Thursday, January 5. 2006How Sharon's Medical Tragedy Happened
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I'm unfamiliar your trackback system, so I'm adding them to comments: Thoughts on Sharon's Health and Political Legacy and the same comments at Kesher Talk
Just correcting the link from above which I was notified was incorrect.
http://abracadabrah.blogspot.com
re:
"Using less agressive anti-coagulation after the first stroke" However, on December 21, 2005, your under-cover neurologist indicated there might be cause for a robust anti-coagulant: http://www.iris.org.il/blog/archives/803-Sharons-Medical-Team-Disputes-Clean-Bill-of-Health.html "...the most important thing would be to initiate anti-coagulation, probably using low doses of aspirin. If other factors were involved such as heart problems there may be a need for more powerful anticoagulation." And, indeed, a heart problem was found, indicating, from your neurologist's reasoning, that a robust anti-coagulant was needed. He now, however, appears to be second-guessing his own opinion. My own opinion (I am not a physician) is that he should have only taken aspirin, and should have had the procedure to repair the hole in his heart within a few days of his stroke. I am 58 years old. Many members of my family have had strokes - both thrombotic and hemorrhagic - and even though I am 20 years younger than the Prime Minister, I would be terrified at the thought of taking an anti-coagulant (other than aspirin), even if I had just had a minor stroke or transient ischemic attack.
Reuven,
Your comment is quite perceptive. Obviously you read very carefully to notice such a seeming discrepancy. Here's how my neurologist responded: "When I found out that Sharon had an atrial septal defect I became more comfortable with the strategy of more powerful anticoagulation (in accordance with "there may be a need for more powerful anticoagulation"), but when I found out that it was only a 2 mm hole I was less impressed with the cardiac history. " "Putting Sharon on anticoagulation was not a crazy thing to do. It was a reasonable gamble that failed, but it is clear that the bleed was so severe because he was on big-league anticoagulation." By the way, I did not record all of the comments the neurologist sent me post-stroke #1, but after the revelation of the 2mm size of the hole, he consistently and clearly indicated his judgement would have been aspirin as a moderate anticoagulant. Thanks again for commenting.
Very good inside information. It is important to note that the septal defect is very unlikely to have caused the initial stroke not only b/c of the size but also he would need a source of clot. Almost 100% of small ASD have no clinical importance. The fact that they even considered further anticoagulation is classic VIP treatment. It is key to note that they were using Lovenox. It is a low molecular heparin that normaly requieres no monitoring with regard to level of anticoagulation, it makes it very easy to use in most patients. But it is not safe if you have Kidney dysfunction, not uncommon in patients of older age and with HTN. In those cases close monitoring is requiered. Most people forget that fact b/c overall Lovenos is a very safe drug. Some people consider that using the actual weight of obese patients also adds to the risk of bleeding.
thank you for the info.
There is typically very little reason to use anticoagulation, especially in an obese 77 year old with a unilateral stroke, and likely with other vascular risk factors. Unless they saw a thrombus (blood clot) or unless Sharon had an arrhythmia (irregular heartbeat) there is no indication for anticoagulation. Aspirin in not an anticoagulant - as was mentioned in an above comment, it is an anti-platelet agent which helps to prevent plaque formation on arterial walls. If someone lives 77 years without problems from an atrial septal defect, it probably didn't cause his stroke, and anticoagulation is a poor choice which will now likely cause him to be pretty incapacitated.
Coagulation of blood is the same thing as clotting. Aspirin acts on the cell fragments (platelets) involved in coagulation, other drugs act on the proteins involved in coagulation. Both increase bleeding tendency and decrease coagulation, but aspirin is far gentler than bigger league drugs of the heparin or warfarin groups at doses typically used.
First, thank you for commenting. It is an honor to have knowlegeable physicians jumping in here. Unfortunately one of the main problems with Sharon's treatment was that his medical team chose a closed information strategy, rather than taking advantage of the willingness of other physicians to contribute and point out items that were likely overlooked.
I will apologize to the general audience at this point for delving into a technical complex issue (quoting my neurologist source). "Others also question closing the atrial septal defect, but they don't offer an explanation of where the clot came from. The fact that a second stroke occurred on the opposite side of the brain from the first stroke, apparently at the same time as a pulmonary embolus, suggests that the atrial septal defect may indeed have been important in letting a clot reach the brain and it should have been fixed as soon as possible despite its size reported as 2 mm. We would be in a better position to evaluate this if we had information about whether there were leg vein clots and whether there was significant carotid artery atherosclerosis. Sharon's doctors may have this information but it has not been released as far as I know." Add Comment
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Sharon under deep sedation, and in induced coma for at least 24 more hours on a respirator. He continues to be in serious but stable condition, the director of Hadassah University Hospital, Ein Karem, Jerusalem said Thursday. From an editorial...
Tracked: Jan 05, 20:47
While PM Sharon is in an induced coma and on a respirator after undergoing emergency surgery to relieve bleeding on his brain, the political situation in the Middle East remains murky.
Tracked: Jan 06, 04:43