scholarly journals Thoracic Aortic Dissecting Aneurysm Presenting with Stroke, Disseminated Intravascular Coagulopathy (DIC), and Gastrointestinal Hemorrhage

1970 ◽  
Vol 9 (4) ◽  
Author(s):  
Soraya Moghadam MD, ◽  
Yoshitsugu Nakamura MD, ◽  
Mackenzie Quantz MD, ◽  
Raymond Kao MD
Keyword(s):  
Ischemic Stroke ◽  
Upper Gastrointestinal Bleeding ◽  
Laboratory Diagnosis ◽  
Dissecting Aneurysm ◽  
Vessel Occlusion ◽  
Vascular Abnormality ◽  
Disseminated Intravascular Coagulopathy ◽  
Uncommon Presentation ◽  
Intravascular Coagulopathy ◽  
Upper Gastrointestinal

Acute ischemic stroke secondary to vessel occlusion from an aneurismal dissection is an uncommon presentation. Disseminated intravascular coagulation (DIC) can present as a consequence of aortic dissection, although this is also rare. In some cases, the laboratory diagnosis of DIC uncovers a vascular abnormality or bleeding diathesis. This article describes a patient presenting with three sequential complications of a dissecting thoracic aortic aneurysm: ischemic stroke, upper gastrointestinal bleeding, and consumptive coagulopathy.

scholarly journals Role of Helicobacter pylori in Upper Gastrointestinal Bleeding Among Ischemic Stroke Hospitalizations: A Nationwide Study of Outcomes

2019 ◽  
Vol 1 (3) ◽  
pp. 358-371
Author(s):  
Urvish K. Patel ◽  
Mihir Dave ◽  
Anusha Lekshminarayanan ◽  
Nidhi Patel ◽  
Abhishek Lunagariya ◽  
...  
Keyword(s):  
Helicobacter Pylori ◽  
Ischemic Stroke ◽  
Risk Stratification ◽  
Gastrointestinal Bleeding ◽  
Health Care Cost ◽  
Upper Gastrointestinal Bleeding ◽  
Increased Risk ◽  
H Pylori ◽  
Upper Gastrointestinal

Introduction: Helicobacter pylori (H. pylori) is a well-recognized risk factor for upper gastrointestinal bleeding (UGIB). The exposure to tissue plasminogen activator (tPA), anti-platelets, and anticoagulants increases the risk of UGIB in acute ischemic stroke (AIS) patients, the risk stratification of H. pylori infection is not known. In this retrospective cross-sectional study, we aimed to evaluate the relationship between H. pylori and GIB in patients hospitalized with AIS. Methods: In the nationwide data, hospitalization for AIS was identified by primary diagnosis using International Classification of Diseases, clinical modification (ICD-9-CM) codes. Subgroup of patients with GIB and H. pylori were identified in AIS cohort. A stepwise multivariable logistic regression model was fitted to evaluate the outcome of upper GIB and role of H. Pylori in UGIB. Results: Overall 4,224,924 AIS hospitalizations were identified, out of which 18,629 (0.44%) had UGIB and 3122 (0.07%) had H. pylori. The prevalence of H. pylori-induced UGIB among UGIB in AIS was 3.05%. The prevalence of UGIB was markedly elevated among the H. pylori infection group (18.23% vs. 0.43%; p < 0.0001) compared to the non-H. pylori group. In multivariable regression analysis, H. pylori was associated with markedly elevated odds of UGIB (aOR:27.75; 95%CI: 21.07–36.55; p < 0.0001). Conclusion: H. pylori infection had increased risk-adjusted occurrence of UGIB amongst the AIS hospitalized patients. H. pylori testing may improve risk stratification for UGIB and lower the health care cost burden in stroke hospitalization.

Intravenous tissue plasminogen activator for acute ischemic stroke in patients with renal dysfunction

QJM ◽  
2020 ◽  
Author(s):  
I-K Wang ◽  
T -H Yen ◽  
C -H Chen ◽  
S -P Hsu ◽  
Y Sun ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Gastrointestinal Bleeding ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Renal Dysfunction ◽  
Upper Gastrointestinal Bleeding ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Intravenous Tissue Plasminogen Activator ◽  
Upper Gastrointestinal

Summary Objective This study used the Taiwan Stroke Registry data to evaluate the efficacy and safety of intravenous tissue plasminogen activator (tPA) in treating acute ischemic stroke in patients with renal dysfunction. Design We identified 3525 ischemic stroke patients and classified them into two groups according to the estimated glomerular filtration rate (eGFR) at the emergency department: ≥60, and &lt;60 ml/min/1.73 m2 or on dialysis and by the propensity score from August 2006 to May 2015. The odds ratio of poor functional outcome (modified Rankin Scale ≥2) was calculated for patients with tPA treatment (N = 705), compared to those without tPA treatment (N = 2820), by eGFR levels, at 1, 3 and 6 months after ischemic stroke. We also evaluated the risks of intracerebral hemorrhage, upper gastrointestinal bleeding, mortality, between the two groups by eGFR levels. Results Among patients with eGFR levels of &lt;60 ml/min/1.73 m2, tPA therapy reduced the odds ratio of poor functional outcome to 0.60 (95% confidence interval = 0.42–0.87) at 6 months after ischemic stroke. The tPA therapy was not associated with increased overall risk of upper gastrointestinal bleeding, but with increased risk of intracerebral hemorrhage. The low eGFR was not a significant risk factor of intracerebral hemorrhage among ischemic stroke patients receiving tPA treatment. Conclusions tPA for acute ischemic stroke could improve functional outcomes without increasing the risks of upper gastrointestinal bleeding for patients with or without renal dysfunction. The low eGFR was not a significant risk factor for intracerebral hemorrhage among patients receiving tPA treatment.

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