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For acute care physicians, anticoagulated patients presenting with intracranial hemorrhage (ICH) is an incredibly challenging clinical scenario. ANNEXa-I is a randomized, controlled, clinical trial which provides clinicians with important information on appropriate reversal of anticoagualtion to optimally care for these patients.

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Real World Evidence for Management of Severe Bleeding in the Anticoagulated Patient: Impact of Specific Reversal Therapy for Intracranial Hemorrhage and Gastrointestinal Bleeding

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Real World studies can provide the foundational support necessary for clinicians to effectively manage anticoagulated patients with severe, often life-threatening intracranial and gastrointestinal bleeding. While randomized controlled clinical trials have provided the initial data necessary for appropriate use of reversal agents such as andexanet alfa for Factor Xa associated bleeding, broader studies enrolling thousands of patients, many with significant co-morbidities, are extremely valuable to clinicians. New information regarding the randomized controlled trial ANEXXA-I, which was halted due to andexanet alfa efficacy, provides additional information supporting reversal therapy for severe bleeding.

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The Role of Real World Evidence in Driving Clinical Care for Anticoagulated Patients with Life-Threatening Bleeding

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Experts in Emergency Medicine, Pharmacy, and Neurocritical Care describe the impact of real world evidence on the care of life-threatening bleeding in the anticoagulated patient. While clinical trial data remain the standard for clinicians, real world data provide important additional information on the use of a particular Repletion or Reversal therapy for these patients.

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What Are the Barriers to Success When Implementing Care Pathways for ICH Patients?

July 12, 2022

ICH remains deadly and pathways matter but they aren't always what we need and barriers can be overcome with knowledge.

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How Do We Coordinate Care Within Our Hospitals To Improve Outcomes in Hemorrhagic Stroke Patients?

July 5, 2022

Coordinating the necessary care for hemorrhagic patients is complicated- learn the ropes from experts on the UC Stroke Team. "Smoother, faster better" is the name of the game.

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Jun 8

CT Angiography - What Should the Rest of Us Know?

Haemin Go posted on 6/8/2021

Moderator: William A. Knight IV, MD, FACEP, FNCS
Other Participants: Achala Vagal, MD, MS

Neuroradiologist Achala Vagal, MD, discusses the fundamentals of CT Angiography for non-radiologists in podcast recorded with Dr. William Knight. Dr. Vagal decribes her techniques and approach to efficiently reviewing and interpreting a CT Angiogram of the head and neck in suspected stroke patients. Drs. Vagal and Knight review the checklist approach to minimize errors of omission, MIPS, and the challenges of difficult lesions such as M2 occlusions. They agree on optimal communication with the consulting radiologist, and discuss the benefits and pitfalls of artifical intelligence radiology software.

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2 comments on article "CT Angiography - What Should the Rest of Us Know?"

Mohammad Kassem

I'd love to hear what your personal checklists are that you have found successful when reading a CTA. Thanks!

William Knight

Great question! Here is Dr. Vagal's approach to having a systematic evaluation of CTAs - particularly for a non-radiologist:

1. Look for the LVO (ICA/M1/basilar).

2. Check the MIPs for smaller vessels such as M2

3. Check the MIPs for collaterals/decreased branching of M2 (as we know M2 occlusions are hard and easy to miss)

4. Check CTA source images for ASPECTS, especially if NCCT is normal.

Hope this helps!

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