I can see why Bosh would be acting like this if his doctor thinks Bosh could feasibly play on blood thinners. Riley has a $22 million cap space and $40 million medical insurance pay out worth of reasons to not want Bosh to come back. Bosh wouldn't be the first professional athlete to play on blood thinner. I am waiting on a different doctor to make the same call that Miami's doctor did about Bosh's health before I mark Bosh off as being delusional.
do you want to hear something crazier! Hakeem should've been dead or had at least multiple ICH , he had AF too . webMD wasn't a popular thing back then
... do you know the epidemiology of atrial fibrillation? Or the risk of stroke or intracranial hemorrhage? What you said is basically completely incorrect, except for the fact that Hakeem Olajuwon had atrial fibrillation.
He was at higher risk of stroke related to AF and bleeding because of the blood thinner which is he most likely used continuously through out his career
Someone with his risk factors would have probably been on aspirin. Moreover, his annual risk of stroke was extremely low for many reasons. He eventually did take a blood thinner in 2001 for a blood clot - NOT atrial fibrillation, and that was basically the end of his career if he were to remain on anticoagulation. This is NOT related to atrial fibrillation. I see no evidence that Olajuwon was on a blood thinner for his atrial fibrillation issues. See this link: http://a.espncdn.com/nba/news/2001/0313/1153235.html This factored into the decision for Houston to let him walk to Toronto, and is often ignored for whatever reason. Exiled, you don't know what you're talking about. You should feel ashamed for spreading misinformation like that, if you really are in the healthcare field.
did you intentionally ignore that fact Hakeem had blood clot in 1989, AF in 1991,1995 before 2001 ! he was frequently hospitalized for weeks with frequent episodes in between (and those are just the reported incidents that we know of ) ? do you think Aspirin was enough! did you eliminate the possibility of use of ablation, blood thinner & genetic factors ? cant you see the correlation between the two ?
1) He had a traumatic blood clot in 1989, that isn't considered to be unprovoked 2) There are no genetic mutations which are shared by thrombophilia and arrhythmias that I am aware of, and I challenge you to prove me wrong 3) Aspirin is the recommended treatment for AF with no major risk factors (two decades of data here, FYI) 4) Hakeem's second clot in 2001 was unprovoked, which is why Houston thought his career was over. They grey area here is that the first clot was considered to be provoked, even though I'm not sure that was definitively proven. Given his tenure as a Raptor, I think he would have been better off retiring a Rocket. 5) Ablation of AF, even in older patients with risk factors, is still very controversial. 6) Again, atrial fibrillation and venous thrombosis do not share a common pathogenic mechanism, even if the two diseases can cause more complications when they are comorbid. Not sure you want to be going toe-to-toe with me on this one since I deal with this on a daily basis.
amazing insight ,thanks for taking time to rephrase the previous conversations, nothing new but it may give better impression ,not saying you were wrong but just a tad slow 1) venous thromboembolic disease which include DVT and PE is associated with an increased risk of AF , check out the latest on atrial fibrillation.assuming of course you have access to uptodate{{clinical manifestation diagnosis of chronic thromboembolic pulmonary .....}} (a thing you may not know) 2)akeem was admitted for AF, he spent 2 weeks, i'm not sure he would stay that long on Aspirin alone ,there could be even a possibility that he had heart failure,if so, he would had been on anticoagulant.other intervention could come later as after math,as a possible intervention ( a thing we're both unaware of details) 3)you realized "Finally" there was a complications when both treatment combined, the mechanism was not even mentioned before , but if i had to explain the relation between the two :it has been speculated of an increase in pulmonary vascular resistance and cardiac afterload which lead to right atrial strain ( a further explanation) now since you works on this daily , try to understand the benefit and disadvantage between 1st and late generation of blood thinners and what can be more useful in this particular case
you must've noticed my tendency of leaning toward plan B with ease along" what's possibly could go wrong attitude , thanks Dr.Azarde and you are pretty close
There are a lot of fallacies in your logic. I'm happy to discuss with you in private but you are jumping to a ton of conclusions that don't really make sense. One more time, if you're willing to listen: 1) CTEPH is not the same as VTE. It's a manifestation of chronic venous thromboembolic events that leads to right heart failure. It's one of the reasons that people with recurrent unprovoked DVT are recommended to be on blood thinners. As a result of cardiac complications you can develop secondary AF. This is not the same as primary AF being associated with primary VTE. 2) He may have been on heparin acutely, depending on what they did to treat him at that time. I don't see any evidence he was on a blood thinner, as that would preclude contact sports. You can see from my link above that that particular risk was definitely in the front office's minds. 3) I didn't "finally" realize anything, I'm saying that when primary AF and primary VTE co-exist, there are some unique problems due to synergistic pathophysiology. Right atrial strain/enlargement is only one of many reasons that people develop AF. Most of the time people with primary AF have otherwise normal hearts. This is almost always going to be the case in otherwise healthy people. I'm not really going to argue further unless you cite evidence saying that I'm incorrect. I'm happy to be proven wrong.
FYI - AP article from 1996 re: arrhythmia - "Olajuwon was given aspirin and a digitalis drug called Lanoxin to deal with the heartbeat problem..." December 3, 1996 - Rockets' Olajuwon receives medication to regulate heart
December 2,1996 " A statement released by the Rockets said that Olajuwon was presented with two treatment options: electrical cardioversion, a procedure in which jolts of electricity are applied through paddles to correct an irregular heartbeat, or electrical cardioversion combined with medication. Pacifico said he would wait until today to see if the heart corrects its own rhythm. If not, doctors plan to shock it back into sync with a defibrillator, as was done when he experienced the problem last month. It has not been determined if Olajuwon's arrhythmia is sporadic or chronic. After the episode on Nov. 21, 1991, he did not report any other problems until this November. Doctors may consider putting Olajuwon on medication to help keep his heartbeat regular. In the meantime, the team said, Olajuwon is being given medication to prevent blood clotting....." http://www.nytimes.com/1996/12/02/sports/olajuwon-in-hospital-after-heart-episode.html?_r=0 the aim was to restore his regular blood pressure + restore rhythm +prevent clot
I take it you're a physician or some sort of healthcare guy? This is what you do in acute atrial fibrillation. If it's life-threatening, you shock and admit to an ICU or telemetry unit. If it's not, you have several options. None have been proven to be superior. 1) If you want to try and shock (cardioversion), you start someone on heparin prophylactically and then shock 1-2 days later. Sounds like that's what they did with Hakeem, and then he went on aspirin and digoxin. Reasonable strategy, since beta-blockers may affect physical performance and other anti-arrhythmics don't necessarily work. 2) You can wait it out. Most of the time it doesn't cause issues. You'd put them on some sort of prophylactic blood thinner - but it can be as weak as aspirin where you can go out and do physical contact sports. There's good data supporting the risk/benefit ratio of aspirin in very low risk atrial fibrillation. 3) You can try rate control. There is NO evidence that rhythm restoration is a superior strategy. This isn't an option since primarily you're going to be using beta-blockers for this. 4) You can try rhythm control. It's not superior to rate control and the drugs have worse side effect profiles. This option isn't particularly popular or attractive. Again, this has nothing to do with Chris Bosh. He has a completely different problem. Exiled, at this point if you don't understand where I'm coming from with this, I don't know that I can explain it any more clearly.
