“ A Bloody Mess”
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Transcript of “ A Bloody Mess”
“ A Bloody Mess”
Registrar: Dr M HarmseConsultant: Dr J v Rensburg
CASE
Mrs M, 58 y old lady from Vryburg
AML with multilineage dysplasia Admitted for second induction Complicated by DVT, started on Warfarin
INR >8
Phoned by sister:-trauma-disorientated
AAICH(Anticoagulant associated intracerebral hemorrhage)
INTRODUCTION
Wider use of Warfarin:-Warfarin related deaths-Permanent disability
-Mayo clinic Proceedings, Jan 2007; 82(1):82-89
INCIDENCE OF AAICH
-5x more in period 1988 - 1999-Paralleled 4X higher
warfarin prescribed in same period
-Most episodes of AAICH during therapeutic INR ( 2- 3)
-Birmingham atrial fibrillation treatment of the aged study, Lancet 2007; 370;493-503
AAICH RISK FACTORS
ESTABLISHED
-INR level-Hypertension (Systolic > 160 mmHg) -Advange age (> 75 years)-History of cerebrovascular disease
AAICH RISK FACTORS
POSSIBLE
- Aspirin use -Asian / Mexican American ethnisity-Tabacco smoking
-Heavy Alcohol consumption
WARFARIN, mechanism of action
II
VII
IX
X
1) ANTICOAGULATION
2)ANTIPLATELETS
1) ANTICOAGULATION
2)ANTIPLATELETS
REVERSAL OF ANTICOAGULATION
Additional optionsManagement of Hpt
Not a independent predictor of outcome
Keep systemic BP < 180 mmHg
(no data available)
Additional options
Should we restart with oral anti-coagulation?
AF PV
Should warfarin be restarted for AF/PV?
-Mayo clinic proceedings, Jan 2007;82(1);82-92
1. Warfarin: prevalance
2. Management of uncontrolled INR
3. AAICH: Emergency!
4. Restart?
How to fix a bloody mess!
Thank you