Sharon's treatment after stroke questioned
(AP)
Updated: 2006-01-13 14:01

Ariel Sharon's doctors faced new criticism Thursday for failing to divulge a brain disease discovered after the prime minister's initial stroke and for prescribing blood thinners that may have contributed to a massive second stroke.

The criticism added to a growing chorus of questions about Sharon's treatment. Some experts, however, said there was no clear-cut answer.

As Sharon lay comatose for an eighth day Thursday, a brain scan showed the remnants of the blood in his brain from a Jan. 4 stroke have been absorbed, hospital officials said in a statement.

In response, doctors removed a tube they had inserted into Sharon's skull to relieve pressure on his brain, the statement said.

In coming days, doctors may have to cut a hole in Sharon's neck to assist breathing, while still waiting for the clearest sign of improvement: the moment he opens his eyes.

After Sharon, 77, suffered an initial, minor stroke Dec. 18, doctors put him on Clexane, an anticoagulant. At a news conference a few days later, doctors acknowledged blood thinners increased the risk of brain hemorrhage, but said the fear of a clot leading to another stroke was greater in this case.

The debate gained momentum after the Haaretz daily revealed that Sharon also suffered from cerebral amyloid angiopathy, known as CAA, a disease common in the elderly that weakens the blood vessels in the brain and increases the risk of hemorrhage.

Doctors confirmed they knew about the disease after the first stroke, but prescribed the blood thinners anyway, a move outside experts criticized Thursday.

"If someone has a disease that caused bleeding, that causes bleeding, that could cause bleeding in the future, giving anticoagulants ... is certainly an undesirable situation," said Amos Korczyn, head of the Tel Aviv University Medical School's neurology department.

Doctors were prescribing the Clexane until they could seal a small hole in Sharon's heart they said caused Sharon's first stroke. Clexane, or enoxaparin, is sold as Lovenox in the United States.

But some experts questioned that theory and said the initial stroke was more likely caused by Sharon's brain condition. Sharon suffered his massive stroke a day before he was to undergo the procedure to seal the hole in his heart.

"The likelihood is that the hole in the heart was of no relevance," said Dr. Anthony Rudd, a stroke specialist at London's St. Thomas' Hospital. He said CAA could have caused the first stroke.

Doctors did not disclose the condition in December, and several Israeli media outlets chided Sharon's medical team for keeping it under wraps.

Israel's Channel 10 TV quoted an anonymous medical official as saying that Sharon's advisers asked them not to divulge the CAA ahead of the March 28 election. Asaf Shariv, a top Sharon adviser, denied the report, saying he learned about the condition from the media. "I don't even know if the prime minister knew," Shariv said.

Rudd said he would not have prescribed Clexane if he suspected CAA, and might have gone for a weaker drug, such as aspirin, or a lower dose of blood thinners.

Other doctors disagreed, saying each physician must weigh the risks based on their knowledge of medications and the patient's condition.

"This is a very difficult situation because you are between the devil and the deep blue sea," said Dr. John Martin, a professor of cardiovascular medicine at University College in London. "The decision is always different and it's never black and white, and it's very easy in hindsight to say that was the wrong decision."

Sharon's medical team said the criticism was inappropriate.

"Let's say they would have given him less or wouldn't have given him anything and then suddenly he would have developed a clot in the brain instead of bleeding in the brain. Then everybody would have asked why didn't you give him a higher dosage of blood thinners?" Dr. Jose Cohen, one of Sharon's neurosurgeons, told Israel TV.

For the moment, Cohen said, doctors are trying to draw Sharon out of his induced coma. His condition remained critical but stable Friday, according to a statement from Hadassah, the hospital in Jerusalem that has been caring for him.

The statement said an "additional neurological evaluation" will be made Friday but did not elaborate.

Over the past three days, doctors worked to wean Sharon off sedatives. They completely removed the anesthetics for a few hours at a time, but Sharon's blood pressure spiked and at one point his heart beat irregularly, forcing doctors to resume the sedation.

The daily Maariv reported that if Sharon does not wake up in the next few days, doctors may perform a tracheotomy to insert a tube directly into his windpipe.

Ron Krumer, a Hadassah spokesman, said the hospital will inform the public if doctors decide to do the procedure.

If Sharon remains on a respirator, doctors will have to perform a tracheotomy, Martin said, because the plastic tube now in the prime minister's windpipe begins to cause damage after a week.

Rudd said any kind of invasive procedure, including intravenous lines, carries a great risk of infection. An immobile patient on a respirator, as Sharon is, is also at risk for chest infection, he said.

"Combined with the fact that the immune system is bound to be less effective than normal, infection is a constant worry," he said. "I'm sure they are trying to minimize this, but when you have all these lines of various sorts, every single one of them is a way infection can get in."

The fact that doctors are considering a tracheotomy means they are preparing for the long haul, Martin said. It is also becoming more probable that Sharon will remain in a vegetative state, he said.

"If there was no brain damage, I would have expected him to wake up at this point," Martin said.