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José Biller

Publications and source records attributed to José Biller.

12 recordsLinked to original sources
PubMed2006

Discontinuation of perioperative antiplatelet and anticoagulant therapy in stroke patients.

Growing evidence suggests that perioperative withdrawal of ASA for secondary stroke prevention increases thromboembolic risk without the associated benefit of decreased bleeding complications. ASA maintenance is acceptable in many procedures, including invasive ones. Many procedures, in particular ophthalmologic, dermatologic, and dental surgeries, also are safe while continuing oral AC. Warfarin has been continued successfully even in some surgeries that have high bleeding risk. When the risk is too high, temporary bridging therapy with LWMH is safe in many populations. Although the exact thromboembolic risks associated with temporary cessation of AP and AC are unknown and likely low, morbidity and mortality associated with thromboembolism are high. Further studies investigating the risks and benefits of maintaining AP and AC during procedures, particularly invasive ones, are needed. Meanwhile, it is critical that physicians understand the risks and benefits of perioperative AP and AC and the variety of procedures in which these agents can be safely continued.

Anticoagulants↗
PubMed2005

New treatments in acute ischemic stroke.

Since the advent of intravenous thrombolytic therapy with recombinant tissue plasminogen activator (tPA) for acute ischemic stroke, there has been a marked change in our management approach to patients with acute ischemic stroke. Although the major part of our focus in treating patients with stroke remains prevention of complications post-stroke and reduction of stroke recurrence, there is a paradigm shift to immediate "clot" lysis. This concept is being actively promoted through certification of institutions as stroke centers in order to increase the number of patients with stroke treated in an ultra-rapid fashion. However, options for acute treatment remain limited. Other than aspirin, the only US Food and Drug Administration-approved agent for acute ischemic stroke is intravenous tPA. Some physicians treating patients with acute ischemic stroke still frequently use heparin and low-molecular-weight heparinoids, but there are no firm data to support routine use of this drug class. However, a number of new lytic agents and strategies are being pursued. Some of these treatments, such as intra-arterial chemical thrombolysis or mechanical intra-arterial thrombolysis, are available only at specialized stroke centers. In addition, new antithrombotic agents are being studied. Drugs that can rescue neurons from impending hypoxia-ischemia cell death represent the "holy grail" of acute stroke therapy. To date, these "neuroprotectant" strategies have been unsuccessful, although this concept remains under active investigation in animal and human trials.

Journal Article↗
PubMed2005

Hemorrhagic stroke in the tropics.

With the increasing industrialization of countries in the tropical and subtropical regions, cerebrovascular disease is becoming an increasingly recognized cause of morbidity and mortality. The incidence of hemorrhagic stroke versus ischemic stroke is unclear as data regarding hemorrhagic stroke in developing countries of the tropical and subtropical regions, especially in the English literature, continues to be sparse. As in the developed world, however, the major etiologies for hemorrhagic stroke in developing countries relate to typical vascular risk factors and, to a lesser extent, central nervous system vascular malformations, medications, and infectious etiologies.

Cerebral Hemorrhage↗
PubMed2003

Antiplatelet prescribing patterns for TIA and ischemic stroke: the Indiana University experience.

OBJECTIVE: To evaluate antiplatelet prescribing patterns by Indiana University Hospital (IU) neurologists, determine what drives antiplatelet agent decisions, and determine changes made with recurrent cerebrovascular events despite proven antiplatelet therapy. There are now four approved therapies for secondary prevention of cerebrovascular events. As these agents exhibit their effects through different pathways, physicians must choose antiplatelet agents based on other factors. DESIGN: We retrospectively reviewed charts of neurology patients diagnosed with non-fatal ischemic stroke or TIA at IU from January 1, 1997 to August 31, 2001. Patients were excluded if: discharge diagnosis was not non-fatal ischemic stroke or TIA, they were enrolled in clinical trials, or were placed on anticoagulation therapy with warfarin. Patients' antiplatelet agents at discharge were reviewed to determine if specific factors led to the choice of antiplatelet agent. RESULTS: A total of 177 patients experienced non-fatal ischemic strokes or TIAs. Of these, 74 were not on prior antiplatelet therapy and 103 were on antiplatelet agents prior to admission. For patients not on therapy, aspirin was the most commonly prescribed agent, with a trend for low-dose aspirin. For patients already on an antiplatelet agent, typically the dose of aspirin was increased or combination therapy initiated. CONCLUSION: Our experience supports the use of aspirin as a first-line agent for secondary prevention in cerebrovascular disease. For antiplatelet-nai;ve patients, low-dose aspirin is the most frequently used agent. For patients previously on antiplatelet agents, aspirin dosage is increased or clopidogrel is added. High-dose aspirin and ticlopidine use is no longer favored.

Adult↗
PubMed2002

Contrasting the neurologic complications of cardiac transplantation in adults and children.

The objective of this study was to evaluate neurologic complications associated with cardiac transplantation and compare the neurologic complications seen in adults and children. As advances in immunology have led to longer survival times for cardiac transplant recipients (1- and 5-year survival rates have improved to 86% and 65%, respectively), a number of neurologic complications have emerged. We performed a 14-year retrospective review of all adults and children (<18 years old) who had orthotopic cardiac transplantation at either Indiana University Hospital or James Whitcomb Riley Hospital for Children. The rates of neurologic complications involving the central and peripheral nervous systems in adults and children were assessed for differences using the chi-square test and Fisher's exact test where appropriate. A total of 191 orthotopic cardiac transplants were performed from 1986 to 2000, with follow-up available for 184, including 107 adults and 77 children. Thirty-two of 107 (30%) adults experienced a total of 47 complications, with peripheral neuropathies being the most frequent complication. Eighteen of 77 (23%) children experienced a total of 22 complications, with seizures being the most frequent complication. Other complications occurring in both groups were cerebrovascular, infectious, encephalopathies, neoplasms, and "other." Neurologic complications in children and adults after orthotopic cardiac transplantation are similar in both incidence and type. However, peripheral neuropathies tend to occur more frequently in adults than in children (P = .04), and the types of complications in the immediate post-transplant period seem to differ.

Adolescent↗
PubMed2002

Aneurysm observation versus intervention: a literature review.

Aneurysmal subarachnoid hemorrhage (SAH) is a devastating illness that affects persons at the peaks of their lives. The 1990s witnessed rapid growth in noninvasive vascular imaging technologies, which allowed safe diagnosis of unruptured saccular intracranial aneurysms. Presently, it is unclear who will benefit from screening. Mass screening is neither feasible nor cost-effective. The current literature suggests that persons in a family with two or more relatives with a history of SAH are most likely to benefit from screening. Individuals with a history of SAH, with aneurysms greater than 10 mm in diameter or with symptomatic aneurysms are clearly at increased risk for SAH. These aneurysms should be treated, though the method of treatment remains open to question. Treatment of older patients or those with smaller aneurysms has been modeled by decision analysis, but has yet to be verified in a prospective clinical trial. Future directions for aneurysm management are explored.

Cost-Benefit Analysis↗
PubMed2002

Outcome of extracranial cervicocephalic arterial dissections: a follow-up study.

Cervicocephalic arterial dissections (CCAD) are an increasingly recognized cause of ischemic stroke in young adults. Various treatments have been suggested but no controlled trial has ever been performed. Medical treatment has included anticoagulant or platelet antiaggregant therapy. Surgical correction has been proposed for selected patients who have failed medical therapy. Percutaneous balloon angioplasty and stenting have been increasingly used in some patients, although long-term results are unknown. The objective of the study was to review our recent experience with the management and outcome of extracranial CCAD. We identified 27 patients with extracranial CCAD who were evaluated, treated and/or followed by our Stroke Service from September 1995 to August 2001. Clinical presentation, diagnostic evaluation, management, and outcome were reviewed. There were 15 men (56%) and 12 women (44%) with mean ages of 38 and 43 years respectively. Diagnosis was made by cerebral angiography in 15 (56%) patients and by MRI/MRA only in 12 (44%) patients. Twenty-two patients had spontaneous and five had traumatic extracranial CCAD. Most common associated disorders were arterial hypertension (37%) and migraine (26%). One patient presented only with a painful post-ganglionic Horner syndrome, another patient with neck pain and post-ganglionic Horner syndrome, another patient solely with protracted unilateral headaches, three with transient ischemic attacks (TIA), and 21 with ischemic strokes. The internal carotid artery (ICA) was the most frequently involved vessel (63%), followed by the vertebral artery (30%, and multivessel involvement in two patients (7%). Eighteen patients received anticoagulant therapy and nine platelet anti-aggregants. Follow-up extended from 2 to 115 months, with a mean of 58 months. At the end of follow-up, 23 (85%) patients had either no disability or only minor sequelae (modified Rankin score: 0 to 1), and four (15%) patients had moderate limitations (modified Rankin score: 2 to 3). Two patients had a recurrent ischemic stroke, one unrelated to recurrent CCAD, and the other following percutaneous balloon angioplasty/stenting for treatment of a persistent vertebral artery pseudoaneurysm. Most CCAD involved the extracranial ICA. The clinical presentation is variable, most patients having an ischemic stroke or TIAs. The short- and long-term outcome are usually favorable with either anticoagulant or platelet antiaggregant therapy. A medical initial approach to the management of extracranial CCAD is recommended for most patients.

Adult↗
PubMedDate not supplied

GQ1b antibody testing in Guillain-Barre syndrome and variants.

Guillain-Barre syndrome (GBS) is characterized by an ascending muscle paralysis with progressive loss of muscle stretch reflexes. Annually, approximately 2.4 cases per 100,000 population of GBS are reported. Variant forms do exist. These include the Fisher syndrome, GBS with ophthalmoplegia, Bickerstaff's brainstem encephalitis (BBE), and acute ophthalmoparesis without ataxia. In the last 15 years, attention has been directed towards the association of the GQ1b IgG antibody and several GBS variants, particularly the Fisher syndrome and those associated with ophthalmoparesis. We present three cases of GBS variants. All three cases had associated ophthalmoplegia but only one of the three had a positive GQ1b antibody association.

Adult↗
PubMedDate not supplied

Long-term therapy to prevent stroke.

Cerebrovascular disease is the third leading cause of mortality and the leading cause of long-term neurological disability in the United States. Most strokes are of ischemic origin and, other than cardioembolic or small vessel strokes, are caused by the development of platelet-fibrin thrombi on an atherosclerotic plaque. This underlying disease mechanism shares important features with coronary artery disease and peripheral artery disease, highlighting the systemic nature of atherothrombosis and the elevated cross risk in stroke patients for ischemic events in other vascular beds. It has been estimated that up to 80% of ischemic strokes could be prevented with application of currently available treatments for blood pressure, cholesterol, and antithrombotic therapies. Stroke is not, like cancer, waiting for a scientific breakthrough; stroke preventive treatments are well understood and widely available. It is only the application of these treatments to patients, many of whom do not visit physicians, that is lacking. Clearly, better education of the public and active participation of primary care physicians is essential to get the message out to all those at risk.

Anticoagulants↗