Anticoagulation and stroke . . . and other stories

Timing of anticoagulation in strokeEarlier this year, a large randomised controlled trial reported that early anticoagulation in people with atrial fibrillation who had sustained a stroke probably carried a small benefit over delayed anticoagulation. However, the confidence intervals around the estimated treatment effects were too wide to make definite recommendations (N Engl J Med doi:10.1056/NEJMoa2303048). A re-analysis finds that this conclusion isn’t changed when infarct size is taken into account. The important finding is that early treatment with direct acting oral anticoagulants doesn’t carry a higher risk of bleeding complications, intracranial haemorrhage, or other adverse events, even when the infarct is large (JAMA Neurol doi:10.1001/jamaneurol.2024.1450).New treatments for dementiaLecanemab and donanemab, both monoclonal antibodies that target the accumulation of amyloid protein in the brains of people with Alzheimer’s disease, have been shown to slow the progression of dementia in clinical trials. This of course is welcome news, but it’s important to…
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