I'm just wondering if you guys would do anything differently in this case. I had a patient who presented with 25 years of afibrillation that he did not want to be on treatment for. He presented with acute aphasia and mild right side weakness, maybe 30 minutes outside tPA parameters. CT was negative and MRI showed a left MCA stroke with some sparing. Would you give heparin to prevent a second infarct, or would you avoid it for fear of a hemorrhagic conversion
Heparin for atrial fibrillation in stroke
- Thread starter Rendar5
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Well, if the patient doesn't want anticoagulation and never did, I don't know where the dilemma is. He knew the risk of stroke without being anticoagulated, and then had a stroke. What's the point in antiocoagulating now? The stroke is done and irreversible. It seems like a good question for a neurologist, but realistically what difference would it make for you to anticoagulate for the hour or two you've got the patient in the ED? Afib has what, a 1% stroke risk per year, and he already had his stroke? So are you going to run a heparin drip for the next 1 yr, to prevent the next one, considering the clot's already been thrown? Obviously not.
The only effective plan would be to find a time machine (which I imagine would be very expensive) and go back in time 25 years and convince this person to take Coumadin, but unfortunately that's not in your cost-conscious CEOs hospital budget, as classic Deloreans are super expensive, not to mention a working flux capacitor. Otherwise, I don't think it would make a difference what you do. Ischemic CVA outside of tPA window? Aspirin, maybe treat an elevated blood pressure (controversial; argue back and forth, lower BP? how much? how fast? answer depends on the year in which you're asking the question, could change next year) and admit to a neurologist, none of which are going to make one bit of difference in the outcome, either. Would a heparin drip acutely change the outcome? I seriously doubt it. Six months of rehab, might help, 5% or so.
Don't beat yourself up over this one.
The only effective plan would be to find a time machine (which I imagine would be very expensive) and go back in time 25 years and convince this person to take Coumadin, but unfortunately that's not in your cost-conscious CEOs hospital budget, as classic Deloreans are super expensive, not to mention a working flux capacitor. Otherwise, I don't think it would make a difference what you do. Ischemic CVA outside of tPA window? Aspirin, maybe treat an elevated blood pressure (controversial; argue back and forth, lower BP? how much? how fast? answer depends on the year in which you're asking the question, could change next year) and admit to a neurologist, none of which are going to make one bit of difference in the outcome, either. Would a heparin drip acutely change the outcome? I seriously doubt it. Six months of rehab, might help, 5% or so.
Don't beat yourself up over this one.
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