Blood Thinners Were Risky for PM Due to Undiagnosed Brain Disease

Prime Minister Ariel Sharon received anticoagulant drugs despite suffering from a disease of the blood vessels in the brain which, if diagnosed, would almost certainly have prevented doctors from prescribing these drugs - which are known to increase the risk of strokes and brain hemorrhage. One doctor close to the situation told Haaretz yesterday that the disease was diagnosed by doctors treating Sharon at Hadassah University Hospital during his current hospitalization.

The disease, cerebral amyloid angiopathy (CAA) could have greatly increased the risk of a brain hemorrhage, following the administration of the medication that he received after his first stroke Dec. 19, Haaretz has learned.

The diagnosis ocurred after examining CT scans Sharon has undergone, according to testimony presented yesterday to Haaretz by a medical source involved in the treatment of the prime minister.

Ron Krumer, Hadassah's external affairs director, said in response "We are busy treating the prime minister and fighting to save his life. We are not dealing with anything else."

The doctor who provided the testimony defined the administering of the blood-thinning medication after the first stroke as a "screw up."

According to the medical testimony, had the disease been detected when Sharon was admitted to Hadassah University Hospital after his first stroke, the doctors would probably have refrained from administering the blood-thinning medication, which, as doctors believe, led to the subsequent severe hemorrhaging and the prime minister's current condition.

According to a senior medical source, in some instances CAA is a genetic disorder, while sometimes its origin is unknown. The disease is diagnosed by means of interpreting CT and MRI scans, or by performing a biopsy on a small sample of the brain. However, medical literature is also filled with testimony that the disease is very difficult to diagnose, and can sometimes be detected only following a brain hemorrhage.

The medical testimony given to Haaretz yesterday reinforces the questions raised regarding the quality of the treatment and supervision Sharon received in recent weeks, following his hospitalization after the first stroke he suffered.

As reported in Haaretz, senior doctors - including two hospital directors and a senior physician at Hadassah itself - have raised numerous questions since Sharon's hospitalization regarding his medical supervision over the past two weeks; the administering of the blood-thinning medication; the dosage administered; the medical and laboratory supervision in the wake of administering the blood-thinning medication; and the decision to perform the cardiac catheterization as well as its timing.

According to a senior medical source, CAA can lead to bleeding into the brain as tiny blood vessels carrying amyloid deposits become heavier and more brittle, and are therefore more likely to burst with minor trauma or with fluctuating blood pressure.

Aneurysms, or ballooning of the blood vessel wall, may develop, and may also rupture as the stretched wall becomes thinner and is under more pressure. Amyloid deposits may destroy smooth muscle cells or cause inflammation in the blood vessel wall. This may also cause the blood vessel to break more easily.

A senior doctor told Haaretz last night that CAA is one of the main causes of cerebral bleeding in elderly individuals, and that studies in recent years have shown that the administering of blood-thinning medication to individuals with CAA is a "significant factor" in causing cerebral hemorrhages.

The central question now, said the senior doctor, concerns whether the MRI after the first stroke made it possible to identify the illness or signs of a possible illness.

"If the image facilitates identifying the illness and this wasn't done, then it appears that we are dealing with a significant failure on the part of Hadassah," the doctor said. "However, it is important to note that it is difficult to diagnose this illness by means of computer imaging only."