Abstract W P313: Risk of Rebleed with Resumption of Anticoagulation after Intracranial Hemorrhage

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Jonathan M Weimer ◽  
Errol Gordon ◽  
Jennifer A Frontera
Keyword(s):  
Intracranial Hemorrhage ◽  
De Novo ◽  
Hemorrhagic Complication ◽  
Major Hemorrhage ◽  
Vein Thrombosis ◽  
Ischemic Complications ◽  
History Of ◽  
Artery Disease ◽  
A Minor ◽  
Ischemic Events

Introduction: Rebleed after resumption of anticoagulation following intracranial hemorrhage (ICH) remains a substantial concern, but little data is available describing the occurrence of such events. Methods: Prospectively collected data from 2008-2011 was reviewed in patients with intraparencymal (IPH), subdural (SDH), and subarachnoid (SAH) hemorrhage. Patients with anticoagulant use prior to ictus were identified, as were patients started on full anticoagulation during hospitalization. In hospital rates of ischemic events, major and minor hemorrhages were collected. Univariate analyses were performed using either Fisher’s exact or Mann-Whitney U tests. Results: 387 total ICH patients were identified, including 132 (34.1%) SAH, 134 (34.6%) SDH, and 121 (31.3%) IPH. At time of ictus, 67 (17.3%) were anticoagulated and underwent reversal of coagulopathy. Of these 67 patients, ischemic complications including myocardial infarction (MI), pulmonary embolism (PE), and deep vein thrombosis (DVT) occurred in 8 (11.9%) during hospitalization. 6 of 67 (9.0%) patients resumed full anticoagulation at a median of 14.5 days from ictus. 14 additional patients were started on full anticoagulation de novo at a median of 12 days from ictus. Significant indications for anticoagulation after ICH included: 4 (20%) history of valvular heart disease, 7 (35%) DVT, 1 (5%) PE, 7 (35%) arrhythmia, and 1 (5%) coronary artery disease. Of the 20 patients fully anticoagulated after ICH, 2 (10%) experienced a major hemorrhagic complication. 1 new ICH occurred 36 days from ictus on the day anticoagulation was restarted, and 1 SDH expansion occurred 56 days from ictus and 47 days from resuming anticoagulation. 1 patient experienced a minor hemorrhagic complication (retroperitoneal hematoma). Conclusions: Ischemic complications occurred in 11.9% of ICH patients who underwent coagulopathy reversal. It remains unclear if coagulopathy reversal or delay to resuming anticoagulation is the cause of ischemic events. Initiation of anticoagulation after a median of 14 days from ictus was associated with major hemorrhage in 10% of patients. Reversal of anticoagulation and initiation of anticoagulation after a median of 14 days is associated with an acceptable risk profile.

scholarly journals Preoperative radiation as part of a multidisciplinary strategy for a medically inoperable patient with a bleeding colon cancer

2019 ◽  
Vol 12 (8) ◽  
pp. e229488
Author(s):  
June S Peng ◽  
Neha L Lad ◽  
Edward J Spangenthal ◽  
David M Mattson ◽  
Steven J Nurkin
Keyword(s):  
Colon Cancer ◽  
Complete Response ◽  
Disease Recurrence ◽  
Right Hemicolectomy ◽  
Bare Metal Stent ◽  
Preoperative Radiation ◽  
Vein Thrombosis ◽  
Inoperable Patient ◽  
History Of ◽  
Artery Disease

An 84-year-old man with a history of deep vein thrombosis on warfarin and coronary artery disease presented with haematochezia and was diagnosed with an ascending colon cancer. He was short of breath with lower extremity oedema at the initial surgical consultation. Evaluation revealed an acute exacerbation of congestive heart failure, and further workup and treatment were recommended by the cardiology team. After multidisciplinary discussion, he underwent radiation for the control of bleeding, followed by cardiac catheterisation and placement of a bare metal stent. The patient subsequently underwent robotic-assisted right hemicolectomy. Pathology demonstrated a complete response, and the patient recovered uneventfully. He is alive swith no evidence of disease recurrence 12 months after surgery and 18 months after initial diagnosis.

Abstract P596: How Common Are Microembolic Signals After Cerebrovascular Events and Are They Related to Recurrent Admissions?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Behnam SABAYAN ◽  
Simin Mahinrad ◽  
Sanaz Sedaghat ◽  
Eric M Liotta ◽  
Farzaneh A Sorond
Keyword(s):  
Cox Regression ◽  
Hospital Readmissions ◽  
Smoking History ◽  
Vein Thrombosis ◽  
Complication Risk ◽  
Cerebrovascular Events ◽  
History Of ◽  
Artery Disease ◽  
Ischemic Attack ◽  
Deep Vein

Introduction: Microembolic signals (MES) identified by transcranial Doppler (TCD) reflect an ongoing embolic phenomenon with implications for the recurrence of cerebrovascular events and complications. In this study, we investigated the prevalence of MES detected after stroke or transient ischemic attack (TIA) and studied their relationship with future re-admissions. Method: This clinical cohort study is comprised of 961 consecutive patients (mean age 65 years, 59% male) admitted to Northwestern Memorial Hospital with the diagnosis of acute stroke (n: 872) or TIA (n: 89) and underwent TCD evaluation. TCD is performed within the first 48 hours of admission as a routine component of stroke etiology evaluation at our institution. After discharge, patients were followed for an average of 18 months for any hospital readmissions. Cox regression models were used to estimate risk of re-admissions in relation to MES. Results: MES were detected in 99 (10%, 95% CI; 8-12%) patients. During the follow up period, 356 patients had emergency room re-admissions. Compared to patients without MES, those with MES were younger ( p =0.007) and had longer index hospital stay ( p =0.008). Patients with MES, as compared to patients without MES, had 1.56-fold (hazard ratio 95% CI=1.15, 2.13; p =0.005) higher risk of readmission. This association was independent of age, sex, race, smoking, history of hyperlipidemia, diabetes, atrial fibrillation, history of pulmonary emboli, deep vein thrombosis, hypertension, coronary artery disease and heart failure. Conclusion: We show that MES are present in one tenth of patients admitted with stroke or TIA, and they are associated with higher risk of re-admission. These data highlight the importance of embolic signals in stroke complication risk stratification and suggest the need for prospective clinical trials targeting MES in secondary stroke risk and complication prevention.

Superficial Vein Thrombosis: Incidence in Association with Pregnancy and Prevalence of Thrombophilic Defects

1998 ◽  
Vol 79 (04) ◽  
pp. 741-742 ◽  
Author(s):  
J. E. Ramsay ◽  
R. C. Tait ◽  
I. D. Walker ◽  
F. McCall ◽  
J. A. Conkie ◽  
...  
Keyword(s):  
Post Partum ◽  
Previous History ◽  
Minor Role ◽  
Vein Thrombosis ◽  
Early Postpartum Period ◽  
Early Postpartum ◽  
Superficial Vein Thrombosis ◽  
History Of ◽  
A Minor ◽  
Deep Vein

SummarySuperficial venous thrombotic (SVT) events are a feature of thrombophilic abnormalities, particularly those involving the protein C pathway. We have determined the incidence of SVT associated with pregnancy and the early postpartum period in a retrospective study involving 72 000 deliveries. Fourty-nine cases occurring in 47 individuals were recorded, with an overall incidence of 0.68/1000 deliveries (95% CI 0.48-0.88). None had a previous history of deep vein thrombosis or pulmonary embolism. Most events occurred in the early post-partum period (0.54/1000 deliveries). Twenty-four/fourty-seven were screened for established thrombophilic abnormalities, with only 1 abnormality detected (FVLeiden heterozygote). Thrombophilia may play a minor role in the aetiology of SVT associated with pregnancy, although a larger study is required to confirm this.

Acute heart failure: epidemiology, classification, and pathophysiology

2021 ◽  
pp. 603-616
Author(s):  
Dimitrios Farmakis ◽  
Gerasimos Filippatos
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Renal Dysfunction ◽  
Acute Heart Failure ◽  
De Novo ◽  
Rapid Development ◽  
Previous History ◽  
Cardiovascular Comorbidities ◽  
History Of ◽  
Artery Disease

Acute heart failure (AHF) is defined as the rapid development or change of symptoms and signs of heart failure that requires urgent medical attention and usually hospitalization. it represents the first reason for hospital admission in individuals aged 65 or more and accounts for nearly 70% of the total healthcare expenditure for heart failure. It is generally characterized by adverse prognosis, with an in-hospital mortality rate of 4-7%, a 2 to 3-month post-discharge mortality of 7-11% and a 2 to 3-month readmission rate of 25-30%. The majority of patients have a previous history of heart failure and present with symptoms and/or signs of congestion and normal or increased blood pressure, while about half of them have preserved left ventricular ejection fraction. A high prevalence of cardiovascular or non-cardiovascular comorbidities is further observed, including coronary artery disease, arterial hypertension, atrial fibrillation, diabetes mellitus, renal dysfunction, chronic lung disease, anemia and iron deficiency. Different classification criteria have been proposed for AHF, reflecting the clinical heterogeneity of the syndrome. Classifications according to the past history of heart failure (acutely decompensated chronic or de novo), the systolic blood pressure upon presentation (hypertensive, normotensive or hypotensive) and the presence or absence of congestion and peripheral hypoperfusion are among the most widely used. The pathophysiology of AHF involves several mechanisms, including volume overload, pressure overload, myocardial loss and restrictive filling, while several cardiovascular and non-cardiovascular precipitating factors lead to AHF. Regardless of the underlying mechanism, peripheral and/or pulmonary congestion is present in the vast majority of AHF, resulting from fluid retention and/or fluid redistribution, while a marked reduction in cardiac output with peripheral hypoperfusion occurs in a minority of cases. Myocardial injury and renal dysfunction are important factor involved in the precipitation and progression of the syndrome.

Thrombolysis in Deep Vein Thrombosis: Is there still an Indication?

2001 ◽  
Vol 86 (07) ◽  
pp. 499-508 ◽  
Author(s):  
Alan Forster ◽  
Philip Wells
Keyword(s):  
Thrombolytic Therapy ◽  
Meta Analysis ◽  
Local Therapy ◽  
Therapeutic Modality ◽  
Major Hemorrhage ◽  
Vein Thrombosis ◽  
History Of ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens

SummaryThe most accepted therapy for DVT consists of anticoagulation with unfractionated heparin or low molecular weight heparin, followed by variable duration oral anticoagulation but thrombolytic therapy has been proposed in addition to standard anticoagulation. This paper reviews the literature on post thrombotic syndrome, the natural history of vein patency after therapy, and we perform a systematic review, using accepted standards for meta-analysis, to determine the outcomes when thrombolytic therapy is used to treat DVT. We demonstrate that thrombolytic therapy for DVT results in a significant increase in the risk of major hemorrhage and a significant increase in the rate of vein patency. However, although thrombolytic therapy is advantageous over anticoagulation as measured by early vein patency, a benefit in terms of a reduction in PTS risk, is unproven. Our review also shows that there is no evidence that there is a difference in efficacy between thrombolytic agents or that local therapy differs from systemic therapy. Finally, the potential role of catheter directed therapy is unknown since appropriate trials have not been performed but it is reasonable to use catheter directed therapy in patients with phlegmasia cerulea dolens. We conclude that more work is needed to define the role of thrombolytic therapy but it is too early to abandon this therapeutic modality.

Ischemic Complications of Pregnancy: Who is at Risk?

2016 ◽  
Vol 10 (1) ◽  
pp. 14
Author(s):  
Sara C Martinez ◽  
◽  
Sharonne N Hayes ◽  
Keyword(s):  
Artery Dissection ◽  
Cardiac Events ◽  
Coronary Artery Dissection ◽  
Reduction Strategies ◽  
Ischemic Complications ◽  
Substantial Risk ◽  
History Of ◽  
Invasive Management ◽  
In Pregnancy

The physiologic demands of pregnancy may either trigger or uncover ischemic heart disease (IHD) via largely unknown mechanisms, leading to an increased mortality compared with nonpregnant individuals. Risk factors for IHD in pregnancy are age, smoking, multiparity, and prior cardiac events. A multidisciplinary team at a referral center is key to coordinating medical or invasive management and inpatient observation. Etiologies may be revealed by experienced angiographers, and are predominantly spontaneous coronary artery dissection, followed by atherosclerotic disease and thrombus, while a significant percentage of women are found to have normal coronary arteries by angiogram. The management of these conditions is varied and, in general, conservative management is preferred with adequate coronary flow and stable hemodynamics. A woman with a history of IHD in pregnancy is at a substantial risk for further complications in future pregnancies and beyond; therefore, aggressive risk factor-reduction strategies and regular cardiology follow-up are imperative to decrease adverse events.

Giant right coronary artery aneurysm

2020 ◽  
Vol 28 ◽  
pp. 1-3
Author(s):  
Alexandre Bonfim ◽  
Ronald Souza ◽  
Sérgio Beraldo ◽  
Frederico Nunes ◽  
Daniel Beraldo
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Coronary Artery Aneurysm ◽  
Clinical Course ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Coronary Artery Aneurysms ◽  
History Of ◽  
Artery Disease ◽  
The Right

Right coronary artery aneurysms are rare and may result from severe coronary disease, with few cases described in the literature. Mortality is high, and therapy is still controversial. We report the case of a 72-year-old woman with arterial hypertension, and a family history of coronary artery disease, who evolved for 2 months with episodes of palpitations and dyspnea on moderate exertion. During the evaluation, a giant aneurysm was found in the proximal third of the right coronary artery. The patient underwent surgical treatment with grafting of the radial artery to the right coronary artery and ligation of the aneurysmal sac, with good clinical course.

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