The edition · Neurology
Choice of seizure drug may matter for people on anticoagulants, and tirofiban added nothing in branch atheromatous stroke
A 9,529-patient cohort comparing antiseizure drugs in people taking DOACs, a negative 970-patient trial of tirofiban in branch atheromatous stroke, an observational signal for anti-CGRP antibodies in early pregnancy, and an ablation analysis in AF after stroke.
The edition in brief
In 9,529 adults with epilepsy who started a direct oral anticoagulant on stable antiseizure monotherapy, levetiracetam was associated with higher thromboembolic risk (HR 1.98, 95% CI 1.37 to 2.87) and mortality (HR 1.60, 1.23 to 2.08) than lamotrigine or lacosamide, strong enzyme inducers with more thromboembolism (HR 1.55) but less major bleeding (HR 0.62), and valproate with higher intracranial bleeding (HR 3.01). It is a target trial emulation from electronic records and cannot prove causation or exclude confounding by indication. The STRATEGY trial randomised 970 patients with branch atheromatous disease stroke to tirofiban plus aspirin or aspirin alone and found no significant difference in early neurological deterioration or new stroke (17.1% vs 19.6%, HR 0.88, 95% CI 0.65 to 1.19). In a claims cohort of 7,579 pregnancies in people with migraine, anti-CGRP monoclonal antibody exposure was associated with spontaneous abortion (adjusted HR 1.42, 95% CI 1.12 to 1.80), while propranolol was not (1.02); this is an association needing confirmation. A retrospective emulation of 431 patients with AF and prior stroke linked early catheter ablation to fewer major cardiovascular events at 36 months, rated Class III evidence. An FDA supplement was recorded for an oxcarbazepine generic application. The pearl covers checking glucose in acute stroke symptoms.
Tirofiban added to aspirin did not reduce deterioration in branch atheromatous stroke
Do not add tirofiban to aspirin routinely for branch atheromatous stroke; continue standard guideline-based care with close monitoring.
Anti-CGRP antibodies in early pregnancy were linked to more spontaneous abortion
Consider discussing pregnancy plans before prescribing anti-CGRP antibodies, and treat this signal as unconfirmed.
Early ablation after stroke in atrial fibrillation: a signal from observational data
Consider discussing rhythm control with cardiology in selected patients, while recognising the evidence is observational.
FDA records a supplement to a generic oxcarbazepine application
No change to prescribing follows from this FDA entry; rely on the current labelling for the product in use.
Check capillary glucose first in sudden neurological deficit
Check capillary glucose first in sudden neurological deficit, and record the time last known well.
Which antiseizure drug a person takes may alter outcomes on a DOAC
Review the antiseizure drug alongside the DOAC and discuss any change with the epilepsy team rather than switching on this study alone.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this one is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for neurology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free