Stroke in young people
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees in Stroke in Practice, 2017
This chapter reviews the ways in which cerebrovascular disease may affect young people. It discusses how the investigation and management of stroke differs in the young compared to the elderly. Sickle-cell disease confers a high risk of stroke throughout the patient's lifetime and is a particularly important cause of stroke during childhood. Children may develop stroke either as a direct consequence of the structural abnormality or as a complication of surgical intervention to treat it. Abnormalities of the cerebral vessels, either inherited or acquired, may predispose to stroke in childhood. Dissection of the carotid and vertebral arteries is a common cause of stroke in young people, accounting for about 10% of all strokes in those fewer than 45 years of age. There is a paucity of evidence to guide then management of patients with stroke secondary to arterial dissection: most guidelines recommend anticoagulation for between three and six months until recanalisation occurs.
Arteriography of the vascular beds
Peter A. Schneider in Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Carotid and cerebral arteriography is the only type of strategic arteriography where anticoagulation is used routinely, even when no treatment is planned at the time of catheterization. Occlusive and aneurysmal diseases involving the infrarenal arteries comprise a significant proportion of contemporary vascular practice. Aortography with lower extremity runoff may be carried out by placing the catheter at the level of the renal arteries and performing a sequence of films that covers the distance from the aorta to the feet. Femoral arteriography may be performed with a catheter placed either up-and-over the aortic bifurcation or in a retrograde or antegrade direction through the common femoral artery ipsilateral to the lesion. The anterior tibial artery projects laterally and anteriorly from its origin, through the interosseus membrane and then inferiorly through the anterior compartment. Inadequate pedal arteriography may lead to the subsequent surprise of the “angiographically occult” outflow artery in the foot. Pressure measurement is time-consuming and is usually performed selectively.
Management strategies
Gregory YH Lip in Atrial Fibrillation in Practice, 2020
Evaluation of the cause or precipitating factor for acute atrial fibrillation (AF) may be as important as treating the arrhythmia. The objectives of management of paroxysmal AF are the suppression of paroxysms and the long-term maintenance of sinus rhythm, and appropriate thromboprophylaxis. Many patients with paroxysmal AF are young and ‘lone AF’ is more common when compared to sustained AF. Many patients with paroxysmal AF will have asymptomatic paroxysms, but there is increasing evidence that frequent, uncontrolled paroxysms of fast AF may lead to impairment of cardiac function and a higher progression to sustained AF. In patients with persistent AF, appropriate use of antiarrhythmic therapy to maintain sinus rhythm and anticoagulation to reduce the risk of thromboembolism post-cardioversion should be considered. Cardioversion of AF has been shown to improve cardiac haemodynamics and quality of life in the short term.
How D-dimer assay can be useful in deciding the duration of anticoagulation after venous thromboembolism: a review
Published in Expert Review of Hematology, 2015
Venous thromboembolism has a relatively strong tendency to recur, especially when the event is unprovoked. In this case, the duration of anticoagulation should not be shorter than 3 months, but it is also suggested to be indefinite. The decision to discontinue or extend indefinitely anticoagulation is not easy. D-dimer assay has a predictive value for individual risk of recurrence and can therefore be used in the decision-making process regarding duration of anticoagulation. This article reviews studies on D-dimer measurement as a predictor of the recurrence risk and analyzes the results of a very recent clinical study (the DULCIS study) that investigated how D-dimer assay can effectively and safely be used to decide the duration of anticoagulation in individual patients after an unprovoked event.
Anticoagulation in Glaucoma Surgery
Published in Seminars in Ophthalmology, 2018
Shiraaz I. Rahman, Angela Turalba
Anticoagulation medications are used commonly, particularly in an elderly population. There are many systemic diseases and scenarios that require modulation of coagulation to prevent serious adverse outcomes. While there is some consensus about their use in cataract surgery, there is less certainty about their management with glaucoma surgery. Glaucoma surgery presents a unique challenge when considering anticoagulation. Currently, there is great diversity in surgeon practices regarding anticoagulation in glaucoma surgery. Based on available evidence, it is unclear whether it is beneficial to hold anticoagulation, with or without bridging therapy, leading up to a planned surgery. Considering the potential serious adverse outcomes related to holding anticoagulation therapy, altering these medications for glaucoma surgery should be done sparingly and in consultation with the primary prescriber of such medications.
Update on perioperative bridging in patients on chronic oral anticoagulation
Published in Expert Review of Cardiovascular Therapy, 2009
Bishoy Faltas, Peter A Kouides
Oral anticoagulation (OAC) with vitamin K antagonists is commonly used for long-term prevention or treatment of arterial or venous thromboembolism. In the USA alone, approximately 250,000 patients will require temporary interruption of OAC annually. Managing anticoagulation in those patients on chronic OAC who require invasive procedures continues to be a major clinical dilemma. This article summarizes the existing evidence in light of the recommendations of the American College of Chest Physicians. Management of anticoagulation in the perioperative period will continue to be an important clinical challenge and an evolving area of research. If new oral anticoagulants are successful in replacing warfarin, the entire perioperative anticoagulation scene will change.
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