The MDs who anti coagulated Ariel Sharon after his first stroke when he was known to have cerebral amyloid antipathy (CAA) effectively killed him. Sometimes you don’t know a patient has CAA, although lobar hemorrhage is a clue. CAA replaces the normal lining of cerebral blood vessels by structureless proteinaceous gunk, making them incredibly fragile.
I know that most of you are not histologists, but look at the picture anyway
The distorted oval with the relatively clear center in the middle of the picture is a blood vessel within the brain. At 3 o’clock it looks fairly normal, and you can see dark cell nuclei within purplish cytoplasm. At 11 to 2 o’clock the red stuff is amyloid. Note how it distorts the normal anatomy, thickening the vessels wall and decreasing the number of cells. This is where these vessels break.
Using anticoagulants on a patient with known CAA is ghastly malpractice. What were they thinking? Unsurprisingly he had a massive brain hemorrhage shortly thereafter, which kept him in a vegetative state until his passing this month.