Brown fat is better ?
Sunday, September 25, 2011
Warfarin use is increasing - does that mean there is going to an increase in the intracranial bleeds in clinical practice?
In a recent study from Finland, it was shown there was increased use of warfarin to prevent thrombotic episodes ( atrial fibrillation) there was no corresponding increase in the intracranial bleeds.
Effect of Increased Warfarin Use on Warfarin-Related Cerebral Hemorrhage
Juha Huhtakangas, MD , A Longitudinal Population-Based Study
Results—The proportion of warfarin users among the population increased 3.6-fold from 0.68% in 1993 to 2.28% in 2008. Of a total of 982 patients with ICH, 182 (18.5%) had warfarin-related ICH. One-year survival rate after onset of stroke was 35.2% among warfarin users and 67.9% among nonusers. The annual incidence (P=0.062) and 28-day case fatality of warfarin-related ICHs (P=0.002) decreased during the observation period. Warfarin users were older (mean difference 6.6; 95% CI, 5.0 to 8.1; P<0.001) than nonusers. Admission international normalized ratio values above the therapeutic range (2.0 to 3.0) decreased through the observation period, suggesting improved control of anticoagulant therapy over time. Conclusions—The annual incidence and case fatality of warfarin-related ICHs decreased, although the proportion of warfarin users almost quadrupled in our population.
In a recent study from Finland, it was shown there was increased use of warfarin to prevent thrombotic episodes ( atrial fibrillation) there was no corresponding increase in the intracranial bleeds.
Effect of Increased Warfarin Use on Warfarin-Related Cerebral Hemorrhage
Juha Huhtakangas, MD , A Longitudinal Population-Based Study
Results—The proportion of warfarin users among the population increased 3.6-fold from 0.68% in 1993 to 2.28% in 2008. Of a total of 982 patients with ICH, 182 (18.5%) had warfarin-related ICH. One-year survival rate after onset of stroke was 35.2% among warfarin users and 67.9% among nonusers. The annual incidence (P=0.062) and 28-day case fatality of warfarin-related ICHs (P=0.002) decreased during the observation period. Warfarin users were older (mean difference 6.6; 95% CI, 5.0 to 8.1; P<0.001) than nonusers. Admission international normalized ratio values above the therapeutic range (2.0 to 3.0) decreased through the observation period, suggesting improved control of anticoagulant therapy over time. Conclusions—The annual incidence and case fatality of warfarin-related ICHs decreased, although the proportion of warfarin users almost quadrupled in our population.
Heparin neutralization
Is there a better way to neutralize or remove the excess heparin from the patients?
In the new study, Krzysztof Szczubialka and colleagues point out doctors often want to remove heparin from the blood of patients undergoing surgery or other procedures immediately after completing the procedure. Leaving the heparin alone could lead to unwanted bleeding.
In the new study, Krzysztof Szczubialka and colleagues point out doctors often want to remove heparin from the blood of patients undergoing surgery or other procedures immediately after completing the procedure. Leaving the heparin alone could lead to unwanted bleeding.
Doctors now eliminate heparin by giving patients protamine, a drug that stops heparin's anticoagulant effects. However, they are seeking a better drug because protamine carries a risk of serious side effects.The scientists describe development of a potential new approach that involves use of microscopic beads of a polymer made from modified chitosan, a material obtained from shellfish. In laboratory tests, the beads reduced concentrations of heparin to nearly zero within 10 minutes.
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