acenocoumarol and Ischemic-Attack--Transient

Diffuse superficial siderosis of the central nervous system (CNS) is a rare condition due to hemosiderin deposits in the subpial layers of the brain and spinal cord. The source of chronic or recurrent bleeding into the subarachnoid space is detected in only 50 % of cases. The most characteristic symptoms are cerebellar ataxia and sensorineural hearing impairment. T2-weighted gradient echo magnetic resonance imaging constitutes the diagnostic method of choice.. We report four patients of diffuse superficial siderosis of the CNS associated to cerebral amyloid angiopathy, oral anticoagulation, schwannoma VIII, and without known source of bleeding in one case. Two patients developed cerebellar ataxia, three of them present transient focal neurological episodes, one dementia and, the last one, the diffuse superficial siderosis of the CNS is a radiological finding. No clinical progression was observed during follow-up (2-11 years) in three of them. The patient with cerebral amyloid angiopathy progresses to dementia.. Transient focal neurological episodes were the most common symptom in our cases of diffuse superficial siderosis of the CNS. The natural history of this condition is not very known and may be regarded as a radiological finding.. Siderosis superficial difusa del sistema nervioso central: descripcion de cuatro casos y revision de la bibliografia.. Introduccion. La siderosis superficial difusa del sistema nervioso central (SNC) es una rara condicion debida a depositos de hemosiderina en las capas subpiales del cerebro y la medula espinal. La fuente de sangrado cronico o recurrente en el espacio subaracnoideo se detecta solo en un 50% de los casos. Los sintomas mas caracteristicos son ataxia cerebelosa e hipoacusia neurosensorial. Las secuencias eco de gradiente potenciadas en T2 de resonancia magnetica constituyen el metodo diagnostico de eleccion. Casos clinicos. Presentamos cuatro pacientes con siderosis superficial difusa del SNC relacionada con angiopatia amiloide, anticoagulacion oral, schwannoma del VIII par craneal y sin fuente de sangrado conocida en un caso. Dos pacientes desarrollaron ataxia cerebelosa; tres de ellos, episodios recurrentes de alteracion focal neurologica; uno, demencia; y el cuarto es un hallazgo radiologico. No se objetivo progresion clinica durante el seguimiento (2-11 años) en tres de ellos. El paciente con angiopatia amiloide evoluciono a demencia. Conclusiones. Los episodios recurrentes de alteracion focal neurologica son los sintomas mas frecuentes en nuestros casos de siderosis superficial difusa del SNC. La evolucion natural de esta condicion no se conoce bien y puede constituir un hallazgo radiologico.

Topics: Acenocoumarol; Aged; Anticoagulants; Brain Chemistry; Cerebellar Ataxia; Cerebral Amyloid Angiopathy; Comorbidity; Dementia; Female; Hemosiderin; Hemosiderosis; Humans; Hypertension; Ischemic Attack, Transient; Magnetic Resonance Imaging; Male; Middle Aged; Neuroma, Acoustic; Radiography; Smoking; Subarachnoid Hemorrhage

Chronic Kidney Disease (CKD) constitutes an adverse risk factor in chronic anticoagulated atrial fibrillation (AF) patients, being related to adverse cardiovascular events, mortality and major bleeds. It is unclear if CKD adds independent prognostic information to stroke risk stratification schemes, as the risk factor components of the CHADS2 and CHA2DS2-VASc scores are themselves related to renal dysfunction. The aim of our study was to determine if CKD independently improves the predictive value of the CHADS2 and CHA2DS2-VASc stroke stratification scores in AF. We recruited consecutive patients (n=978) patients (49% male; median age 76) with permanent or paroxysmal AF on oral anticoagulants with acenocoumarol, from our out-patient anticoagulation clinic. After a median follow-up of 875 (IQR 706-1059) days, we recorded stroke/transient ischaemic attack (TIA), peripheral embolism, vascular events (acute coronary syndrome, acute heart failure and cardiac death) and all-cause mortality. During follow-up, 113 patients (4.82%/year) experienced an adverse cardiovascular event, of which 39 (1.66%/year) were strokes, 43 (1.83%/year) had an acute coronary syndrome and 32 (1.37%/year) had acute heart failure. Also, 102 patients (4.35%/year) died during the following up, 31 of them (1.32%/year) as a result of a thrombotic event. Based on c-statistics and the integrated discrimination improvement (IDI), CKD did not improve the prediction for stroke/systemic embolism, thrombotic events and all-cause mortality using the CHADS2 and CHA2DS2-VASc scores. In conclusion, evaluating renal function in AF patients is important as CKD would confer a poor overall prognosis in terms of thromboembolic events and all-cause mortality. Adding CKD to the CHADS2 and CHA2DS2-VASc stroke risk scores did not independently add predictive information.

Topics: Acenocoumarol; Administration, Oral; Aged; Aged, 80 and over; Atrial Fibrillation; Decision Support Techniques; Female; Humans; Ischemic Attack, Transient; Kidney; Male; Multivariate Analysis; Proportional Hazards Models; Renal Insufficiency, Chronic; Risk Assessment; Risk Factors; Stroke; Time Factors; Treatment Outcome

The aim of this study was to test the hypothesis that a specific bleeding risk score, HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly), was better at predicting major bleeding compared with CHADS2 (congestive heart failure, hypertension, 75 years of age or older, diabetes mellitus, and previous stroke or transient ischemic attack) and CHA2DS2-VASc (congestive heart failure, hypertension, 75 years of age and older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, 65 to 74 years of age, female) in anticoagulated atrial fibrillation (AF) patients.. The CHADS2 and CHA2DS2-VASc scores are well-validated stroke risk prediction scores for AF, but are also associated with increased bleeding and mortality.. We recruited 1,370 consecutive AF patients (49% male; median age, 76 years) receiving oral anticoagulation therapy from our outpatient anticoagulation clinic, all of whom were receiving acenocoumarol and had an international normalized ratio between 2.0 and 3.0 during the preceding 6 months. During follow-up, major bleeding events were identified by the 2005 International Society on Thrombosis and Haemostasis criteria. Model performance was evaluated by calculating the C-statistic, and the improvement in predictive accuracy was evaluated by calculating the net reclassification improvement and integrated discrimination improvement.. After a median follow-up of 996 (range, 802 to 1,254) days, 114 patients (3.0%/year) presented with a major bleeding event; 31 of these events were intracranial hemorrhages (0.8%/year). Based on the C-statistic, HAS-BLED had a model performance superior to that of both CHADS2 and CHA2DS2-VASc (both p < 0.001). Both net reclassification improvement and integrated discrimination improvement analyses also show that HAS-BLED was more accurately associated with major bleeding compared with CHADS2 and CHA2DS2-VASc scores.. In anticoagulated AF patients, a validated specific bleeding risk score, HAS-BLED, should be used for assessing major bleeding. The practice of using CHADS2 and CHA2DS2-VASc as a measure of high bleeding risk should be discouraged, given its inferior predictive performance compared with the HAS-BLED score.

Topics: Acenocoumarol; Adult; Age Factors; Aged; Alcohol Drinking; Anticoagulants; Atrial Fibrillation; Diabetes Complications; Female; Follow-Up Studies; Heart Failure; Hemorrhage; Humans; Hypertension; International Normalized Ratio; Ischemic Attack, Transient; Kidney; Liver; Male; Middle Aged; Predictive Value of Tests; Risk Assessment; Risk Factors; Stroke; Substance-Related Disorders

Left ventricular noncompaction (LVN) is a rare anomaly with increased morbidity and mortality. We report on a 33-year-old man who suffered a transient ischemic attack having non-dynamic electrocardiographic abnormalities. Notably, thorough investigation for the presence of an embolic source revealed the presence of LVN.

Topics: Acenocoumarol; Adult; Carbazoles; Carvedilol; Diagnosis, Differential; Electrocardiography; Heart Ventricles; Humans; Ischemic Attack, Transient; Magnetic Resonance Imaging; Magnetoencephalography; Male; Perindopril; Propanolamines; Tomography, X-Ray Computed; Ventricular Dysfunction, Left

Topics: Acenocoumarol; Aged; Aryl Hydrocarbon Hydroxylases; Benzodiazepines; Cytochrome P-450 CYP2C9; Drug Interactions; Gastric Mucosa; Gastrointestinal Hemorrhage; Genetic Predisposition to Disease; Homozygote; Humans; Inactivation, Metabolic; Indomethacin; Ischemic Attack, Transient; Male; Polymorphism, Genetic

Topics: Acenocoumarol; Anticoagulants; Cerebral Hemorrhage; Diagnosis, Differential; Female; Humans; Ischemic Attack, Transient; Middle Aged; Phlebitis; Time Factors

During a 5-year period, 85 patients with TIAs, 65 patients with embolic brain ischemia of cardiac source and 50 patients with progressing stroke received intravenous heparin within 96 h. Twelve (6%) developed an early bleeding in the area involved by ischemia. In the 2 cases with transient ischemic attacks (TIAs) (2.3%), major functional sequelae persisted and the 2 cases with emboli from heart (3.2%) died, whereas among the 8 cases with progressing stroke (16%), only 3 worsened from anticoagulant-induced bleeding. Intracerebral bleeding was not associated with excessive anticoagulation or high blood pressure and was related to a large infarction only in the cases with emboli from the heart. Among the 108 patients who were placed on acenocoumarol during 3-12 months after heparin therapy, only one (0.9%) suffered a hemorrhagic infarct from a probable recurrent embolization. The risk of anticoagulant-induced intracerebral bleeding is quite different between the varieties of preceding ischemic events, with different subsequent impact on prognosis.

Topics: Acenocoumarol; Aged; Brain Ischemia; Cerebral Hemorrhage; Cerebrovascular Disorders; Female; Heart Diseases; Heparin; Humans; Intracranial Embolism and Thrombosis; Ischemic Attack, Transient; Male; Middle Aged