Bold Voices - August 2013 - (Page 17)

AT THE BEDSIDE Clot Busters Safe for Patients With Stroke Who Take Aspirin A spirin is taken by millions of Americans who want to reduce the risk of heart attack. For patients with stroke, it has been thought that clot-busting drugs such as tPA could react adversely with certain blood thinners and cause serious brain bleeding. “Does Preexisting Antiplatelet Treatment Influence Postthrombolysis Intracranial Hemorrhage in Community-treated Ischemic Stroke Patients? An Observational Study,” published in Academic Emergency Medicine, finds this belief is unfounded in many cases. The University of Michigan Stroke Program, Ann Arbor, organized the study, analyzing data from 830 patients with stroke who received tPA while at 28 Michigan-area hospitals. Nearly half the patients were taking aspirin or clopidogrel (Plavix) before having a stroke. The study found no significant difference in the rate of brain bleeding — including low-level bleeding that did not cause symptoms — among those who were taking aspirin compared to those who were not. However, the findings did show there was a small increase in risk of non-symptomatic brain bleeding in patients older than 81. The study didn’t include patients taking more potent blood thinners such as warfarin, heparin, dabigatran (Pradaxa) or rivaroxaban (Xarelto), and it cautions that the potential use of tPA in patients taking these drugs needs more research. Lead study author William Meurer, assistant professor of emergency medicine at the University of Michigan Medical School, Ann Arbor, says the findings support his recommendation that physicians not alter their decision to use tPA when treating patients with stroke. “In light of the long-term benefit that patients receive from antiplatelet therapy, the small increase in risk of intracranial hemorrhage after tPA treatment should not be a game-changer for emergency physicians,” Meurer notes in a related article in Science Daily. Study did not include potent blood thinners such as warfarin, heparin and dabigatran. Updated Stroke Definition Reflects New Knowledge, Advances If neuroimaging shows brain tissue injury, it should be called a stroke even if the patient has no symptoms. I n an effort to eliminate inconsistencies and reflect technological and scientific advances, a committee of experts from the American Heart Association and American Stroke Association has produced a new consensus document defining stroke. The updated definition, published in Stroke, says that if neuroimaging shows brain tissue injury, it should be called a stroke even if no symptoms exist. The committee suggests that the tissue injury, rather than a fixed time designation, be a distinguishing factor. The committee defines a stroke broadly in several distinct categories with the goal of creating consistency among clinical practice, research and public health dialogue. “The most important message here is that advances in neuroimaging, and in medical science in general, allow us to define stroke as any permanent injury to the central nervous system caused by a vascular disorder, whether there are symptoms or not,” co-chair Scott Kasner of the University of Pennsylvania AACN BOLD VOICES AUGUST 2013 17 in Philadelphia and colleagues tell MedPage Today in a related article. The committee acknowledged a struggle with silent infarctions discovered during routine MRI exams when stroke is not suspected, such as for head injuries. Ultimately, the committee decided its purpose was definition, not treatment, and thus declined to make specific suggestions about the potentially large category of clinical identification.

Table of Contents for the Digital Edition of Bold Voices - August 2013

Bold Voices - August 2013
Another Angle
Seamless Staff Leadership Transition Is Goal of AACN's CEO Search
A Pool of Exceptional Talent
Progressive Care Nurses: A Conference, Las Vegas and CNEs Just for You
Communication Is Critical to Avoid Readmissions
Hospital Deaths Decrease Slightly Over 10 Years
Leapfrog Rates Hospital Safety Performance
Patient Safety Threatened by Insufficient Nurse Staffing, Fatigue
Number of Americans With Dementia, Cost of Care to Double by 2040
Updated HHS Standards Support Improved Cultural and Linguistic Competency
Decrease Noise Levels to Improve Patient Outcomes
Alarm Management (AACN Practice Alert)
Survey Reports High Levels of Burnout, Job Seeking
New HIPAA Rule Seeks to Balance Patients' Privacy Protection
Pet Ownership May Be Heart-Friendly
Hospitals Better at Preventing CLABSIs
Online Program Helps Military Service Members, Veterans Become Nurses
Clot Busters Safe for Patients With Stroke Who Take Aspirin
Updated Stroke Definition Reflects New Knowledge, Advances
In Our Journals
Antibiotics May Relieve Back Pain in Certain Cases
Certification Capsules
AACN Members, Friends Inducted as AANP Fellows
Empowered ED Case Managers
New CCN Resource Expands Reader Access to Nursing Care Studies
Contribute to the Evidence: Apply for an AACN Research Grant by Nov. 1
Nurse Leaders, Aspiring Nurse Leaders: Get Ready for Las Vegas, Sept. 18-20
AACN Scholarships Support Your Learning Journey
What Is Your Wake? (From the President)

Bold Voices - August 2013