CV treatments can threaten neurological safety

mainstory_smallAlthough anticoagulation and antiplatelet therapies have greatly improved outcomes for patients who have cardiovascular disease, such treatment regimens could have neurological consequences.

ISC Pre-Conference Symposium I will use a series of debates, lectures and workshops to open discussions between neurologists and cardiologists on the pros and cons of their treatments. “Stroke in the Real World: Thinking From the Heart — Management of Cardiac Disease to Improve Stroke Outcomes” will be presented from 9 a.m. to 5:20 p.m. Feb. 21 in Grand Ballroom C.

“We are focusing on controversies or overlap between the diseases and how each specialty views the appropriate treatments for them. We tried to choose topics that were of relevance both to cardiologists and neurologists and that sometimes lead to different approaches for treating the same disease process. Even in treating the same disease process, while one thing may be better for the heart, does it place the brain at risk?” asked Ted Wein, MD, FRCPC, FAHA, symposium chair.

Debate topics will include the pros and cons of medications and the effectiveness of procedures, such as using a closure device to manage patent foramen ovale to reduce the risk of cryptogenic stroke. The FDA recently approved a PFO closure device.

“We will have an interactive debate between a cardiologist and a neurologist on whether we should be closing the PFO and if we all are interpreting the literature in the same fashion,” said Wein, assistant professor of neurology and neurosurgery at McGill University in Montreal.

The indications for antiplatelet therapy, potential complications and its use in combination therapy will be examined in a lecture and a workshop.

“While dual antiplatelet therapy may be great for protecting the heart, we do know that in individuals with a history of stroke, there is an increased risk of bleeding in the brain,” Wein said. “So, the question is what to do with a patient who has both problems going on.”

With the advent of newer anticoagulants, many practical clinical questions exist, he said. How can these drugs be stopped and started safely in the perioperative period? Are there means available to assess whether patients have been compliant with medications, or can the degree of anticoagulation be determined if an urgent procedure — either surgical or even endovascular — is needed? The use of newer anticoagulants will be examined in thought-provoking debates and in a workshop to review protocols.

“We will have a hematologist discussing mechanisms of action and explaining how thin the blood is, and whether we can predict that we can safely do a procedure,” Wein said. “This will be an avant-garde discussion of non-evidence-based therapy to see how we can better approach and treat people with these new drugs, what the current standards are to measure them and whether we can use these techniques in our daily clinical practice.”

Another workshop will look at options for managing carotid artery stenosis for asymptomatic patients. In addition, one presenter will review the use of a left atrial appendage closure procedure rather than blood thinners to reduce the risk of blood clot formation.

“People should be aware of both the cardiology and neurology perspectives of common disorders,” Wein said. “This symposium can help bring them to a comprehensive treatment approach that will maximize the safety and security of their patients without exposing them to any risk.”