Meds May Have Worsened Stroke

The blood thinner may be to blame for the severity of Israeli Prime Minister Ariel Sharon's stroke, but his doctors should not be criticized for prescribing it, independent experts said Thursday.

Sharon was fighting for his life in an Israeli hospital after seven hours of surgery to remove blood from the right side of his brain following a burst blood vessel, or hemorrhagic stroke. His doctors said they planned to keep him sedated for another 72 hours. Experts say his chances of recovery are slim.

Experts agree that while the blood thinner, an anticoagulant called enoxaparin, did not cause the blood vessel in Sharon's head to burst, the bleeding would probably not have been so severe if he had not been taking the medication.

The 77-year-old premier was given the blood thinner after a minor stroke Dec. 17 after a blood clot traveled from his heart to his brain. That stroke led to the discovery of a small hole in his heart, a birth defect. Doctors had prescribed the blood medication to prevent another clot-related stroke before the hole in his heart could be repaired.

Dr. Shlomo Mor-Yosef, director general of Hadassah Hospital, defended Sharon's treatment with blood thinners, saying Thursday he was given appropriate doses.

"The doctors were responding to that first stroke properly with the use of blood thinners," said Dr. Keith Siller, medical director of the Comprehensive Stroke Care Center at New York University. "That comes with a price. The price is the increased risk of brain hemorrhage, which is what happened in this case. They shouldn't be criticized because it has not been proven what is the best choice of treatment for patients with these holes in their heart."

There are two types of stroke. Most of them — about 85 percent — are caused by blood clots traveling to the brain. The others are caused by a ruptured blood vessel in the head.

Blood thinners are commonly given after clot-related strokes. They reduce the risk of another clot-related stroke but at the same time raise the risk of bleeding.

Giving Sharon a blood thinner was a tough judgment call, but one that many of the best doctors would have made, Siller said.

"If they hadn't given him blood thinners and he had another clot-related stroke — which could have happened — there would have been outrage and criticism that the doctors had not treated the first stroke aggressively enough," said Siller, who is leading a study on whether medication or closure of a hole in the heart is the best way to prevent strokes.

The bleeding risk is usually considered a long-term one, from use of the drugs over months, not a few weeks, Siller noted.

"The fact that it happened in such a short time indicates it was very bad luck," he said, adding that he probably would have given the same treatment if Sharon had been his own patient.

Having the original stroke made a bleeding stroke more likely, regardless of the blood thinners, experts say. The blood vessels in the area of a stroke are weaker and more prone to break open. It is unknown whether Sharon's bleeding came from a blood vessel involved in the original stroke.

However, without blood thinners the rupture might have spilled just a tiny spurt of blood that could have stopped flowing, said Dr. John Martin, a professor of cardiovascular medicine at University College in London.

"Blood thinners make it more likely that the bleed continues and becomes massive," he said.

Whatever the role of the blood thinners, experts said Sharon's chance of recovery were slim.

Dr. Anthony Rudd, a stroke specialist at St. Thomas' Hospital in London, said that in such cases survival is unlikely.

The chances of recovery will depend on where the bleeding was, how bad it was and how well Sharon's brain rebounds, experts said.

"If (the bleeding) was on the left side of the brain, it will undoubtedly involve his speech and comprehension. If it was on the right side of the brain then it's possible he could emerge from this with the ability to converse and make some decisions," Siller said. "At a minimum, he's going to be terribly incapacitated with at least a paralysis on one side of the body."

Doctors will not be able to determine the extent of brain impairment until Sharon has been taken off the sedatives, Rudd said. They also cannot tell until then whether the premier is unconscious as a result of the drugs or from the stroke itself, he added.