1 / 26

“ A Bloody Mess”

“ A Bloody Mess”. Registrar: Dr M Harmse Consultant: 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

caspar
Download Presentation

“ A Bloody Mess”

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related