Antithrombotic management of stroke patients before colonoscopy.

BACKGROUND: Uncertainty exists regarding the management of antithrombotic medications in ischemic stroke and transient ischemic attack (TIA) patients around the time of colonoscopy. We sought to evaluate whether there was a difference in adverse events among patients who continued medications and those who had temporary discontinuation. METHODS: Using a hospital administrative database, electronic charts of patients with a diagnostic code for stroke or TIA and a procedural code for colonoscopy were reviewed. Information collected included baseline demographics, medical history, and antithrombotic medications. Outcome measures were stroke (ischemic and hemorrhagic), myocardial infarction, venous thromboembolism, and major systemic bleeding (i.e., requiring transfusion) up to 4 weeks after the procedure among patients who had medications continued versus temporarily discontinued. RESULTS: One hundred seventy-seven patients met inclusion criteria. Antithrombotic medication was temporarily discontinued in 42 patients and continued in 135 patients. Comparing patients who had medications held to those who had medications continued, stroke occurred in 1 (2.4%) versus 0 (0%; P = .237) patients; myocardial infarction in no patients in either group; venous thromboembolism in 0 (0%) versus 1 (0.7%; P > .99) patients; and major system bleeding in 2 (4.8%) versus 4 (3.0%; P = .628) patients. CONCLUSIONS: In this retrospective analysis, there was no significant difference in the occurrence of stroke, myocardial infarction, venous thromboembolism, and major bleeding between patients who had medications continued around the time of colonoscopy versus those who had temporary discontinuation. A prospective, randomized controlled study is warranted to further elucidate this issue.

Frecuencia de roncopatía en mujeres durante el tercer trimestre del embarazo, en un hospital general / Snoring frequency in women during the third trimester of pregnancy in a general hospital

Objetivo: Determinar la frecuencia y distribución de la roncopatía durante el tercer trimestre de gestación en pacientes hospitalizadas en un hospital general. Materiales y métodos: Estudio descriptivo y transversal, realizado entre septiembre y octubre del año 2004 en el Hospital Nacional Cayetano Heredia. Se incluyeron 295 voluntarios de 304. Se emplearon 3 encuestas: Cuestionario de Ronquidos, Escala de somnolencia de Epworth y Prueba de Calidad del Sueño. Adicionalmente se aplicó la medida morfométrica de Kushida. Resultados: La edad promedio fue de 25,9 +/- 1,67 años; con una edad gestacional promedio de 39,3 +/- 1,55 semanas. El 44,7% presentó roncopatía en el tercer trimestre y el 10,5% eran roncadoras habituales, 23,7% reportó tener somnolencia. Solo el 0,7% tuvo resultado positivo para la medida morfométrica de Kushida. Se encontró un riesgo incrementado de presentar roncopatía habitual en las pacientes mayores de 25 años. Finalmente, el 13,6% tuvo Hipertensión Inducida por la Gestación yde estas, 22,5% eran roncadoras habituales. Estas últimas con un riesgo 3 veces mayor de tener hipertensión inducida por la gestación. Conclusiones: La prevalencia de roncopatía y roncadoras habituales durante el tercer trimestre en pacientes hospitalizadas en el Hospital Nacional Cayetano Heredia es similar a la reportada en literatura internacional. El índice de Kushida no resultó aplicable en nuestra población. Existe una relación entre la presencia de roncopatía habitual e hipertensión inducida por la gestación.

Objective: To determine the frequency and distribution of snoring during the third trimester of pregnancy in patients hospitalized in a general hospital. Material and Methods: We conducted a cross sectional and descriptive study during September and October of 2004. 295 volunteers of a total of 304 were included. We used three validated questionnaires: Snoring questionnaire, Epworth Sleepiness Scale, Sleeping Quality Test. Additionally, we used the Kushida's Morphometric Model. Results: The average age was 25,9 +/- 1,67 years old with an average gestational age of 39,3 +/- 1,55 weeks. We found 44,7% patients with snoring during the third trimester; the frequency of habitual snoring was 10,5%. 23,7% of patients reported having somnolence. Only 0,7% of patients had a positive result in the Kushida's morphometric model. There was an increased risk of having habitual snoring in patients older than 25 years old. Finally, 13,6% had Pregnancy Induced Hypertension with a 22,5% of them having habitualsnoring. Those with habitual snoring had 3 times higher risk of having pregnancy induced hypertension. Conclusions: This study found the same frequency of snoring and habitual snoring as previous studies in pregnant patients during the third trimester. The morphometric model of Kushida is not applicable to our population. There is a relation between habitual snoring and gestational hypertension.