Internal medicine essentials - أساسيات أمراض الباطنة

27/07/2026

https://www.nice.org.uk/guidance/ng145

22/07/2026

https://www.nice.org.uk/guidance/ng145/chapter/Recommendations -suspected-thyroid-dysfunction

19/07/2026

Transfusion guidelines for SCD

11/06/2026

1.7.26
Consider adding metformin to insulin therapy for adults with type 1 diabetes if:

they have a BMI of 25 kg/m2 or above (23 kg/m2 or above for people from South Asian and related family backgrounds) and

they want to improve their blood glucose control while minimising their effective insulin dose.

This guideline covers care and treatment for adults (aged 18 and over) with type 1 diabetes. It includes advice on diagnosis, education and support, blood glucose management, cardiovascular risk, and identifying and managing long-term complications

01/06/2026

NOGG 2021

14/02/2026

NICE Algorithm for heart valve referral

https://www.nice.org.uk/guidance/ng208

11/02/2026

🧠 Anticoagulation in Stroke Patients with Other Comorbidities

(Quick, ward-friendly summary for clinical practice)

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1️⃣ Disabling ischaemic stroke + atrial fibrillation

Start aspirin 300 mg daily for the first 14 days

Delay anticoagulation until after this initial period
🔹 Rationale: reduce early haemorrhagic transformation risk

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2️⃣ Prosthetic heart valve + disabling cerebral infarction

Withhold anticoagulation for 1 week if haemorrhagic transformation risk is high

Substitute aspirin 300 mg daily during this period
🔹 Then reassess and restart anticoagulation when safe

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3️⃣ Ischaemic stroke + symptomatic DVT or PE

Anticoagulation is preferred over aspirin, unless contraindicated
🔹 Treat the VTE adequately—stroke alone is not a reason to avoid anticoagulation

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4️⃣ Haemorrhagic stroke + symptomatic DVT or PE

Aim to prevent further pulmonary emboli using:

Anticoagulation, or

IVC (caval) filter, if bleeding risk is prohibitive
🔹 Choice depends on bleeding risk vs thrombotic risk balance

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📝 Key Clinical Pearls

Aspirin is often a temporary bridge, not definitive therapy

VTE treatment takes priority even in stroke patients

Decisions must be individualised, especially after haemorrhagic stroke

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📚 Reference
Adapted from National Institute for Health and Care Excellence (NICE) guideline NG128 – Stroke and transient ischaemic attack in over 16s
👉 Recommendations 1.4.17–1.4.20
🔗

This guideline covers interventions in the acute stage of a stroke or transient ischaemic attack (TIA). It offers the best clinical advice on the diagnosis and acute management of stroke and TIA in the 48 hours after onset of symptoms