Anticoagulation After Stroke

00:00 - Intro
01:25 - Case
04:12 - Early Risk And Long-Term Benefit
07:05 - 2018-2019 ASA/AHA Guidelines
10:58 - Ischemic Stroke Severity Classification
12:12 - Expert Opinion: ACT-SAFe Study
13:23 - Hemorrhagic Transformation Severity Classification
14:07 - Expert Opinion: ACT-SAFe Study
16:16 - Prediction of Ischemic Recurrence Risk
19:25 - Anticoagulation Algorithm
22:06 - Practice Cases
Narrated by:
Igor Rybinnik, MD
Produced by:
Igor Rybinnik MD
Neurology Clerkship Director
Rutgers Robert Wood Johnson Medical School
Graphics, video clips adapted from:
- The Late Late Show with James Corden, "Spill Your Guts or Fill Your Guts with Arnonld Schwarzenegger," 2019.
Sounds Effects, Music: Adobe Audition Content, Bizet "Habanera," JVNA "Wonders"
Disclaimer: Please note that this material was simplified for educational purposes. For patient management, please review your clinical society's guidelines and engage expert consultation where appropriate. Also, the opinions of the presenters do not necessarily reflect those of Rutgers Robert Wood Johnson Medical School or Rutgers University as a whole.

[@rhcorr]

Us physicians from around the world are truly blessed to be able to watch such quality medical educational material on the internet. I hope someday the team at Rutgers will offer an online refresher course in neurology. I would be the first to sign up!

[@theneurophile]

Thank you! We have an annual refresher course in Stroke and Neurocritical care, but unfortunately it is in person. We will work on making something online. For now, I would recommend International Stroke Conference and the American Academy of Neurology's annual conference. These are excellent and have online content.

[@BTabs]

Outstanding production! Excellent quality with a true excellence in making the content fun and engaging. I can't recommend this video enough to other neurologists. Please keep creating high value content!

[@theneurophile]

Thank you for the kind words. This is unfortunately my third job, so I will try my best.

[@beriorroch2617]

I've only discovered your channel yesterday and it amazed me completely. So easily explained with occasional humour so you don't get bored and drift off. I can only imagine the tremendous work that goes into making each video. Huge thanks from all the aspiring physicians, including me.

[@theneurophile]

Thank you!

[@doctorabouleila]

This channel is the best channel in Neurocritical and neurology… I am big fan and I been using it every day

[@theneurophile]

Thank you!

[@milalcr2006]

Dr. Rybinnik, please don't stop making videos.

[@theneurophile]

Getting my next video ready shortly.

[@milalcr2006]

@@theneurophile Nice! Is it possible for you to make another neuroimaging video which focuses (in more detail) on how a lot of diseases look like + their typical localization? eg. wernicke's, lymphoma, tb, toxoplasma, aids, cancers etc (autoimmune aswell)

[@theneurophile]

​@@milalcr2006 Yes. Unfortunately, each of those disorders are so complex that each will require their own video.

[@pavelboico9283]

If there were a prize for the best educational youtube channel, you my friend would have a great chance to win. Just outstanding how structured, deep, jet easy to understand. Thanks for your time and hard work

[@NPCrash]

That was entertaining, to the point, informative, fun. Keep up the good work.

[@cesarjoelbenitesmoya5528]

Outstanding lecture! Didactic, informative, complete and "to the point"....Thanks so much.

[@danielajoshua9022]

You always amaze me doc! An excellent evident-based lecture! Thank you!

[@oliviamckay3335]

One of the best presentations i've seen on this topic. Thank you!!!!

[@vickysongjnvickysongjn8881]

I am so grateful to you for such a spectacular channel! I had followed so many channels within the past year, and this one is by far the most comprehensive and most interesting channel with the highest quality in production and content selection. Compared with other channels with more subscribers, I have to say this channel is significantly under-appreciated, may be because you really don't have much to disclose about the conflict of interest that I guess has made the KZbin's algorithm does not favor you...... I truly hope more medical professionals will discover your channel soon. Gold will be shining everywhere even with KZbin's algorithm :)

[@theneurophile]

Thank you!

[@weenadeleon601]

I am so glad i found this video it is making me confident in my job

[@doctormsigwa8578]

Thank you! An excellent lecture!

[@AlienAngel543]

Many thanks for your videos. Very insightful!

[@serban277]

Great Job! Thank you for your videos!

[@gentleman7951]

Thank you dr.rybinnik I think it takes time and work to direct this The best neurology lectures ever We are so grateful 😘

[@theneurophile]

Thanks a lot. I truly appreciate the encouragement. I will keep posting whenever I can.

[@omarsalem2699]

outstanding videos thanks

[@caiyu538]

Great lectures.

[@edenbc5778]

Thanks a lot doctor, very interessting videos

[@shayaanp9207]

Thank you so much, this topic always confused me, I am neurology resident, learnt a lot, I was always thinking about it.

[@theneurophile]

This topic confuses us all. We are eagerly awaiting new data.

[@nhutnhut2x24]

Thank you!

[@raminvakili1038]

Thanks. I learned a lot

[@anastasiostsogkas]

Nice video!

[@omarmaamouri]

Thank you so much 🙏🏼👌

[@arnabsarkar4266]

Thank You Sir 🙏🏻

[@henamamoni6407]

Thank you.🙂

[@mb5101]

Last night we had a patient with small stroke (dwi) on Xarelto. We discharged pt on his home Xarelto. He did not miss even one dose. I got confused 🫤 help 😭 Is it because we are watching this video three years later?

[@WalidShibl1987]

Thank you

[@wassimzurba3254]

Best lecture Black Blooooood !!!

[@gabbiet9138]

Yes! I know what I'm watching tomorrow morning before patients. 😁

[@theneurophile]

Enjoy!

[@khaledatef6450]

Doctor, you are amazing, we need to illustrate how manage hgeic transformation in pt wih anti platelet therapy

[@theneurophile]

Thank you. Actually, antiplatelet can be started immediately despite hemorrhagic transformation unless the hemorrhage is massive (then I would wait for a 24 hour stability imaging).

[@beckyterrell1441]

yes

[@deeeeesha]

Love your content ❤ , I have a question when starting anticoagulation do we add them to antiplatelets or are antiplatelets discontinued

[@theneurophile]

Thank you. This depends on the indication. If you are anticoagulating for stroke prevention with AFib, then antiplatelet agents should be discontinued. However, in patients with fresh stents or acute cardiac disease together with atrial fibrillation, antiplatelets may need to be added to anticoagulation.

[@abhishekguha8145]

which software do you use to create this videos? .........btw love your videos.

[@theneurophile]

Thank you. I use PowerPoint.

[@mb5101]

I think now we start anticoagulation sooner

[@theneurophile]

Correct. With ELAN trial, mild or moderate strokes without severe hemorrhagic transformation can be anticoagulated within 48 hours. Anticoagulation in severe strokes are delayed by 6 days. I am waiting for the other two anticoagulation trials to be published before revising the video.

[@mb5101]

@@theneurophile so with the ELAN trial we wait 2-6 days not 4-14 days! Right? Thank you so much!

[@arcdexie913]

Hi doc, any update on this topic? Did ELAN study change anything?

[@theneurophile]

Not much. ELAN study essentially provided supportive evidence for our algorithm. We are awaiting the results of other studies.

[@mb5101]

This video is for 3 years ago. What do we do differently now?

[@theneurophile]

Mild-moderate stroke with AFib - may anticoagulate within 48 hours. Severe strokes with AFib - delay anticoagulation for 6 days (per ELAN trial).

[@mahdifreealgerie9351]

What's about patients on VKA for mechanical mitral valve + AF

[@theneurophile]

There is little food evidence there, but metallic valves tend to be thrombogenic so we tend to start anticoagulation earlier.

[@Chernoochene]

Do the rules apply for LMWH as well or only DOACs?

[@theneurophile]

The most recent ELAN trial used DOACs. The bleeding risk for LMWH is slightly higher, but generally yes, the rules are the same.

[@Chernoochene]

So even prophylactic doses of LMWH for hemiplegic patients with AFib are contraindicated during the first days? We leave them only on ASA?

[@theneurophile]

@@Chernoochene DVT prophylaxis is not contraindicated in acute ischemic stroke regardless of size. DVT prophylaxis dosing of LMWH is not anticoagulation. Aspirin is usually continued until full-dose anticoagulation may be started.

[@dramirfarhadbahreini6477]

Антикоагулянтов с гипертензии@# it's death specially in elderly patients.i have the experience

[@suomynonaanonymous]

Lol rated r

[@bengalslash]

wow, expert neurologist and a great head of lettuce, leave some women for the rest of us doc

[@theneurophile]

Not exactly sure what that means, but thanks?

Nice! Keep it up! Would you like to be KZbin friends? :)

[@ArasLtu]

I recently started watching your videos and I find them outstanding. Normally I have big trouble watching those dry theoretical videos and yours are pretty much the only ones, which I found recently, which are not only watchable, but actually also enjoyable. Cheers!

[@theneurophile]

Thank you