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“ A Bloody Mess” PowerPoint Presentation
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“ A Bloody Mess”

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  1. “ A Bloody Mess” Registrar: Dr M Harmse Consultant: Dr J v Rensburg

  2. 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

  3. Phoned by sister: • trauma • disorientated

  4. AAICH (Anticoagulant associated intracerebral hemorrhage)

  5. INTRODUCTION • Wider use of Warfarin: -Warfarin related deaths -Permanent disability -Mayo clinic Proceedings, Jan 2007; 82(1):82-89

  6. 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

  7. AAICH RISK FACTORS • ESTABLISHED -INR level -Hypertension (Systolic > 160 mmHg) -Advange age (> 75 years) -History of cerebrovascular disease

  8. AAICH RISK FACTORS • POSSIBLE - Aspirin use -Asian / Mexican Americanethnisity -Tabaccosmoking -Heavy Alcohol consumption

  9. WARFARIN, mechanism of action IX VII X II

  10. 1) ANTICOAGULATION 2)ANTIPLATELETS

  11. 1) ANTICOAGULATION 2)ANTIPLATELETS REVERSAL OF ANTICOAGULATION

  12. Additional options Management of Hpt Not a independent predictor of outcome Keep systemic BP < 180 mmHg (no data available)

  13. Additional options

  14. Should we restart with oral anti-coagulation? AF PV

  15. Should warfarin be restarted for AF/PV? -Mayo clinic proceedings, Jan 2007;82(1);82-92

  16. Warfarin: prevalance Management of uncontrolled INR AAICH: Emergency! Restart?

  17. How to fix a bloody mess!

  18. Thank you