Biography
Biography: Alex Bekker
Abstract
After attending this presentation, the participants will be able to discuss the incidence, etiology, mechanisms and diagnosis of perioperative stroke; understand preventive strategies which may reduce occurrence of perioperative stroke and identify treatment strategies that are available during perioperative period. Perioperative stroke is defined as an episode of focal or global loss of cerebral function with symptoms lasting more than 24 hours. General surgical procedures are associated with a 0.08-0.7% risk of stroke. Potential stroke etiology includes hypoperfusion, thromboembolism and hemorrhage. The preoperative patient related risk factors for perioperative stroke are: Advanced age, previous cerebrovascular diseases, peripheral vascular disease, chronic obstructive pulmonary disease (COPD), atrial fibrillation, hypertension, cardiac valvular disease, diabetes mellitus, HTN, atherosclerosis, and renal disease. General anesthesia, dehydration, bed rest, stasis in the postoperative period, and perioperative withholding of antiplatelet or anticoagulation agents can aggravate surgery-induced hypercoagulability and increase the risk of perioperative thrombogenic events. Elective surgery should be delayed for at least 1 month after a documented ischemic stroke. Another consideration in the preoperative period is patients who require chronic anticoagulation. Bridging oral anticoagulant therapy (warfarin) with heparin or low molecular weight heparin should be considered for the majority of patients who require temporary interruption of warfarin therapy. Postoperative risk factors for a stroke include heart failure, myocardial infarction, arrhythmias (atrial fibrillation), dehydration (blood loss) and hyperglycemia. Preoperative administration of statins, ASA, a continuation of anticoagulation therapy (when indicated), as well as appropriate timing of surgery do appear to reduce the incidence of stroke after CABG and vascular surgery and may show similar results in the general surgery population as well