الفهرس 
Physiology of CoagulationOnly 14 pages are availabe for public view
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Abstract
Prof. Dr. Fekry Fouad Ahmed Elbokl; Prof. Dr.; Waleed Abdelmaged Mohamed Altaher; Dr. Eman Aboubakr El Siddik Ahmed Ramadan Said Abdel Halim Faculty of Medicine- Ain Shams University
Oral anticoagulation is widely used for patients with cardiovascular disease. However, use of these agents is associated with increased risk of intracranial haemorrhage (ICH), which is manifested mainly by intracerebral bleeding or subdural haemorrhage. Warfarin-associated ICH has increased 4-fold since the 1990s, is 10 times more common than spontaneous ICH, and can occur in up to 1.8% of stroke-prone patients. When an ICH occurs with warfarin use, the mortality rate is exceedingly high, estimated at nearly 50% (Yang et al. , 2012).
Reinitiating warfarin therapy in a patient with a recent Warfarin-associated ICH is a difficult proposition, and the assessment of risks is a pertinent question for any physician. Competing risks include the risk of recurrent ICH if warfarin therapy is restarted vs the risk of recurrent thromboembolism without warfarin therapy. In addition, patients with residual neurological deficits from Warfarin-associated ICH could be at increased risk of traumatic bleeding from falls. Very limited clinical data describe the long-term risk of recurrent ICH among patients with Warfarin-associated ICH. Recent American Heart Association guidelines state that careful control of the anticoagulation level decreases the risk of ICH. However, no practical knowledge exists to address this important clinical problem (Claassen et al., 2008).
Because interactions with warfarin represent a serious risk to patients, drug information sources used by clinicians should contain accurate, timely,and practical drug interaction informations.warfarin has a Fatal intracerebral haemorrhage possibly caused by interaction with paracetamol ,and many other drugs (Naver et al., 2015).
After administering vitamin K, ensure that daily INR checks are organized until the INR is stable within the target range. Patients on long term warfarin should be reviewed annually or more often if there is doubt about their safety on continued anticoagulation. If INR continues to be high despite efforts to identify a precipitating cause, refer to the local hospital anticoagulation clinic or consider switching to a new oral anticoagulant such as the factor Xa inhibitor rivaroxaban after appropriate counselling. The direct thrombin inhibitor dabigatran is another new oral anticoagulant approved by the National Institute for Health and Care Excellence (Reddy et al., 2015)