eMedicine Specialties > Neurology > Neuro-vascular Diseases

Blood Dyscrasias and Stroke: Follow-up

Author: Souvik Sen, MD, MS, FAHA,, Associate Professor of Neurology, Founding Director of UNC Hospital Stroke Center, Director of Neurovascular Residency, Department of Neurology, University of North Carolina at Chapel Hill
Contributor Information and Disclosures

Updated: Jul 14, 2009

Follow-up

Further Outpatient Care

Patients being treated with an oral anticoagulant need to be monitored with outpatient blood testing for PT (INR). Initially, PT (INR) must be tested frequently to determine the maintenance dose (ie, daily to twice a week); once a regular maintenance dose is determined, PT (INR) may be checked monthly.

Patient Education

For excellent patient education resources, visit eMedicine's Stroke Center. Also, see eMedicine's patient education article Stroke.

Miscellaneous

Medicolegal Pitfalls

  • Supratherapeutic oral anticoagulation without monitoring can lead to intracranial and extracranial hemorrhage. Common reasons for such a state include overdosage, interaction with other drugs, and variation in dietary vitamin K. Subtherapeutic anticoagulation can lead to ischemic stroke. These potential pitfalls need to be discussed with the patient before initiating anticoagulation.
  • Another pitfall is starting a patient with a known history of life-threatening bleeding disorder and a hypercoagulable state on either an antiplatelet agent or an anticoagulant. Treatment needs to be individualized for each patient, and the benefits of any treatment need to outweigh the risks.
  • At the time of acute thrombotic events, certain coagulation parameters have acquired deficiencies (protein S and antithrombin III). In addition, patients on warfarin can have low protein C and S values, while patients on heparin have low antithrombin III values. Other conditions known to affect coagulation parameters are liver disease (protein C and S and antithrombin III), estrogens, pregnancy, and inflammatory disease (protein S).
  • More than 100 mutations account for each deficiency; thus, genetic testing is not performed in clinical practice.
  • Caution is advised to check candidates for oral anticoagulation for amyloid angiopathy with a higher propensity to bleed in the brain. MRI sequences such as gradient echo (GRE) are useful tools to detect multiple bleeds, a feature suggestive of amyloid angiopathy.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Anand Vaishnav, MD to the development and writing of this article.



More on Blood Dyscrasias and Stroke

Overview: Blood Dyscrasias and Stroke
Differential Diagnoses & Workup: Blood Dyscrasias and Stroke
Treatment & Medication: Blood Dyscrasias and Stroke
Follow-up: Blood Dyscrasias and Stroke
References
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Further Reading

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Keywords

hypercoagulable state, cerebrovascular event, cerebrovascular accident, coagulation disorder

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Contributor Information and Disclosures

Author

Souvik Sen, MD, MS, FAHA,, Associate Professor of Neurology, Founding Director of UNC Hospital Stroke Center, Director of Neurovascular Residency, Department of Neurology, University of North Carolina at Chapel Hill
Souvik Sen, MD, MS, FAHA, is a member of the following medical societies: American Academy of Neurology, American Heart Association, and Association for Patient Oriented Research
Disclosure: Nothing to disclose.

Medical Editor

Draga Jichici, MD, FRCP, Associate Clinical Professor, Department of Medicine, Division of Neurology and Critical Care Medicine, McMaster University, Canada
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Howard S Kirshner, MD, Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center
Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association
Disclosure: Boehringer Ingelheim Honoraria Speaking and teaching; BMS/Sanofi Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Helmi L Lutsep, MD, Professor, Department of Neurology, Oregon Health & Science University; Associate Director, Oregon Stroke Center
Helmi L Lutsep, MD is a member of the following medical societies: American Academy of Neurology and American Stroke Association
Disclosure: Co-Axia Consulting fee Review panel membership; Talecris Consulting fee Review panel membership; AGA Medical Consulting fee Review panel membership; Boehringer Ingelheim Honoraria Speaking and teaching; Concentric Medical Consulting fee Review panel membership; Abbott Consulting fee Consulting; Sanofi  Consulting

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