher risk of overall and major gastrointestinal bleeding than apixaban or dabigatran. The results, which were published in the Annals of Internal Medicine, could help guide DOAC selection for high-risk groups with a prior history of peptic ulcer disease or major GI bleedin...

USPSTF Rules Out Aspirin for Over 60s in Primary CVD Prevention
https://www.medscape.com/viewarticle/960745

Oct 12th, 2021 - New draft recommendations from the US Preventive Services Task Force (USPSTF) on the use of aspirin for the primary prevention of cardiovascular disease (CVD) have been released and appear to limit the population in which it should be considered.   "The USPSTF concludes with moderate certainty that aspirin use for the primary prevention of CVD events in adults ages 40 to 59 years who have a 10%...

Little Benefit From Adding Aspiration to Thrombectomy for Stroke
https://www.medscape.com/viewarticle/960588

Oct 11th, 2021 - A first-line thrombectomy approach that combines contact aspiration and stent retrieval techniques does not significantly improve the reperfusion rate compared to stent retrieval alone in patients with acute ischemic stroke and large-vessel occlusion, a newly published study shows. Dr Bertrand Lapergue However, the trial was likely underpowered, so the question of whether the combined approach ...

Saccular Aneurysm No Bar to Thrombolysis in Ischemic Stroke
https://www.medscape.com/viewarticle/960543

Oct 8th, 2021 - Intravenous thrombolysis (IVT) seems to be relatively safe for acute ischemic stroke patients who have even larger-sized saccular unruptured intracranial aneurysms (UIAs), a Finnish study suggests. "I think there is now sufficient evidence that saccular aneurysms should not be considered a contraindication for thrombolysis," Jyri Virta, MD, PhD, with the Department of Neurosurgery and Neurology...

Balancing the Risk and Benefit of Anticoagulation in Patients on BTKi
https://www.onclive.com/view/balancing-the-risk-and-benefit-of-anticoagulation-in-patients-on-btki

Oct 7th, 2021 - Farrukh Awan, MD: We’ll keep talking about specific things. I’ll tell you a few specific issues that I deal with. I’m sure a lot of people in the audience might have to deal with these issues. I’ve had problems, and I’ve had discussions, arguments, and fights with various cardiologists. With the cardio-oncology group, as we keep working with them, we have a very nice equation and we’re thinking...

Optimum A1c to Prevent Events in Stroke Patients With Diabetes?
https://www.medscape.com/viewarticle/960409

Oct 7th, 2021 - For patients with diabetes who have had a stroke, glycated hemoglobin (A1c) level at the time of admission to the hospital was significantly associated with the risk for future vascular events in a new study. The optimum range of admission A1c associated with a minimum risk for vascular events and stroke recurrence was estimated to be between 6.8% and 7.0%. The risk significantly increased abov...

Dr. Miller on the Characteristics of Clonal Hematopoiesis
https://www.onclive.com/view/dr-miller-on-the-characteristics-of-clonal-hematopoiesis

Oct 6th, 2021 - Peter G. Miller, MD, PhD, physician, Dana-Farber Cancer Institute, instructor in medicine, Harvard Medical School, discusses the characteristics of clonal hematopoiesis. With age, cells acquire mutations that mostly do not affect cell growth, Miller says. However, some mutations can affect growth and, eventually, lead to cancer. For example, a colon polyp can develop with some mutations, but...

'Public Health Emergency' Declared With 1 in 10 Adults Having Diabetes by 2030
https://www.medscape.com/viewarticle/960340

Oct 6th, 2021 - Nearly 1 in 10 of the UK's adult population will be living with diabetes by the end of the decade, if further action to prevent and treat both type 1 and type 2 diabetes is not taken, shows an analysis by Diabetes UK. Further to the projected 5.5 million adults (10% projected adult population) who could be living with diabetes by 2030, an extra 17 million people could also be at increased risk ...

An MD and a Healthcare Exec Sued Their Employers for Fraud: What Happened?
https://www.medscape.com/viewarticle/960345

Oct 6th, 2021 - James Taylor, MD, a former physician director of coding and medical director of revenue cycle at Kaiser's Colorado Permanente Medical Group, just wanted Kaiser to do the right thing and stop submitting false claims to Medicare Advantage. Dr James Taylor Taylor, who describes himself as tenacious to a fault, says he waited 7 years to file his lawsuit because he thought he could convince Kaiser t...

A Sexually Active 23-Year-Old With Seizures and Tongue Pain
https://www.medscape.com/viewarticle/865890

Oct 5th, 2021 - Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please ...

No Protective Effect of Cognitive Reserve in Vascular Brain Injury
https://www.medscape.com/viewarticle/960294

Oct 5th, 2021 - Cognitive reserve, through which normal cognition is preserved despite pathologic brain changes, does not protect cognitive function for patients with vascular brain injury, new research shows. In a cross-sectional study, vascular brain injury was associated with a 0.35-point reduction in the Montreal Cognitive Assessment Tool (MoCA) and a 2.19-point decrease in score on the Digit Symbol Substi...

Screening for AF: More Questions Than Answers
https://www.medscape.com/viewarticle/960097

Oct 4th, 2021 - In the early days of the pandemic, we were debating the merits of telemedicine to avoid bringing patients into the office. I was very much in favor of telemedicine, but some of my colleagues argued that seeing patients in person in the clinic gave you the opportunity to do ECGs and catch atrial fibrillation (AF). I don't doubt that you will catch some AF that way and that some patients might ha...

AF a Stroke Cause or Innocent Bystander? The Debate Continues
https://www.medscape.com/viewarticle/960224

Oct 4th, 2021 - Discovery of substantial atrial fibrillation (AF) is usually an indication to start oral anticoagulation (OAC) for stroke prevention, but it's far from settled whether such AF is actually a direct cause of thromboembolic stroke. And that has implications for whether patients with occasional bouts of the arrhythmia need to be on continuous OAC.   It's possible that some with infrequent paroxysma...

Extracranial Cerebrovascular Disease Clinical Practice Guidelines (SVS, 2021)
https://www.medscape.com/viewarticle/960036

Oct 1st, 2021 - Guidelines for the management of extracranial cerebrovascular disease were published in June 2021 by the Society for Vascular Surgery (SVS) in Journal of Vascular Surgery.[1] Carotid endarterectomy (CEA) is recommended as first-line treatment for symptomatic low-risk surgical patients with stenosis of 50% to 99% and asymptomatic patients with stenosis of 70% to 99%. Carotid revascularization is...

'Metabolically Healthy Obesity' Has Heart Risks. Is it a Misnomer?
https://www.medscape.com/viewarticle/959994

Sep 30th, 2021 - Carrying excess weight is associated with an increased risk for certain heart problems even when there are no metabolic disturbances, data from a large French longitudinal study have shown. In an analysis of almost 3 million people with no prior heart issues, there was a 34% increased risk for developing heart failure and a 33% increased risk for developing atrial fibrillation, it was reported ...

COVID Is Killing Rural Americans at Twice the Rate of Urbanites
https://www.medscape.com/viewarticle/960023

Sep 30th, 2021 - Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center. Rural Americans are dying of covid at more than twice the rate of their urban counterparts — a divide that health experts say is likely to widen as access to medical care shrinks for a population that tends to be older, sicker, heavier, poorer and less vaccinated. While the initial surge of covi...

Women With Type 2 Diabetes Get Fewer Cardioprotective Drugs Than Men
https://www.medscape.com/viewarticle/959852

Sep 28th, 2021 - Among those with type 2 diabetes, women receive some cardioprotective treatments less often than men, according to a post-hoc analysis of data from the REWIND trial, conducted in nearly 10,000 adults from 24 countries. At study entry, significantly fewer women received a statin, at 73%, or daily aspirin, at 44%, compared with men, who had treatment rates of 81% and 58%, respectively, Giulia Fer...