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Cerebral Vasospasm and Delayed Cerebral Ischemia after Warfarin-Induced Subarachnoid Hemorrhage
Subarachnoid hemorrhage (SAH) associated with anticoagulation is a rare event. About 30% of in-hospital patients with aneurysmal SAH develop delayed cerebral ischemia (DCI); however, the occurrence of vasospasm and DCI in patients with nonaneurysmal SAH is still controversial.
Source: Journal of Stroke and Cerebrovascular Diseases - July 18, 2015 Category: Neurology Authors: Irapuá Ferreira Ricarte, Fabrício G. Calente, Maramélia M. Alves, Daniela L. Gomes, Raul A. Valiente, Flávio A. Carvalho, Gisele S. Silva Tags: Case Report Source Type: research

Management of Bleeding Complications in Patients Taking Direct Oral Anticoagulants at a Large Tertiary Academic Medical Center
Abstract Direct oral anticoagulants (DOACs) offer a fixed-dose alternative to warfarin for stroke prevention in patients with atrial fibrillation. However, there is minimal evidence to guide the management of bleeding in patients taking a DOAC. We retrospectively evaluated the acute management of major bleeding in this patient population at a large, tertiary academic medical center. We evaluated various strategies of management including dialysis, transfusions, pharmacologic agents, surgical intervention, and reinitiation of anticoagulation. We also assessed length of intensive care unit and hospital stay, mor...
Source: Current Emergency and Hospital Medicine Reports - June 13, 2015 Category: Emergency Medicine Source Type: research

Prehospital Reversal of Warfarin-Related Coagulopathy in Intracerebral Hemorrhage in a Mobile Stroke Treatment Unit Clinical and Research Innovations
Source: Stroke - April 27, 2015 Category: Neurology Authors: Gomes, J. A., Ahrens, C. L., Hussain, M. S., Winners, S., Rasmussen, P. A., Uchino, K., on behalf of the Cleveland Pre-Hospital Acute Stroke Treatment Study Group Tags: Coumarins, Anticoagulants Clinical and Research Innovations Source Type: research

Literature Update in Hospital Medicine
Publication date: April 2014 Source:Hospital Medicine Clinics, Volume 3, Issue 2 Author(s): William Southern , Bradley A. Sharpe , Romsai Tony BoonyasaiTeaser Perioperative statins reduce perioperative myocardial infarctions, atrial fibrillation, and length of stay. Statins do not increase the risk of intracranial hemorrhage. New oral anticoagulants are superior to warfarin in preventing stroke in patients with atrial fibrillation, and may have a better safety profile. In patients who have an acute gastrointestinal bleed while on warfarin, restarting warfarin after a week may lead to fewer thromboses and lower mortality ...
Source: Hospital Medicine Clinics - October 12, 2014 Category: Internal Medicine Source Type: research

The Case Files: Unusual Headache
By Al-Hashimi, Siddhartha DO; Leavens, John MD A 23-year-old woman with a history of migraine headaches presented to the emergency department for a different-than-usual headache. She had a six-day history of intermittent headaches. The onset was at rest, and there was no history of trauma.   The headache was located behind her left eye, and it radiated into the posterior portion of her head. She characterized it as being 8/10 in intensity. Bright lights were reported as an exacerbating factor. The headache was associated with nausea and multiple episodes of emesis. She had 10 episodes of vomiting the evening prior to arri...
Source: The Case Files - June 5, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

The Case Files: Traumatic Carotid Dissection
By Hsiao, Jonie MD   A 30-year-old man who was right-hand dominant presented 10 days after sustaining left-sided face and head trauma from a fall from a skateboard at an unknown speed. He lost consciousness for several seconds, and initially developed a headache with nausea and vomiting. A non-contrast head CT performed at another hospital done two days after the incident was reportedly negative.   He now presents primarily with concerns about the appearance of his left eye. He has notable anisocoria and a droopy eyelid. His left pupil is notably smaller, 2 mm, compared with the right eye, 5 mm. Both are reactive. The re...
Source: The Case Files - June 4, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Case studies in prehospital care from London HEMS: pre-hospital administration of prothrombin complex concentrate to the head-injured patient
A case of pre-hospital administration of prothrombin complex concentrate to a patient anticoagulated with warfarin and with suspected intracranial haemorrhage is described. Effective, early reversal of anticoagulation by the time of arrival at hospital was achieved.
Source: Emergency Medicine Journal - February 13, 2013 Category: Emergency Medicine Authors: Lendrum, R. A., Kotze, J.-P., Lockey, D. J., Weaver, A. E. Tags: Drugs: cardiovascular system, Stroke Cases from hems Source Type: research

Warfarin treatment and thrombolysis: How to persuade procrastinators?
This study, which uses data from the American Heart Association Get With The Guidelines (GWTG)–Stroke Registry, concluded that there was no association between IV thrombolysis and symptomatic intracranial hemorrhage (SICH).1 These findings are in agreement with some2–4 but contrast with other studies (including 2 meta-analyses).5–8 The study by Xian et al. is the largest study to date drawing from hospitals throughout the United States, including 23,437 patients who received IV thrombolysis.1 Nearly 8% of these patients had prior warfarin use and 48.6% of the warfarin-treated patients who met the eligibil...
Source: Neurology - February 4, 2013 Category: Neurology Authors: Seet, R. C. S., Harrer, J. U. Tags: EDITORIALS Source Type: research

Warfarin-associated Intracerebral Hemorrhage is Increasing in Prevalence in the United States
Background: Warfarin-associated intracerebral hemorrhage (WAICH) is expected to increase in prevalence as the population ages. We sought to evaluate national trends, characteristics, and in-hospital outcomes among intracerebral hemorrhage (ICH) patients taking warfarin at baseline.Methods: We reviewed the Nationwide Inpatient Sample to identify all admissions with primary diagnosis of ICH by International Classification of Diseases, Ninth Revision code (431) from 2005 to 2008. We identified premorbid warfarin use by the V code (V58.93) and calculated the proportion of WAICH among all ICH patients in each year. We employed ...
Source: Journal of Stroke and Cerebrovascular Diseases - January 3, 2013 Category: Neurology Authors: Eric M. Liotta, Shyam Prabhakaran Tags: Original Articles Source Type: research

Tissue Plasminogen Activator Thrombolytic Therapy for Acute Ischemic Stroke in 4 Hospital Groups in Japan
In October 2005 in Japan, the recombinant tissue plasminogen activator (tPA) alteplase was approved for patients with acute ischemic stroke within 3 hours of onset at a dose of 0.6 mg/kg. The present study was undertaken to assess the safety and efficacy of alteplase in Japan. Between October 2005 and December 2009, a total of 114 consecutive patients admitted to 4 hospitals received intravenous tPA within 3 hours of stroke onset. Clinical backgrounds and outcomes were investigated. The patients were divided into 2 chronological groups: an early group, comprising 45 patients treated between October 2005 and December 2007,...
Source: Journal of Stroke and Cerebrovascular Diseases - October 4, 2011 Category: Neurology Authors: Syoichiro Kono, Kentaro Deguchi, Nobutoshi Morimoto, Tomoko Kurata, Shoko Deguchi, Tohru Yamashita, Yoshio Ikeda, Tohru Matsuura, Hisashi Narai, Nobuhiko Omori, Yasuhiro Manabe, Taijyun Yunoki, Yoshiki Takao, Sanami Kawata, Kenichi Kashihara, Koji Abe Tags: Original Articles Source Type: research

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