Relationship of Ethanol, Cannabinoids, Benzodiazepines, and Opioids to Serious Injuries from Falls in Adults Aged 55 and Older.

Sex differences in the incidence of composite ischemic and bleeding events in ischemic stroke patients with nonvalvular atrial fibrillation and atherosclerosis.

Fetal and neonatal alloimmune thrombocytopenia (FNAIT): From reactive transfusion to proactive prevention.

The Society for Vascular Surgery clinical practice guideline on the management of blunt thoracic aortic injury: Focused update.

The impact of pre-hospital transport process optimization on rescue efficiency and complications in patients with traumatic intracranial hemorrhage.

The comparative performance of the DOAC score versus established bleeding risk scores in patients with atrial fibrillation (AF) receiving direct oral anticoagulants (DOACs) remains uncertain. This meta-analysis evaluated the predictive ability of the DOAC score compared with HAS-BLED and ORBIT. PubMed and Embase were systematically searched to identify studies assessing the predictive performance of the DOAC score in AF patients treated with DOACs. Pooled C-indices were calculated to compare discrimination. Reclassification metrics (net reclassification improvement [NRI], integrated discrimination improvement [IDI]), calibration analyses, and decision curve analyses (DCA) were synthesized qualitatively. Nine studies comprising 12 cohorts were included (n = 89 688). The DOAC score demonstrated significantly superior discrimination for major bleeding compared with HAS-BLED (C-index 0.68 vs. 0.63). No significant differences were observed for intracranial hemorrhage, gastrointestinal bleeding, or clinically relevant non-major bleeding, nor in comparisons with ORBIT. Reclassification analyses showed heterogeneous findings, with several studies reporting no incremental benefit of the DOAC score, although one large cohort demonstrated improved NRI and IDI over HAS-BLED. Calibration analyses revealed good performance across scores, though both HAS-BLED and DOAC tended to overestimate bleeding risk in high-risk groups. DCA suggested variable but occasionally greater net benefit of the DOAC score at clinically relevant risk thresholds. The DOAC score provides modest but statistically significant improvement in predicting major bleeding compared with HAS-BLED, with comparable performance to ORBIT. However, reclassification, calibration, and clinical utility vary across settings, underscoring the need for further prospective validation.

Ischemic stroke (IS) is an acute cerebrovascular disease in which blood circulation to brain tissue and neurological function are impaired due to obstruction of cerebral blood vessels, and it is one of the most common causes of death worldwide. Therapies such as intravenous thrombolysis and endovascular thrombectomy can open occluded cerebral vessels and restore blood flow through reperfusion, but ischemia/reperfusion (I/R) may trigger pathological processes such as oxidative stress, electrolyte disorders, and inflammatory responses, leading to secondary tissue damage such as cerebral edema and intracranial hemorrhage. Therefore, it is crucial to mitigate cerebral ischemia-reperfusion injury (CIRI). Mitochondria, as organelles, usually exist inside cells. However, under the stimulation of CIRI, mitochondria and their components can affect brain tissue cells by transcellular transfer through tunneling nanotubes (TNTs), gap junctions (GJs), and releasing and capturing of extracellular vesicles (EVs), etc. The mitochondrial transcellular transfer therapy for CIRI can reduce oxidative stress damage, improve neuronal energy metabolism, regulate neuroinflammation, and promote neural repair and regeneration. Mitochondrial transcellular transfer is regarded as a promising therapeutic approach for the treatment of CIRI, and in-depth investigation of the mechanism of mitochondrial transcellular transfer is expected to open up a new clinical pathway for the treatment of CIRI. This paper explores the molecular mechanism of mitochondrial transcellular transfer and its effects in the treatment of CIRI, which is expected to broaden clinical therapeutic approaches and provide a new direction for the treatment of CIRI.

Intracranial atherosclerotic disease (ICAD) is a major cause of ischemic stroke and transient ischemic attack, particularly in Asian populations. Despite best medical therapy, symptomatic ICAD carries a substantial risk of recurrent ischemia. To evaluate the safety and feasibility of the fibrin-heparin coated CREDO heal stent for the treatment of symptomatic high grade ICAD in routine clinical practice. This retrospective observational case series included patients with symptomatic intracranial stenosis ≥70% treated with the CREDO heal stent. All patients were receiving best medical therapy and had at least one qualifying ischemic event. The primary safety endpoint was stroke, intracranial hemorrhage, or death within 30 days. Secondary endpoints included technical success, angiographic patency, recurrent ischemic events, and functional outcomes measured by the modified Rankin Scale (mRS). Clinical follow-up occurred at discharge, and at 30, 90, and 180 days, with CT angiography at 90 days and DSA at 180 days. Forty-five patients (78% men; mean age 64.8 years) were treated. Technical success was achieved in all cases, with stenosis reduced from 84.5% to ≤30%. No stroke, intracranial hemorrhage, or death occurred within 30 days. Clinical follow-up was complete in all patients at discharge, and at 90 days and 180 days. Imaging follow-up was available in 41 patients at 90 days and in all patients at 180 days, with no angiographic restenosis or stent thrombosis observed. Favorable functional outcome (mRS score ≤2) was observed in all patients at 6 months. In this retrospective series, elective percutaneous transluminal angioplasty and stenting using the CREDO heal stent appeared feasible and showed no major complications in this selected cohort.

A study using Medicare data concluded that among patients aged 65 years or older, rivaroxaban had a less favorable benefit-harm profile compared with other non-vitamin K oral anticoagulants (NOACs); however, it is unclear whether this finding persists in younger users. To compare major extracranial bleeding (MEB), gastrointestinal bleeding (GIB), intracranial hemorrhage (ICH), and thromboembolic stroke in individuals aged younger than 65 years using non-vitamin K oral anticoagulants (NOAC users) for nonvalvular atrial fibrillation (NVAF). This cohort study using health care claims data between October 2010 and February 2022 in the FDA Sentinel System included standard dose NOAC (rivaroxaban, apixaban, and dabigatran) users with NVAF aged 21 to 64 years. Analyses conducted between December 2022 and August 2023. Hazard ratios (HRs) and 95% CIs were estimated for each outcome (MEB, GIB, ICH, and thromboembolic stroke) in inverse probability of treatment-weighted pairwise comparisons: rivaroxaban vs apixaban, rivaroxaban vs dabigatran, and dabigatran vs apixaban. A total of more than 173 000 patients (mean [SD] age, 56.6 [7.23] years; 27.5% female; 72.5% male) were included across the 3 exposure cohorts. The number of NOAC users for each pairwise comparison were rivaroxaban (57 932) vs apixaban (96 057), rivaroxaban (57 399) vs dabigatran (20 188), and dabigatran (20 163) vs apixaban (96 668). Rivaroxaban was associated with higher risks of MEB and GIB compared with apixaban (MEB: HR, 1.91; 95% CI, 1.56-2.34; GIB: HR, 1.92, 95% CI, 1.54-2.39), while differences in thromboembolic stroke prevention were not significant (HR, 1.05; 95% CI, 0.77-1.44). Dabigatran was associated with higher thromboembolic stroke risk (rivaroxaban vs dabigatran: HR, 0.61; 95% CI, 0.39-0.94; dabigatran vs apixaban: HR, 1.74; 95% CI, 1.13-2.68). These findings suggest that for patients aged younger than 65 years treated with NOACs for NVAF, apixaban was associated with the most favorable benefit-harm profile. While the results suggest that rivaroxaban may have provided greater stroke prevention than dabigatran, it was associated with higher bleeding risks than apixaban without additional stroke prevention. The higher thromboembolic stroke risks observed with dabigatran in younger patients suggest important age-related differences in effectiveness that warrant further investigation.

We evaluate the clinical course of patients with hypoalbuminemia who underwent endovascular thrombectomy (EVT) within 24 h of acute ischaemic stroke (AIS). A retrospective cohort study using data from the global federated research network TriNetX. Adults ≥ 18 years treated with EVT for AIS between 2018 and 2024 with serum albumin measured within 24 h post-EVT were included. Patients were grouped by serum albumin levels: reduced (≤ 3.4 g/dL) vs. normal (≥ 3.5 g/dL). The primary outcome was a 30-day composite of all-cause death, acute heart failure, atrial fibrillation, ventricular arrhythmias, acute myocardial infarction, Takotsubo syndrome. Secondary outcomes included individual components and intracranial haemorrhage. Propensity score matching (1:1) balanced covariates, followed by Cox regression to estimate hazard ratios (HRs) and 95% confidence interval (CI)s. Among 8,698 patients with AIS treated with EVT, 6,233 had normal serum albumin (mean age 67.0 ± 14.5 years, 44.0% female), while 2,465 had reduced albumin (69.7 ± 14.3 years, 51.5% female). After matching, 2,374 patients with reduced albumin had higher risk of the composite outcome (HR 1.28, 95%CI 1.17-1.39), all-cause mortality (HR 1.72, 95%CI 1.50-1.96), and acute myocardial infarction (HR 1.74, 95%CI 1.28-2.35), compared to those with normal albumin. These associations remained consistent across subgroups stratified by age, sex, stroke severity, causes of hypoalbuminemia, degrees of hypoalbuminemia reduction. Hypoalbuminemia in patients with AIS treated with EVT is associated with an increased risk of early cardiovascular events. Serum albumin may be a prognostic biomarker in this population.

Background/Objectives: There is no consensus on standardized treatment algorithms for patients with acute ischemic stroke due to anterior circulation tandem occlusions. This study evaluated the outcomes of mechanical thrombectomy and carotid artery stenting in such patients, with a particular focus on a standardized, adaptive, and escalating antithrombotic strategy. Methods: This single-center retrospective study included patients with atherosclerotic tandem occlusion treated between January 2019 and July 2023 at our comprehensive stroke center. All patients underwent mechanical thrombectomy and carotid artery stenting and received a standardized antithrombotic regimen, including the administration of the GPIIb/IIIa antagonist eptifibatide as rescue therapy. Results: Sixty-seven patients were included in the analysis. Thirty-five patients (52.2%) received eptifibatide due to acute stent thrombosis. Subtotal to total revascularization (mTICI 2b-3) was achieved in 98.5% of patients. The carotid artery reocclusion rate was 3.4% at discharge. Symptomatic intracranial hemorrhage occurred more frequently in patients treated with eptifibatide (9.0% vs. 0%, p = 0.021) but was not associated with mortality or favorable outcome (mRS 0–2) at 90 days. In univariable regression analysis, eptifibatide administration was not significantly associated with symptomatic intracranial hemorrhage (OR 1.9, 95% CI 0.3–11.4; p = 0.465). Older age was associated with mortality. Conclusions: Our adaptive antithrombotic protocol demonstrated high revascularization and low carotid reocclusion rates. Rescue use of eptifibatide was not significantly associated with symptomatic intracranial hemorrhage; however, a clinically relevant risk cannot be excluded. These findings highlight the importance of tailored antithrombotic strategies in acute ischemic stroke to maintain stent patency while minimizing hemorrhagic complications.

The approach to reperfusion therapy for acute ischemic stroke (AIS) in cases of basilar artery occlusion (BAO) remains a matter of debate. Objective: to assess the safety and efficacy of Fortelyzin in patients with BAO in real-world clinical practice, based on data from the FORPI registry. Material and methods. The FORPI registry is an open-label, prospective, non-interventional observational study of Fortelyzin in patients with ischaemic stroke. An analysis was conducted of the safety and efficacy of Fortelyzin in a group of patients with basilar artery occlusion who underwent intravenous thrombolytic therapy (IVT) and bridging therapy. The safety endpoint was the incidence of symptomatic intracranial haemorrhage (SICH) as defined by ECASS III and SITS-MOST, as well as all-cause mortality at 90 days. The efficacy endpoint was defined as good functional recovery, defined as a score of 0–2 on the modified Rankin Scale (MRS) at 90 days. Results. This analysis included 1910 patients who underwent IVT and 53 patients who underwent bridging therapy. The median National Institutes of Health Stroke Scale (NIHSS) scores at admission were 9 and 12 points, respectively (p = 0.01). SICH incidence (ECASS III criteria) was significantly higher in the bridging therapy group compared to IVT group (6 % vs 1 %, p = 0.01). All-cause mortality at day 90 did not differ significantly between the groups (9 % and 7 %, respectively, p = 0.52). Good functional recovery at day 90 was achieved by 69 % of patients in the IVT group and 60 % of patients in the bridging therapy group (p = 0.31). Conclusion. The use of Fortelyzin in AIS patients with BAO may be considered an effective and safe form of reperfusion therapy, as well as a component of bridging therapy aimed at increasing the number of favorable functional outcomes.

Patients with atrial fibrillation who experience acute ischemic stroke (AIS) are at high risk of early recurrent ischemic stroke or systemic embolism. Timely initiation of anticoagulation is essential to prevent subsequent ischemic events but must be carefully balanced against the risk of hemorrhagic transformation or intracranial hemorrhage. Historically, early anticoagulation therapy with heparin or vitamin K antagonists for AIS has shown uncertain benefits. The safety and efficacy of early initiation of non-vitamin K oral anticoagulants, initially suggested by observational studies, have been confirmed by randomized controlled trials and further supported by an individual patient data meta-analysis. However, uncertainties remain in specific populations, including those with severe stroke, hemorrhagic transformation, and Asian patients, who are at an increased risk of intracranial bleeding and are underrepresented in clinical trials.

Background: Pulmonary embolism (PE) is a major global health concern and the third leading cause of cardiovascular mortality in the U.S. There are various treatment options available for the treatment of intermediate-to-high risk acute PE, including catheter-based treatments, surgical embolectomy, and systemic thrombolysis. Objective: To perform a systematic review and Bayesian network meta-analysis (NMA) comparing the safety and efficacy of advanced therapies in patients with intermediate-to-high risk acute PE. Methods: We searched PubMed/Medline, Embase, and Scopus for relevant studies published until August 30, 2024, and performed a Bayesian NMA to synthesize direct and indirect evidence using the Bayesian inference Using Gibbs Sampling to conduct a Network meta-analysis package in R. Results: Of 1,586 studies, 47 met the inclusion criteria, of which 45 were non-randomized. A total of 267,695 acute intermediate-to-high risk PE patients were included in the analysis, receiving one of five advanced interventions: ultrasound-assisted thrombolysis (USAT), standard catheter-directed thrombolysis (sCDT), catheter-based embolectomy, surgical pulmonary embolectomy (SE), or systemic thrombolysis. USAT had the lowest risk of short-term (94.11), long-term mortality (94.67), major bleeding (90.38), and risk of blood transfusions (91); sCDT had the lowest risk of intracranial hemorrhage (86.2), and SE had the lowest risk of any bleeding (99.37) and gastrointestinal bleeding (87.46) based on Surface Under the Cumulative Ranking values. Conclusion: In our study, USAT offers significant short- and long-term mortality benefits with the lowest risk of major bleeding and transfusion requirements, while sCDT is ideal for patients at high-risk for intracranial hemorrhage. Relevance for patients: Among catheter-based therapies for acute intermediate-to-high-risk PE, USAT offered the best clinical and safety outcomes.

Abstract Background Cerebral venous thrombosis is a rare form of stroke predominantly affecting young women and is associated with a 6–15% risk of death or long-term dependency. We investigated the impact of age, sex, and genetic risk factors on cerebral venous thrombosis onset, clinical severity, and long-term outcomes among individuals of European ancestry. Methods The BEAST (Biorepository to Establish the Aetiology of Sinovenous Thrombosis) study is an international, prospective, observational cohort that enrolled 1309 adult cerebral venous thrombosis patients from 11 countries (United Kingdom, United States of America, Mexico, and European nations). Genetic analyses assessed associations with factor VIII concentrations and cerebral venous thrombosis risk. Clinical predictors of coma and poor long-term outcomes were identified using logistic regression and non-parametric neural network models. Additionally, a meta-analysis of 25 studies comprising 2301 patients was conducted to compare the long-term (≥ 6 months) safety and efficacy of direct oral anticoagulants and warfarin in cerebral venous thrombosis management. Results Women developed cerebral venous thrombosis ~9 years earlier than men, whilst individuals with ≥2 identifiable risk factor experienced cerebral venous thrombosis onset ~12 years earlier than those without risk factors. Amongst patients aged 45 years or older, malignancy was associated with a 3.6-fold increased risk of cerebral venous thrombosis (OR 3.6; 95% CI: 1.4–9.0; P = 0.006). Genetic analyses identified five PROC (protein C) single nucleotide polymorphisms (rs1799810, rs41280570, rs1158867, rs2069919, rs5937) as novel genetic determinants, each conferring an approximately 1.3-fold increased risk of cerebral venous thrombosis in individuals of European ancestry. Strong linkage disequilibrium amongst these variants implicated rs1799810 in the 5’ UTR promoter region as a functional single nucleotide polymorphisms. Elevated factor VIII concentrations (≥150 IU/dL), an X-linked inherited trait, were associated with an approximately 8-fold increased risk of superior sagittal sinus thrombosis in men and a 2-fold increased risk in women. Although cerebral venous thrombosis was more prevalent in women, men exhibited a 2-fold higher risk of coma. The meta-analysis demonstrated comparable safety and efficacy between direct oral anticoagulants and warfarin, with similar rates of favourable clinical outcomes, intracranial haemorrhage, all-cause mortality, non-recanalisation, and recurrent venous thrombosis. Conclusions Protein C variants, particularly rs1799810, and elevated factor VIII concentrations are significant genetic determinants of cerebral venous thrombosis risk amongst Europeans, with distinct sex-specific effects. Whilst direct oral anticoagulants and warfarin demonstrate equivalent long-term efficacy and safety, direct oral anticoagulants offer practical advantages through simplified clinical management.

Background/Objectives: Acute carotid tandem lesions (TLs), defined by concurrent cervical internal carotid artery (ICA) stenosis or occlusion and intracranial large vessel occlusion, occur in 10–20% of patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Optimal periprocedural antiplatelet management during emergent carotid artery stenting (eCAS) remains uncertain, particularly regarding the balance between preventing stent thrombosis and avoiding hemorrhagic complications. Methods: A narrative review was conducted using PubMed and Scopus (until 6 March 2026) to identify English-language studies evaluating antiplatelet therapies during eCAS for TLs. We included seven real-world studies and registry analyses. Data on study design, patient characteristics, procedural strategies, angiographic results, functional outcomes, and safety metrics were extracted. Results: No randomized controlled trials (RCTs) were identified. The available evidence is derived exclusively from observational studies. Across these cohorts, glycoprotein IIb/IIIa inhibitors (GPIs), particularly tirofiban, were generally associated with lower rates of in-stent thrombosis and higher reperfusion success, with symptomatic intracranial hemorrhage (sICH) rates that appeared comparable to or lower than those reported with acetylsalicylic acid (ASA). Cangrelor, an intravenous (IV) P2Y12 inhibitor, was associated with improved stent patency and increased likelihood of complete reperfusion, although reported effects on clinical outcomes were inconsistent when compared with GPIs or ASA. Aside from abciximab, potent IV antiplatelet agents did not consistently show an increased sICH signal. Oral dual antiplatelet therapy was also associated with improved technical outcomes without a clear excess in bleeding complications. Conclusions: Current real-world observational data suggest that rapid-acting IV antiplatelet agents—particularly GPIs and, increasingly, cangrelor—may represent feasible periprocedural options during eCAS for TLs, with potential benefits for technical success and no consistent evidence of increased hemorrhagic risk. However, interpretation is limited by study heterogeneity and non-randomized designs. The absence of RCTs highlights the need for prospective comparative studies and standardized periprocedural antiplatelet protocols.

Acute ischemic stroke due to tandem or cervical internal carotid artery (ICA) lesions is increasingly encountered, and the optimal carotid stent platform for emergent intervention remains uncertain. The aim of this study was to evaluate the technical feasibility, safety, and early outcomes of the CARESTO heal stent (Acandis GmbH, Pforzheim, Germany), the first coated carotid stent, in patients with acute ischemic stroke and extracranial ICA lesions undergoing endovascular treatment. We retrospectively analyzed consecutive patients with acute ischemic stroke and tandem occlusion, dissection, or acute-on-chronic extracranial ICA stenosis who underwent mechanical thrombectomy with concomitant CARESTO implantation at four centers between June 2024 and June 2025. Clinical, imaging, and procedural data were collected, and outcomes were summarized descriptively. Ninety-two patients (mean age 63.2 years) were treated. CARESTO deployment in the cervical ICA was technically successful in all cases, with median post-stenting residual stenosis of 8% (IQR: 0-14). Successful intracranial reperfusion (mTICI ≥2 b) was achieved in 95.7% of patients, with neurological improvement (median National Institutes of Health Stroke Scale (NIHSS) 12, IQR: 8-16 at baseline to 4, IQR: 2-6 at 24 hours). At discharge, 44.9% of patients had a Modified Rankin Scale (mRS) score of 0-2 and 73.0% an mRS score of 0-3; in-hospital mortality was 5.4%. Symptomatic intracranial hemorrhage occurred in 7.6% and early in-hospital stent occlusion prior to discharge in 1.1%. Emergent carotid stenting with the CARESTO heal stent for acute ICA lesions was technically feasible, achieved high reperfusion rates, and showed an acceptable early safety and patency profile, supporting CARESTO as a promising option that warrants further comparative evaluation.

Between 2021 and 2022, over 6.7 million CT scans were performed in England, most of which contained the orbit within the imaging (1). Emergency CT head and facial trauma radiographs are among the most frequently requested studies in acute medicine, often ordered to exclude intracranial haemorrhage or infarction. In these scans, the orbit is often also imaged but remains a bystander as the focus lies on the intracerebral contents. The orbital contents are consistently included and just as consistently underexamined.

Comparative Analysis of Repeat Cranial Imaging in Mild Traumatic Brain Injury: Evaluating Risk Factors, Costs, and Radiation Exposure between 2017 and 2023.

Thrombocytopenia is one of the most common hematological complications of systemic lupus erythematosus (SLE). In severe cases, it can lead to life-threatening complications such as intracranial hemorrhage, significantly affecting the prognosis of patients. Clinically, after treatment with standard-dose glucocorticoids combined with immunosuppressants (e.g., cyclophosphamide, mycophenolate mo-fetil, etc.), the platelet count of most patients can rapidly increase and remain stable. However, there are still some refractory patients who do not respond to traditional treatment and require advanced therapeutic regimens such as biological agents or thrombopoietin receptor agonists (TPO-RAs). This article reports a case of a 38-year-old young female patient with SLE. By the 17th week of her pregnancy, severe thrombocytopenia (9×109/L) was detected. Laboratory tests showed an antinuclear antibody (ANA) titer of 1 ∶ 320, decreased complement C3, and elevated antiphospholipid antibodies. Additionally, she had a popliteal vein thrombosis in the right lower extremity. Bone marrow aspiration indicated a disorder in the differentiation and maturation of megakaryocytes. The patient was diagnosed with SLE, secondary immune thrombocytopenia, and antiphospholipid syndrome. At the end of 21 weeks of gestation, the patient underwent a cesarean section to terminate the pregnancy due to concurrent asymptomatic pulmonary embolism and pulmonary hypertension. During the entire disease course, the patient only had a transient response (duration no more than 1 week) to intravenous immunoglobulin (IVIG) or high-dose glucocorticoid pulse therapy. She showed no response to conventional-dose glucocorticoids (methylprednisolone 40-80 mg/d), immunosuppressants (such as tacrolimus, mycophenolate mofetil, and sirolimus), rituximab, and TPO-RAs (e.g., eltrombopag). The platelet count persistently fluctuated between 1×109/L and 10×109/L, accompanied by intermittent gingival and vaginal bleeding. Intermittent IVIG infusions and subcutaneous injection of leuprolide acetate for artificial amenorrhea were required for treatment. Finally, after the patient received avatrombopag 20 mg once daily for 5 days, the platelet count rapidly increased to the normal range and remained stable for a relatively long period. This case suggests that TPO-RAs can be an effective treatment option for patients with refractory SLE complicated by thrombocytopenia who are unresponsive to traditional therapies. Additionally, there are differences in response among different TPO-RAs, and switching to another TPO-RA may yield favorable therapeutic effects. This provides a new practical reference for the individualized treatment of such refractory cases in clinical practice.