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“Coagulation & Medications” – Aspirin

9 May

This is aspirin, credit to Bayer for discovering it!

I already was a big fan of #FOAMed and the different EM blogs out there, but working on this post made me even a bigger fan! It is impossible for me to discuss all the anticoagulation and antiplatelets, their purposes and the evidence for their use. It would probably take me years and me my relationship. That’s why a great part of this post is “borrowed” from others and a lot with be cardiology minded. In the end we also need to discuss thrombolytics in acute ischemic stroke. But today is about Aspirin, followed by posts about the other antiplatelets and one about anticoagulation!

ASPIRIN… aka acetylsalicylic acid (ASA). It is the best known antiplatelet out there! It is a COX-inhibitor, which inhibits the activation of platelets. I will discuss the evidence behind the use of aspirin in Acute Coronary Syndrome (ACS). Other reasons to use it, like ischemic stroke or Kawasaki disease won’t be discussed here.

Up till the beginning of the 90’s the spectrum of ACS was different than it is nowadays. It consisted of UA, Non-Q wave MI (NQMI) and Q wave MI (QwMI). Then came the meta-analysis FTT (Fibrinolytic Therapy Trialist), which found that the patients with ST-elevation benefit from fibrinolytics. After this the spectrum became UA and (N)STEMI.

So why all this (old) information, you think? Well, this means that older articles (from the 90’s and before) classified the patients with ACS differently than we do nowadays, which may lead to differences in results. For example, somebody with a STEMI back than could initially be in the UA group.

The article that looked at aspirin in acute MI was ISIS-2 in 1988. ISIS­2: Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction. Lancet. 1988 Aug 13;2(8607):349-60. This article is discussed on the website: theNNT:

This is what they did and found:

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“Coagulation & Medications” – Clot Formation

24 Apr


Welcome back on EMDutch, the Dutch Emergency Medicine website! Today starts the 1st of several posts about “Coagulation and Medications”. Today will only be a short summary about Clot Formation. Just a reminder of what you know from MedicalSchool. The following posts about “coagulation & medications” will look at certain antiplatelet medication, anticoagulation & thrombolysis which are often used in the ED for diseases like (N)STEMI, VTE (PE/DVT) and acute ischemic stroke. I will not just look at their mechanism, but more importantly at the evidence supporting their use. Here we go….

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PE…not as deadly as we think

14 Apr

Hello everybody, Finally the presentation about PE…and you know, I love PE when I have a patiënt with a Hamptons Hump or a EKG wit typical PE-changes or a patient that dropped down with a SpO2 of 80%. But I really hate these patient with a mild cought and low fever, dripping nose and oooo yeah some mild pain while breathing. What do you think the internist or pulmonologist wants….a D-dimer! And why??? what do they want to find in this patient with a viral infection….a small subsegmental PE probably! That’s is why I thought it is time to tell everybody that PE is NOT as deadly as we thought….at least most of the time!

Off course I know people die of PE, but I really think that this is a small group and we are not treating our patients properly if we (the doctors) are to scared an start sending D-dimers for every patient with a cold!

Ok…enjoy the 20-minute PPT presentation , which you can use whenever and wherever you want! Let me know if you have any comments!

MASTERCLASS LE – not as deadly as we think


ED Podcast Overview

9 Mar

During the 1st PSA-course organized by the NVSHA (Dutch Society for Emergency Medicine) I was very happy to hear that a lot of Dutch Emergency Physicians are following! Especially “Back to the Future” seems to have made some impact, but what they missed was an overview of the most interesting ED podcast out there. So here is an small overview, but remember that I started using podcast 2 months ago, so there are probably a lot more….

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Back to the Future

22 Feb

Before we move on to “flip the guideline for Sympathetic Crashing Acute Pulmonary Edema” first something which could be “life changing” for a lot of Emergency Physicians in the Netherlands! The future of Emergency Medicine Education!


When you talk about the future of Emergency Medicine Education you talk about (LITFL) (headed by Mike Cadogan & Chris Nickson) and in particular FOAM! If you think FOAM is some sort of shampoo or deodorant then this is the post for you!


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