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Neurology: Deciding When to Re-Start Anticoagulation
Announced on Jun 07, 2010

Recent findings out of TWRI indicate that, for patients with brain or spinal cord hemorrhage (bleeding) that occurs as a complication of anticoagulant (AC) therapy--medications that thin the blood preventing it from clotting--it would be wise for health care teams to re-start these anticoagulation treatments earlier than previously thought. TEs occur when a clot travels through the blood, obstructing its flow through the circulatory system leading to complications such as heart attack or stroke.

Graduate student Dr. Gregory Hawryluk, supervisor Dr. Michael Fehlings and other research fellows from the Fehlings lab including James Austin, Julio Furlan, Jang Bo Lee and Cian O'Kelly reviewed data from over 60 publications detailing greater than 490 patients from 1975 to 2009. Findings show that the majority of complications resulting from hemorrhage are seen within 72 hours of initially being detected by medical staff. Importantly, the study uncovered strong evidence showing that patients who were re-started on AC treatments after 72 hours were significantly more likely to have a TE complication than patients started before 72 hours.

"If patients were restarted before 72 hours, they were more likely to hemorrhage," explains Dr. Fehlings. "The take away message here is that patients with brain or spinal cord bleeding may have unique characteristics, such as low risk of bleeding and high risk of TE. It is important for medical teams to consider individual patient risk when selecting AC restart time and intensity."

Hawryluk GW, Austin J, Furlan JC, Bo Lee J, O'Kelly C, Fehlings MG. J Thromb Haemost. 2010 Apr 8. [Epub ahead of print]. [Pubmed abstract]. Research supported by the AO Spine North America.

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