Systematic ReviewResearchMedication SafetyPatient Education

Adding antiplatelet therapy to anticoagulation increased major bleeding after stroke

Neurological sciences (PubMed)Aug 25, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A meta-analysis of patients with ischemic stroke, atrial fibrillation, and large-artery atherosclerosis found combined anticoagulant and antiplatelet therapy increased major bleeding without significantly reducing recurrent ischemic stroke versus anticoagulation alone.

What NurseJet pulled from the source

Seven randomized and observational studies included 14,884 patients. Adding antiplatelet therapy to oral anticoagulation was not associated with lower recurrent ischemic stroke or all-cause mortality, but was associated with more major bleeding. The mixed study designs limit certainty and do not replace individualized prescribing decisions.

Why this matters for nurses

Neuro and cardiac nurses reconcile high-risk antithrombotic regimens, watch for bleeding, and reinforce discharge instructions. The synthesis highlights the need to verify the indication and intended duration whenever both an anticoagulant and antiplatelet are prescribed after stroke.

Bedside takeaway

Treat concurrent anticoagulant and antiplatelet therapy as a high-risk regimen that needs a clear indication, duration, and bleeding-surveillance plan.

How This Applies in Practice

Use this when: Reconciling or administering antithrombotic therapy after ischemic stroke in a patient with atrial fibrillation and large-artery atherosclerosis.

On your shift

Verify each antithrombotic agent, dose, documented indication, planned duration, and responsible prescriber during reconciliation.
Assess for overt or occult bleeding indicators and review ordered hemoglobin, platelet, renal-function, and coagulation data as applicable.
Escalate duplicate therapy concerns, unclear duration, bleeding, or neurologic change without independently withholding prescribed medication.

Keep in mind: Some patients have another valid indication for combined therapy. Follow the individualized treatment plan, facility policy, and provider orders.

Key takeaways

Seven studies included 14,884 patients with recent ischemic stroke, nonvalvular atrial fibrillation, and large-artery atherosclerosis.
Combined anticoagulant and antiplatelet therapy did not significantly reduce recurrent ischemic stroke versus anticoagulation alone.
All-cause mortality was not significantly different between strategies.
Major bleeding was higher with combined therapy (RR 1.49, 95% CI 1.04 to 2.15).

Practice implications

During medication reconciliation, identify concurrent anticoagulant and antiplatelet therapy, verify the documented indication and duration, assess for bleeding, and escalate discrepancies or new bleeding promptly. Do not independently stop either drug.

Limitations & cautions

The meta-analysis combined randomized and observational evidence, so residual confounding and differences among studies remain possible. It addresses a specific population with stroke, atrial fibrillation, and large-artery atherosclerosis and does not cover every indication for combined therapy.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Neurological sciences (PubMed)

Neurological sciences (PubMed). Combined antithrombotic therapy vs. oral anticoagulation alone for ischemic stroke with concomitant atrial fibrillation and large artery atherosclerosis: a systematic review and meta-analysis.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42640340/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Renal failure (PubMed)Sep 7, 2026Research Article

A single-center retrospective cohort found that approximately one quarter of laboratory-defined acute kidney injury cases on internal medicine wards were not documented, particularly when maximal creatinine was lower.

Med-SurgAI summaryReview source

Research ArticleResearchQuality ImprovementAI summary · original source linked below

Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

Key takeaways

In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Pediatric emergency care (PubMed)Sep 7, 2026Research Article

A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

Peds EmergencyAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

Telemetry Med-SurgAI summaryReview source

Research ArticleResearchMedication SafetyPatient EducationAI summary · original source linked below

Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

Key takeaways

At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

One in four laboratory-defined AKI cases went undocumented on medicine wards

IV pantoprazole did not improve vomiting or oral tolerance in pediatric gastroenteritis

Targeted vitamin D did not significantly reduce major cardiovascular events after MI