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!
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!
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.
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 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)
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
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?
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.
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!
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 TH-cam's algorithm does not favor you...... I truly hope more medical professionals will discover your channel soon. Gold will be shining everywhere even with TH-cam's algorithm :)
What would you say about this algorithm now that we have the results of the ELAN, TIMING and OPTIMAS trials? In my understanding at least in minor to moderate strokes there doesn't seem to be any benefit in delaying anticoagulation
The algorithm is a lot simpler: Mild, moderate strokes with/without mild hemorrhagic transformation can be anticoagulated at 48 hours. Severe strokes wait for 6 days.
The video is a little dated at this point. ELAN trial helped make this subject a little more straightforward, but I’m waiting for the rest of the anticoagulation trials to be published before remaking the video.
@@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.
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.
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).
Anticoagulation here is not included antiplatelet such as aspirin or plavix, am I right? This instruction you teach apply for A-Fib induced stroke, not for non-embolic stroke? Feel a little confused
That is correct. Antiplatelet agents for Afib-induced stroke are inferior to anticoagulation long term. Also, antiplatelet agents are started on day 1.
@@theneurophile Thank you for your great lectures. Here I feel confused that if thrombotic stroke, do we need to do anti-coagulation treatment based on the criterion you mentioned? All the cases in this lecture seems all have A-Fib. If for pt without A-Fib or thrombotic stroke, if meet the criterion you mentioned, do we need to do anticoagulation?
Anticoagulation is necessary in any patient with a confirmed source of emboli - Afib, cardiac thrombus, DVT/PE, hypercoag state with malignancy, antiphospholipid syndrome, etc. You shouldn’t treat with anticoagulation unless there is such an indication.
@@theneurophile thank you so much. I keep on learning a lot from your great lectures. It means that if there is no source of emboli, such as thrombotic stroke, aspirin and plavix is enough, no need of anticoagulation. I always feel confused on this topic.
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!
Thank you for the kind words. This is unfortunately my third job, so I will try my best.
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!
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.
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.
Thank you!
This channel is the best channel in Neurocritical and neurology… I am big fan and I been using it every day
Thank you!
Dr. Rybinnik, please don't stop making videos.
Getting my next video ready shortly.
@@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)
@@milalcr2006 Yes. Unfortunately, each of those disorders are so complex that each will require their own video.
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
Forever grateful for these videos
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?
That was entertaining, to the point, informative, fun. Keep up the good work.
I think now we start anticoagulation sooner
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.
@@theneurophile so with the ELAN trial we wait 2-6 days not 4-14 days! Right?
Thank you so much!
You always amaze me doc! An excellent evident-based lecture! Thank you!
Outstanding lecture! Didactic, informative, complete and "to the point"....Thanks so much.
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!
Thank you
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 TH-cam's algorithm does not favor you......
I truly hope more medical professionals will discover your channel soon. Gold will be shining everywhere even with TH-cam's algorithm :)
Thank you!
One of the best presentations i've seen on this topic. Thank you!!!!
I am so glad i found this video it is making me confident in my job
Thank you so much, this topic always confused me, I am neurology resident, learnt a lot, I was always thinking about it.
This topic confuses us all. We are eagerly awaiting new data.
thank you very much this lecture is so informative and helped me in prescribing anticoagulants
What would you say about this algorithm now that we have the results of the ELAN, TIMING and OPTIMAS trials? In my understanding at least in minor to moderate strokes there doesn't seem to be any benefit in delaying anticoagulation
The algorithm is a lot simpler: Mild, moderate strokes with/without mild hemorrhagic transformation can be anticoagulated at 48 hours. Severe strokes wait for 6 days.
@@theneurophile many thanks
outstanding videos thanks
Thank you very much doctor for making such an awesome video with crystal clear explanation of this complex subject…
The video is a little dated at this point. ELAN trial helped make this subject a little more straightforward, but I’m waiting for the rest of the anticoagulation trials to be published before remaking the video.
@@theneurophile eagerly waiting for your new video sir…thanking you for all awesome videos..
This video is for 3 years ago. What do we do differently now?
Mild-moderate stroke with AFib - may anticoagulate within 48 hours. Severe strokes with AFib - delay anticoagulation for 6 days (per ELAN trial).
Great Job! Thank you for your videos!
Thank you! An excellent lecture!
Great lectures.
Many thanks for your videos. Very insightful!
Do the rules apply for LMWH as well or only DOACs?
The most recent ELAN trial used DOACs. The bleeding risk for LMWH is slightly higher, but generally yes, the rules are the same.
So even prophylactic doses of LMWH for hemiplegic patients with AFib are contraindicated during the first days? We leave them only on ASA?
@@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.
Hi doc, any update on this topic? Did ELAN study change anything?
Not much. ELAN study essentially provided supportive evidence for our algorithm. We are awaiting the results of other studies.
What's about patients on VKA for mechanical mitral valve + AF
There is little food evidence there, but metallic valves tend to be thrombogenic so we tend to start anticoagulation earlier.
Thank you.🙂
Love your content ❤ ,
I have a question when starting anticoagulation do we add them to antiplatelets or are antiplatelets discontinued
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.
Thank you dr.rybinnik
I think it takes time and work to direct this
The best neurology lectures ever
We are so grateful 😘
Thanks a lot. I truly appreciate the encouragement. I will keep posting whenever I can.
Thanks a lot doctor, very interessting videos
Nice video!
which software do you use to create this videos? .........btw love your videos.
Thank you. I use PowerPoint.
Doctor, you are amazing, we need to illustrate how manage hgeic transformation in pt wih anti platelet therapy
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).
Thanks. I learned a lot
Thank you
Best lecture Black Blooooood !!!
Thank You Sir 🙏🏻
Thank you so much 🙏🏼👌
yes
Amazing 🙏
Anticoagulation here is not included antiplatelet such as aspirin or plavix, am I right? This instruction you teach apply for A-Fib induced stroke, not for non-embolic stroke? Feel a little confused
That is correct. Antiplatelet agents for Afib-induced stroke are inferior to anticoagulation long term. Also, antiplatelet agents are started on day 1.
@@theneurophile Thank you for your great lectures. Here I feel confused that if thrombotic stroke, do we need to do anti-coagulation treatment based on the criterion you mentioned? All the cases in this lecture seems all have A-Fib. If for pt without A-Fib or thrombotic stroke, if meet the criterion you mentioned, do we need to do anticoagulation?
Anticoagulation is necessary in any patient with a confirmed source of emboli - Afib, cardiac thrombus, DVT/PE, hypercoag state with malignancy, antiphospholipid syndrome, etc. You shouldn’t treat with anticoagulation unless there is such an indication.
@@theneurophile thank you so much. I keep on learning a lot from your great lectures. It means that if there is no source of emboli, such as thrombotic stroke, aspirin and plavix is enough, no need of anticoagulation. I always feel confused on this topic.
Yes! I know what I'm watching tomorrow morning before patients. 😁
Enjoy!
Антикоагулянтов с гипертензии@# it's death specially in elderly patients.i have the experience
wow, expert neurologist and a great head of lettuce, leave some women for the rest of us doc
Not exactly sure what that means, but thanks?
Nice! Keep it up! Would you like to be TH-cam friends? :)
Lol rated r
Thank you!