Vitamin K Antagonist (Phenprocoumon) and Subarachnoid Hemorrhage: A Single-Center, Matched-Pair Analysis

AbstractBackgroundDemographic changes are leading to an aging society with a growing number of patients relying on anticoagulation, and vitamin K antagonists (VKA) are still widely used. As mortality and functional outcomes are worse in case of VKA-associated hemorrhagic stroke, phenprocoumon treatment seems to be a negative prognostic factor in case of subarachnoid hemorrhage (SAH). The purpose of this study was to analyze whether phenprocoumon treatment does worsen the outcome after non-traumatic SAH.MethodsAll patients treated for non-traumatic SAH between January 2007 and December 2016 in our institution were retrospectively analyzed. After exclusion of patients with anticoagulant or antiplatelet treatment other than phenprocoumon, we analyzed 1040 patients. Thirty-three patients (3%) of those were treated with continuous phenprocoumon. In total, 132 out of all 1007 patients without anticoagulant treatment of the remaining patients were matched as control group (ratio  = 1:4).Results Patients with phenprocoumon treatment were significantly older (66.5  years vs. 53.9 years;p 
Source: Neurocritical Care - Category: Neurology Source Type: research

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Hereditary hemorrhagic telangiectasia (HHT), a genetic bleeding disorder leading to systemic arteriovenous malformations (AVMs), is caused by loss-of-function mutations in the ALK1/ENG/Smad1/5/8 pathway. Evidence suggests that HHT pathogenesis strongly relies on overactivated PI3K/Akt/mTOR and VEGFR2 pathways in endothelial cells (ECs). In the BMP9/10-immunoblocked (BMP9/10ib) neonatal mouse model of HHT, we report here that the mTOR inhibitor, sirolimus, and the receptor tyrosine kinase inhibitor, nintedanib, could synergistically fully block, but also reversed, retinal AVMs to avert retinal bleeding and anemia. Sirolimus...
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
Leptomeningeal anastomoses or pial collateral vessels play a critical role in cerebral blood flow (CBF) restoration following ischemic stroke. The magnitude of this adaptive response is postulated to be controlled by the endothelium, although the underlying molecular mechanisms remain under investigation. Here we demonstrated that endothelial genetic deletion, using EphA4fl/fl/Tie2-Cre and EphA4fl/fl/VeCahderin-CreERT2 mice and vessel painting strategies, implicated EphA4 receptor tyrosine kinase as a major suppressor of pial collateral remodeling, CBF, and functional recovery following permanent middle cerebral artery occ...
Source: Journal of Clinical Investigation - Category: Biomedical Science Authors: Source Type: research
Heparin has a non-predictable effect in the individual patient. The activated clotting time (ACT) is used to measure the level of anticoagulation after administration of heparin. To date, appropriate heparin dose protocols and corresponding therapeutic ACT values have not been established in non-cardiac arterial procedures (NCAP). The aim of this review was to study the use of ACT monitoring during NCAP, and whether an optimal ACT could be determined based on the fewest arterial thrombo-embolic complications (ATEC) and bleeding complications.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Source Type: research
Review of English-language articles published from PubMed (MEDLINE) and Google Scholar between January 1, 1985, and January 1, 2019.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Crescendo transient ischemic attacks should be treated by carotid endarterectomy within two days – but with increased perioperative stroke risk Source Type: research
Multicenter retrospective analysis of patients entered in the prospective, randomized International Carotid Stenting Study between May 2001 and October 2008.
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Open-cell stents used for carotid artery stenting are less likely to develop recurrent stenosis than closed-cell stents Source Type: research
Currently there is no definitive level I evidence regarding the appropriate management of asymptomatic moderate to severe carotid artery stenosis in the octogenarian patient. In this 5-year review of National Surgical Quality Improvement Program registry data, exceptional “real-world” results are reported with use of carotid endarterectomy (CEA) in this growing cohort.1 The combined stroke and death rate was 2% at 30-day follow-up (stroke rate 1%!), with the authors stating that “age alone should not interdict this modality.”
Source: Journal of Vascular Surgery - Category: Surgery Authors: Tags: Invited commentary Source Type: research
Conclusions: We speculated that damages to the basal ganglia disrupted the cortico-subcortical circuits that facilitated the transhemispheric communications of language functions, resulting in decreased interhemispheric FC. Consequently, the intrahemispheric FC increased as a possible compensatory mechanism to restore the language functions. PMID: 31955634 [PubMed - as supplied by publisher]
Source: Brain Injury - Category: Neurology Tags: Brain Inj Source Type: research
Semin Respir Crit Care Med 2017; 38: 745-759 DOI: 10.1055/s-0037-1607991Spontaneous intracerebral hemorrhage (ICH) is the most common cause of intraventricular hemorrhage (IVH) in adults. Complicating approximately 40% of ICH cases, IVH adds to the morbidity and mortality of this often fatal form of stroke. It is also a severity factor that complicates subarachnoid hemorrhage and traumatic brain injury, along with other less common causes of intracranial bleeding. Medical and surgical interventions to date have focused on limiting ICH and IVH expansion, controlling intracranial pressure, and relieving obstructive hydroceph...
Source: Seminars in Respiratory and Critical Care Medicine - Category: Respiratory Medicine Authors: Tags: Review Article Source Type: research
CONCLUSIONS: Even though no single pharmacological agent or treatment protocol has been identified, the main therapeutic interventions remain ineffective and limited to the manipulation of systemic blood pressure, alteration of blood volume or viscosity, and control of arterial dioxide tension. PMID: 28217390 [PubMed - in process]
Source: Surgical Neurology International - Category: Neurosurgery Tags: Surg Neurol Int Source Type: research
Conclusions Patients with NASAH without a Fi3 bleeding pattern had a similar excellent outcome to patients with PM-SAH. Patients with Fi3 had a high risk for early hydrocephalus, CVS, DCI, and an unfavorable outcome, similar to patients with aneurysmal SAH. After multivariate analysis, early hydrocephalus, elderly patients, and Fi3 were identified as negative prognostic factors. Therefore, patients with Fi3 are at risk and need careful clinical observation.
Source: Journal of NeuroInterventional Surgery - Category: Neurosurgery Authors: Tags: Hemorrhagic stroke Source Type: research
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