Hemorrhagic Stroke

[CrimsonTideRN2B]

I have a test on neurology coming up but I'm having a few problems with certain topics. Why wouldn't you give a patient that is having a hemorrhagic stroke blood thinners?

[JustBeachyNurse, LPN]

They aren't blood thinners but anticoagulants.

What do anticoagulants do?

What is a hemorrhagic stroke?

Why would you almost never give a hemorrhaging/profusely bleeding patient an anticoagulant?

[springchick1, ADN, RN]

Because you want the bleeding to stop and anticoagulants may slow that process down. I would think you would give clotting factor or Vit K. War Eagle by the way)

[JustBeachyNurse, LPN]

Not necessarily. Most hemorrhagic strokes are caused by a ruptured weakened blood vessel or less commonly an AVM. If a patient is also on anticoagulants or anti platelet drugs, they will be given the antidote or blood products to counteract the effects.

Some drugs like mannitol are given to reduce ICP. Ruptured vessels & AVMs are often neurosurgically repaired by clipping, coiling or removal of the damaged vessel

Giving vitamin K, etc is not a primary treatment for a patient with a SAH or ICH due to ruptured aneurysm or AVM.

[Esme12, ASN, BSN, RN]

Welcome to AN! We are happy to help but we want to hear from you first! What has your research shown?

Like Beachy says..What is hemorrhagic Stroke? Google is your friend......http://my.clevelandclinic.org/neurological_institute/cerebrovascular-center/diseases-conditions/stroke.aspx

The term hemorrhagic means flow (or torrent) of blood, referring to bleeding into or around the brain. These may also result in similar symptoms to an ischemic stroke. Subarachnoid, parenchymal, and intraventricular hemorrhages are the major subtypes, depending on where the bleeding is located. In hemorrhagic strokes, brain arteries rupture from high blood pressure, abnormal blood vessel walls, or from an aneurysm (an abnormal outpouching of a blood vessel) and cause blood to flood the brain, creating pressure that leads to significant brain injury.

A subarachnoid hemorrhage (a type of hemorrhagic stroke) is a situation where bleeding occurs in the subarachnoid space, an area between the covering of the brain (dura) and a second thinner layer (the arachnoid mater), and the thinnest layer around the brain itself. This space also normally contains a clear fluid called Cerebral Spinal Fluid.

While the most common cause of subarachnoid hemorrhage is probably from trauma, the most common cause of a subarachnoid hemorrhage not associated with traumatic injury is from a rupture of an aneurysm. Some more rare causes of subarachnoid hemorrhage include arteriovenous malformations, dural fistulae or shunts, as well as vasculitides of the cerebrovasculature.

Now if someone is bleeding would you want to give a drug that prevents them from clotting?

[Esme12, ASN, BSN, RN]

Welcome to AN! We are happy to help but we want to hear from you first! What has your research shown?

Like Beachy says..What is hemorrhagic Stroke? Google is your friend......Stroke | Cerebrovascular Center | Cleveland Clinic

The term hemorrhagic means flow (or torrent) of blood, referring to bleeding into or around the brain. These may also result in similar symptoms to an ischemic stroke. Subarachnoid, parenchymal, and intraventricular hemorrhages are the major subtypes, depending on where the bleeding is located. In hemorrhagic strokes, brain arteries rupture from high blood pressure, abnormal blood vessel walls, or from an aneurysm (an abnormal outpouching of a blood vessel) and cause blood to flood the brain, creating pressure that leads to significant brain injury.

A subarachnoid hemorrhage (a type of hemorrhagic stroke) is a situation where bleeding occurs in the subarachnoid space, an area between the covering of the brain (dura) and a second thinner layer (the arachnoid mater), and the thinnest layer around the brain itself. This space also normally contains a clear fluid called Cerebral Spinal Fluid.

While the most common cause of subarachnoid hemorrhage is probably from trauma, the most common cause of a subarachnoid hemorrhage not associated with traumatic injury is from a rupture of an aneurysm. Some more rare causes of subarachnoid hemorrhage include arteriovenous malformations, dural fistulae or shunts, as well as vasculitides of the cerebrovasculature.

Now if someone is bleeding would you want to give a drug that prevents them from clotting?

[KelRN215, BSN, RN]

Your patient is bleeding. Do you really want to give them a drug that's going to prevent them from clotting?

[nurseprnRN, BSN, RN]

Many people including, alas, physicians and nurses who should definitely know better, refer to anticoagulation medications (both antiplatelet and those acting on other parts of the clotting cascade) as "blood thinners." Unfortunately, and inaccurately, this puts people in mind of paint thinned by solvents or watered-down milk, or maybe thin, inadequate clothing.

The problem then becomes that they are not aware of the actual physiological reason their medications are prescribed to reduce risk for embolic events, either stroke or deep vein thrombosis and pulmonary embolus. I have had patients tell me they are "always cold since taking that blood thinner." The risk of discontinuing the medication because the effects are inaccurately communicated is great, and very real. Anticoagulants do not "thin" the blood. They decrease blood clotting to decrease the chances of a clot in the heart from causing stroke or clot in a vein traveling to the lungs by preventing it from growing larger while the body's natural processes break it down for disposal. Side effects include easier bruising and bleeding. There, is that so hard?

Now, you have someone with a hemorrhagic stroke. Why would you want to decrease that person's ability to clot?

I just noticed your handle-- you give that guy anticoagulants and you'll have a crimson tide, all right. :)

[JustBeachyNurse, LPN]

^^^ I knew you would be along soon to explain this