Sharon's stroke raises questions - Treatment complicated by blood thinners?

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Sharon's stroke raises questions about treatment

http://www.usatoday.com/news/world/2006-01-05-sharon-medical_x.htm

 

JERUSALEM (AP) — Prime Minister Ariel Sharon suffered a massive

stroke in the back of an ambulance while on an hourlong trip to a

Jerusalem hospital, raising a host of questions about his treatment.

Why wasn't he flown to the hospital or at least driven to one closer

to his home? Did doctors take an unnecessary risk by treating him

with blood thinners after he had a mild stroke two weeks ago? Did

they wait too long to schedule a heart procedure designed to prevent

another stroke?

 

And perhaps most important: Could political pressures have colored

his treatment?

 

" There are problems when you treat a figure who is a political

persona, or a VIP, " said Dr. Gabi Barabash, the director of Ichilov

Hospital in Tel Aviv, who was not involved in treating

Sharon. " Treatment of a VIP adds stress to the judgment system, and

stress is unproductive. "

 

Sharon was on a respirator under deep sedation at Hadassah Hospital

in Jerusalem on Thursday after seven hours of emergency surgery to

stop a cerebral hemorrhage, or bleeding stroke. Outside experts said

prospects for recovery were slim.

 

The stroke followed a mild stroke Sharon suffered Dec. 18 that was

caused by a small blood clot. Doctors at Hadassah released him less

than 48 hours after that stroke and gave the 77-year-old leader

blood thinners to prevent future ones.

 

His neurologist, Dr. Tamir Ben-Hur, said " chances are excellent that

he won't have another one. "

 

On Dec. 26, doctors said they found a small hole in Sharon's heart

they said had led to his mild stroke. They planned to seal the hole

in a procedure scheduled for Thursday to prevent another stroke.

 

But on Wednesday night, Sharon complained of feeling ill and his

sons and a paramedic loaded him into an ambulance that had been

stationed at his ranch in the Negev Desert since the stroke. The

closer Soroka Medical Center in Bersheeba was told to prepare for

his arrival, but he was taken instead on the hourlong trip to

Hadassah.

 

" I don't think they made a mistake, " Barabash said. The two

hospitals are just half an hour apart, the medical staff at Hadassah

is familiar with his case, and Soroka doesn't have a magnetic

resonance imager, which is used in brain scans, he said.

 

Sharon was conscious for most of the drive, and didn't deteriorate

badly until about 15 minutes before reaching the hospital.

 

Some Israelis questioned whether the outcome could have been

different if had he been airlifted.

 

" If there is an ambulance that is available at the door to the house

that can leave immediately and a helicopter that still takes time to

arrive, it is preferable to get moving, " Dr. Zeev Feldman, a

neurosurgeon at Tel Hashomer Hospital outside Tel Aviv, told Channel

2 TV.

 

" Generally speaking, it's best to come faster, " said Dr. Itzhak

Fried, a professor of neurosurgery at Ichilov and UCLA. " But I'm not

sure that with such massive bleeding, and the time difference of 10

to 20 minutes (from the hospital) that they're talking about, that

it would have been significant. "

 

Surgery to stop the bleeding apparently had been

complicated by blood thinners Sharon took following his initial

stroke,

and the medication may also have contributed to the severity of

Wednesday's stroke.

 

Still, his doctors should not be criticized for prescribing it,

independent experts said.

 

Blood thinners are commonly given after clot-related strokes. They

reduce the risk of similar strokes, but raise the risk of bleeding.

 

" The doctors were responding to that first stroke properly with the

use of blood thinners. It is unfair to critique them based on the

information we have, " said Dr. Keith Siller, medical director of the

Comprehensive Stroke Care Center at New York University.

 

Giving Sharon a blood thinner was a tough judgment call, and one

that many of the best doctors would have made, Siller said. The

bleeding risk is usually considered a long-term one, from use of the

drugs over months, not a few weeks, he said.

 

Dr. Shlomo Mor-Yosef, Hadassah's director general, defended the

prescription of blood thinners Thursday.

 

Asked about Ben-Hur's assertion that the risk of a repeat stroke was

small, another Hadassah official said: " A small chance is still a

chance. They knew it was possible. " He spoke on condition of

anonymity because he wasn't authorized to speak to the media.

 

Some doctors questioned the need to seal the hole in Sharon's heart,

given that research has not proven that this common, minor birth

defect really causes strokes or that repairing it would prevent

further problems.

 

Siller, who is studying the possible correlation between such holes

and stroke, said closing it sooner wouldn't have prevented the

second stroke.

 

" The closure of the hole was not necessarily an emergency because

the association of that being the actual cause is still not really

known for sure. ... (But) the very fact that you have a fresh scar

in the brain will make you vulnerable to hemorrhage, " he said.

 

Sharon's public stature, and his desire to portray himself in

command ahead of March 28 elections may have also led to some

decisions that clashed with doctors' judgment.

 

At the time he fell ill, Sharon was working on a list of candidates

for his new Kadima Party, which he formed after quitting the Likud

Party.

 

" We would not have advised a regular person to return to the same

intensity of activity, " Dr. Avi Cohen, a neurosurgeon at Soroka,

told Channel 2.