Guess what - Some Doctors are Starting to Notice that We Have a Problem

[Guest]

Cerebrovasc Dis. 2005 Apr 8;19(5):337-342 [Epub ahead of print]

Withdrawal of Warfarin prior to a Surgical Procedure: Time to Follow the Guidelines?

Akopov SE, Suzuki S, Fredieu A, Kidwell CS, Saver JL, Cohen SN. Division of Neurology, Cedars-Sinai Medical Center Los Angeles, Los Angeles, Calif., USA.

Background and Objective: Patients with cardiogenic sources of embolism may be at increased risk of cerebral infarction when anticoagulation therapy is suspended for surgical procedures. The purpose of this study was to determine frequency of cardioembolic cerebral infarction during periprocedural warfarin withdrawal. Methods: Retrospective analysis of prospective cerebral infarction registry data from two tertiary medical centers. Results: Over a 12-month period, 14 cases of cardioembolic cerebral infarction occurring during the period of warfarin withdrawal for a medical procedure were observed, accounting for 7.1% of the 197 cardioembolic cerebral infarctions encountered. Across all patients, cerebral infarctions developed an average of 5.4 days after the last dose of warfarin (range 3-8). Among the 14 patients (8 males and 6 females) with warfarin cessation-related infarcts, age ranged from 54 to 91 years. Each had been on chronic anticoagulation with warfarin for more than 1 year. Retrospective analysis suggested that all these cerebral infarctions had been potentially preventable. In each case, either the planned procedure did not require discontinuation of warfarin or, when withdrawal was required, no bridging, parenteral anticoagulation was provided to lessen the risk during the warfarin-free period. Conclusion: Patients at high risk of cardioembolic cerebral infarction may benefit from more intensive management strategies to reduce cerebral infarction risk during periprocedural periods. Copyright (c) 2005 S. Karger AG, Basel.

The sad part is that the title asks a question.

We've tapped on the door.
We've knocked on the door.
We've banged on the door.
Now it's time to kick the door down.

 

[catwoman]

Cardiogenic sources of embolism -- from my 3 years of high school Latin, I assume that means the source arises within the heart. Such as due to mechanical heart valves??

Am I warm? hot? cold?

 

[geebee]

Withdrawal of Warfarin prior to a Surgical Procedure: Time to Follow the Guidelines?

Well, duh. Why do they have guidelines if they are going to ignore them?

 

[Marty]

Brain death

Brain death

In simple English a clot forms on your valve, your heart contracts and "throws" the clot via big arteries through your neck where the clot lodges finally in a small brain artery and blocks it. The brain supplied by tha little artery dies. Read Warren Meads story. Why don't doctors follow the bridging guidelines? I think its because they think its a lot of trouble and its very smal risk to go off warfarin for five days for instance to have a colonoscopy. A good cardiologist friend of mine says he's never had a problem with a patient simply holding .I told him about Warren Mead and my interest in the case. He just shrugged his shoulders.No comment. But I hope he changes his MO.

 

[lance]

It's enough to freak you out!

It's enough to freak you out!

So the doctor shrugged his shoulders did he? (mental image of a steel coated, pointed toe boot, in contact with his derrierre).

Valvers need to be vigilent to the point of paranoia to protect ourselves from the personnel who dedicated their lives to helping patients.

I need surgery (high risk) and that's enough to deal with.

Thank heaven I found this site.

Cheers!

 

[Barry]

...Valvers need to be vigilent to the point of paranoia to protect ourselves from the personnel who dedicated their lives to helping patients...

When I went in to get my valve replacement, they prepped me for, and tried to get me to sign consent to, a bypass! Yep, pay attention!

 

[William]

The article is both interesting and scary. I can't believe some doctors just don't use a bridge. Looking at the figures now, 14 of 197 (7.1%) stroke cases were the result of no bridge. This leads to a question, is there a percentage of patients who don't stroke without a bridge? Will

 

[RCB]

Every profession has them

Every profession has them

Medicine is no different- good and bad doctors. That is why we are SSSSOOOOOO LUCKY to have VR.com and the expertise of AL's website!
This place is so ahead of the curve!

 

[Barry]

Medicine is no different- good and bad doctors...

What he said. Docs are essentially no different than any other tradesman, whether an auto mechanic, an attorney, or a gardener. There are good ones, there are bad ones. The trick is in finding a good one.

Hard to know how to find a good doc. Malpractice records don't work, because all that a lot of malpractice suits may indicate is that the doc is willing to take on risky cases, whereas the doc with no malpractice suits may simply be playing it safe and not taking on any difficult cases - yet the former doc may be much better than the latter.

I don't know if it works for docs, but rule of thumb I learned a long time ago for selecting an attorney or a psychotherapist was to ask around until three independent parties had referred you to the same person - who'd be most likely to be the good one. I've since found that it works for auto mechanics, too.

 

[Guest]

As my mother says, "Every class has someone who finishes last."

One time the person who finished last in his class at West Point was asked if anyone famous every finished last in his class. His reply, "Yes sir, George Armstrong Custer."