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AcuteCoronarySyndrome

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15

Maintenance of statin use over 3 years following acute coronary syndromes

Stream Maintenance of statin use over 3 years following acute coronary syndromes by BMJ talk medicine from desktop or your mobile device  
feeds.bmj.com
almost 7 years ago
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18

A Secondary Examination of The Adventure of the Cardboard Box - EM Nerd

In November of 1995 stroke care as we know it drastically and permanently changed. With the publication of NINDS-2 the NEJM ushered in the interventional era of acute ischemic stroke (1). No longer were we powerless in our management of these patients. Finally we could offer them more than an aspirin to chew on, a corner to sit in, and an appointment with a neurologist in the morning.¬† And yet NINDS-2 was not the first trial examining thrombolytic therapy for acute ischemic stroke. In fact three trials were published prior to NINDS-2 all of which were negative (NINDS-1, MAST-I, ECASS-1) with two finding an increase in mortality in patients given thromblytics (1,2,3). With the publication of NINDS-2 all this was forgotten. NINDS-2 was impressively positive, demonstrating a 13% absolute increase in patients who were given tPA that were alive and independent (mRS of 0 or 1) at 90 days (1). Supporters justified the 6% absolute increase in symptomatic intracranial hemorrhage by arguing that it did not increase 90-day mortality (21% vs 17%). Despite these impressive results there were still three negative trials to account for. What made NINDS-2 different than all the trials that came before it? Was it the agent? Supporters claim that tPA was the superior thrombolytic and we should ignore all trials studying other agents. Was it time? NINDS examined patients who received tPA within 180 minutes of symptom onset (half in under 90 minutes); two of the earlier trials examined patients who received thrombolytc¬†therapy over a much broader treatment window. Was it the patient population? The authors of NINDS used very strict selection criteria to determine which patients were acceptable candidates. There was of course a fourth reason proposed by a less enthusiastic contingent, that being random chance. This more skeptical party posited that an intervention that possesses little or no efficacy, if studied enough times would eventually demonstrate positive results simply by chance alone. They reminded the more eager supporters of tPA therapy that though the findings of NINDS-2 may be true, taking these results at face value without further validation was not only bad science, but even worse medicine. Despite these warnings the FDA fast tracked the approval of tPA for acute ischemic stroke in under 3-hours and all other trials attempting to validate this benefit were abandoned. As Elliot Grosbard, Genentech scientist, said in internal communications in regards to further trials comparing streptokinase to tPA for acute coronary syndrome;  
emnerd.com
almost 7 years ago
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16

Dr. Smith's ECG Blog: 40 Minute Lecture with Many Cases: Complications of Acute Coronary Syndrome.

Instructive ECGs in Clinical Context ----Archives, Popular Posts, and an Index of all ECGs are down the right-hand side.  
hqmeded-ecg.blogspot.com
over 6 years ago
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32

Complications of Acute Coronary Syndrome - HQMedEd.com

Complications of Acute Coronary Syndrome  
hqmeded.com
over 6 years ago
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Does hyperbaric oxygen therapy improve outcome after heart attack? | Cochrane

Acute heart attacks and severe angina (heart pain) are usually due to blockages in the arteries supplying the heart (coronary arteries). These problems are collectively referred to as 'acute coronary syndrome' (ACS). ACS is very common and may lead to severe complications including death. Hyperbaric oxygen therapy (HBOT) involves people breathing pure oxygen at high pressures in a specially designed chamber. It is sometimes used as a treatment to increase the supply of oxygen to the damaged heart in an attempt to reduce the area of the heart that is at risk of dying.  
cochrane.org
over 6 years ago