Skip to main content

Intensive blood pressure reduction in acute intracerebral haemorrhage: a meta-analysis

By James Heilman, MD (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia CommonsMethodology Score: 3/5                   
Usefulness Score:  3/5

Tsivgoulis G, Katsanos AH, Butcher KS, et al.
Neurology. 2014 Oct 21;83(17):1523-9

  
This systematic review and meta-analysis of 4 RCTs found that mortality rates were similar in patients with acute ICH randomized to intensive-BP (SBP <140) versus guideline-BP (SBP <180) control (OR 1.01, 95% CI 0.83-1.23; p = 0.914). The analysis was largely influenced by one RCT, which used an anti-hypertensive agent that is not available in Canada. Lack of clear reporting of clinically important outcomes and baseline clinical characteristics were discussed. JC attendees agreed that there was no practical or clinical advantage in the resource intensive intervention of aggressive BP reduction in acute ICH in the ED. 
By: Dr. Gauri Ghate
(Presented April 2015)


Epi Lesson: Clinical vs Statistical Heterogeneity

A meta-analysis may attempt to address a compelling clinical dilemma. But one of the key questions to ask when appraising meta-analyses is whether the pooling of the included studies is appropriate. Clinical heterogeneity reflects clinical differences between study populations, the intervention, co-interventions and/or outcomes when pooling studies in meta-analysis. This is distinct from statistical heterogeneity which can be determined by visually assessing the forest plot, measuring the I2 statistic or the Cochran’s Q. Always ask yourself if the meta-analysis is combining apples with apples.  
By: Dr. Lisa Calder

Comments

Popular posts from this blog

Tips for Success in your Emergency Medicine Rotation

Our wonderful medical students are preparing to start their first clinical rotations. With this in mind here are some of the top tips for success in your EM rotation
1)Be On Time – show up to your shifts on time, better yet 5 minutes early.That first impression is immensely important.
2)Introduce yourself to the team - “Hi my name is John Doe, I am the medical student on shift today” introduce yourself to the attending, residents, nurses, etc.You will be called on a lot more to help when there is something interesting going on if they know your name.
3)Be goal-oriented – have a goal for each shift, whether it’s a procedure or a type of presentation to see.
4)Don’t just stand there, do something – whenever there is a trauma or code, come to the bedside.Get gowned up for traumas and pay attention.Help with things that are within your scope of practice: chest compressions, moving patient, cardioversion
5)Don’t just stand there, do nothing – there are times in medicine when the best thing to d…

2014 Canadian Guidelines for AF Management: Part 1: Introduction and CCS “CHADS-65” Algorithm

by Ian Stiell MD @EMO_Daddy














In this and subsequent postings we will discuss the latest recommendations for ED management of atrial fibrillation (AF) as presented in the newly published 2014 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. The Guidelines PDF can be downloaded from the CCS website at 2014 Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation
The 2014 Focused Update uses the GRADE system of evidence evaluation as was the case in the comprehensive 2010 AF Guidelines and the 2012 Update. The CCS AF Guidelines Panel is comprised of Canadian cardiologists plus physicians from internal medicine, family medicine, neurology, and emergency medicine. This 2014 Update provides evidence review and recommendations for 8 aspects of AF care, including ED Management (written by myself and Dr. Laurent Macle of the Montreal Heart Institute). The 2014 Update focuses on advances in oral anticoagulant (O…

You CAN reverse that! Reversal of NOAC's and more..

We have seen a large surge of the utilization of New Oral Anticoagulants (NOAC's) in the past few years, as such, it has been a novel challenge when these patients present to the Emergency Department (ED) with life threatening bleeding. Dr. Michael Ho looks to discuss treatment options, and future options in these patients. 
NOACs vs WarfarinDabigatran, Rivaroxaban and Apixaban have seen a dramatic increase in use since their approval in Canada. Dabigatran is a direct thrombin (Factor II) inhibitor, while the latter two are direct Xa inhibitors. These drugs are collectively referred to as novel oral anticoagulants (NOACs). They have also been called direct, or target-specific oral anticoagulants (DOACs or TSOACs) [1]. 
The NOACs have many practical advantages over warfarin: Rapid onset of actionShorter half-lifeLess food and drug interferencePredictable pharmacokineticsEase of use and no requirement for monitoringThe downsides to NOACs are the higher cost to the patient, the inabilit…