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Thread: Coumadin and strokes

  1. #1
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    Default Coumadin and strokes

    We have 670 members on valvereplacement...just read Darren's concern about being low and having a stroke. (INR).. I would like to know..how many members on coumadin have had a stroke? Related..to taking coumadin? I just posted today that I had two Cardiologist yesterday to tell me to hold my coumadin for 3 days..prior to having 2 teeth pulled in a few weeks. They were more concerned with my bleeding than having a stroke.....I am talking about NORMAL taking coumadin ..no other health reasons. Like..did you have a stroke off coumadin for minor invasive surgery????? As..Dental work, Colon work, Women things, skin cancer removal..ect. Bonnie
    [img]http://banners.wunderground.com/banner/gizmotimetempbig_both/language/www/US/GA/Sautee_Nacoochee.gif[/img]

    Bonnie Anderson
    Date of Surgery..3-25-02
    (Aneurysm) AVR 23 mm St, Jude Valve
    Never stand afar and view with fear and trembling that which lies in your way. Face it boldly and see how very small it is, after all.------------------------------------------------

  2. #2
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    Default

    Bonnie:

    Albert had 3 strokes when his INR was between 1.7 and 1.8. The first was called minor, nothing more than a brain hiccup, or so the hospitalist said. On December 15, 200, while having lunch with friends, he dropped over and passed out. He remained unconscious for several hours. After being hospitalized from Friday to Wednesday morning, he was released. Two days later, as I watched in horror, he had a second stroke that left him unable to speak, walk, use his hands, or have control of any parts of his body. He did not lose consciousness, but could not communicate. After spending 6 days in the hospital, they decided to do an angeogram on him. That night, as I slept on a cot beside his bed, be began to bleed out. One male nurse held him together with his bare hands for nearly an hour. A priest was called for. After 4 hours and numerous shots of vitamin K, and pain killers, the bleeding finally stopped. The next day I had him moved, by ambulance to the Barrows Neurological Center where he stayed for another 9 days. He was released to undergo months of therapy. He made great progress with therapy and we thought it was all behind us until May 16, 2001, five months after his initial stroke, when he, all of a sudden, could not speak clearly. Upon arrival in the ER, his INR was measured at 1.8. His INR, measured at the lab three weeks prior was 3.5.

    What caused Albert's INR to drop no one knows. He had been taking Coumadin for 10 years, 1 month, and 28 days, with no problem whatsoever. Why did he have an anticoagulation failure three times that resulted in two minor and one major stroke? Who knows? It happened and the results were devistating to him, me, and our family and friends. Albert's strokes had nothing to do with dental work. But, I can't understand why any intelligent person would willingly discontinue Coumadin and risk a stroke, however remote, when it is unnecessary and dangerous.

    If you want information and studies on this topic, I have many, including the one I listed. I also have information from The Austrailan Dental Society, the New York State Dental Socitey, the Nassau County Dental Society, Oral Surgeons in metro Atlanta with affiliations with 21 Atlanta hospitals, the University of Michigan Cardio/Vascular and Anticoagulation Unit, as well as research articles from the British Journal of Oral and Maxllofacial Surgery, the Journal of the American Dental Association, and Al Lodwick's site. Recently I read a letter from a dentist in the United Kingdom that stated, "A paper published nearly 20 years ago in the British Dental Journal demonstrated quite clearly this point (namely that there is no need to reduce warfarin providing the INR is within the normal therapeutic range for dental extractions) and since I have NEVER altered the warfarin doses for well controlled patients undergoing dental extractions." {As qutoed from: British Dental Journal, December 21,2002, Vol 193, No. 2.}

    Al Lodwick has mentioned several times the case of a man who received a medhanical valve and had not taken Coumadin for 10 years, and....he was still alive. Not a chance I would take. I also like the saying, you can run across the freeway many times before being hit. While having a stroke in the dentist chair because coumadin was discontinued is very remote (although Al Lodwick was an expert whitness in a court case a where that did happen), if it does happen your cardiologists, dentists, and coumadin nurses, should know that you will have a very good case of malpractice against them, or at least your relatives will.

    If you would like any of the information and research I have mentioned, first read Al Lodwick's materials on dental on his site, then contact me and I will provide what I have. I do care.

    Regards,
    Blanche

  3. #3
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    Default

    Bonnie, I have talked to my cardiologist about concern over periodic low INR's as well as dental work. His response is that with an aortic valve replacement, the INR is not all that important because the blood flows so fast over the valve that its hard for clots to form in the first place so the general risk is low. With mitral valve replacement however, it becomes more important as the blood comes into the heart at a much slower rate and is easier for clots to be created. He also says there is no good reason to stop the coumadin, once on it, for most dental work including pulling teeth (impacted wisdom teeth would be more "surgical" thus different). I am having 2 wisdom teeth pulled in a few weeks and I'm not going to stop the coumadin. At most, I might take the opportunity to bone up on some Greek salads and make some tea to use the tea bags (applied directly) as a coagulant if needed. I guess what I am trying to say is that since you have an aortic valve replacement, either way, you may not be as subject to risk as you would be if you had a mitral valve replacement. I'm certainly not a doctor and even in spite of my also having a "new" aortic valve (5 years old), I'm still not going to stop the coumadin. Not due to fear of stroke, but aggravation of then getting the INR back in range and all that goes with that! This is just "FYI information" as at the end of the day, we all have to either follow our doctors orders or argue for change! Good luck, but I don't think I would be too worried about a stroke and the reasons noted above are probably also why your doctors suggest stopping it. Susan
    Sunshine Susan

  4. #4
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    Please feel free to print out my chart at http://www.warfarinfo.com/dentalprocedures.htm
    it is adapted from the Journal of The American Dental Association.

    The question to ask your doctor is, "Did you ever take care of a gun shot patient who lived?" If the answer is,"Yes." then ask, "Do you really think that I will bleed more than that from having a tooth pulled?"

    Granted an impacted wisdom tooth is more difficult than a simple extraction, but if your cardiologist or dentist wants to vary from the guidelines, ask why.

    Also ask yourself this question -- what would I rather do, sit up all night holding a tea bag on my socket or have a new valve put in?
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  5. #5
    JetService Guest

    Default

    Granbonny, I'm glad you asked this, because I'm kind of freaked out now. Blanche says Albert had three strokes at 1.7-1.8 and I'm at 1.7 as of Wednesday. Again, they told me to take 9mg instead of the usual 6mg that night and then the usual 6mg each day from Thurs-Sun and check again Monday. Now I'm worried that is too long to wait. The note about the AVR being less suseptable to clotting made me feel better, but not enough! Does anyone think I should pop an aspirin just to be safe? If the slide is from healing (which was suggested since there were no other obvious factors), then it would likely still be falling, no? YIKES! Should I insist they check me on Saturday or is it too remote to worry about? I keep hearing 1% chance of problems per patient-year, but I feel like I'm playing Russian Roulette right now.

  6. #6
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    Default

    Relax Jet, your new to all of this, so cut yourself some slack. Your o.k. Your not holding doses, so your risk is miniscule compared to what Bon is being told to do.

  7. #7
    JetService Guest

    Default

    Thanks Ross. I figured I was blowing this out of proportion; I just needed someone to confirm that.

  8. #8
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    Default

    Aspirin works mainly in the arteries and has little effect on blood clots that form under stagnation situations. Stagnation is the problem around mechanical valves because they are not the same shape as natural ones. Eddy currents tend to form more easily around mechanical valves. This is why aortic valves with the faster blood flow are less likely to form clots than mitral valves.

    I have three places where this is discussed in various contexts on my website.

    http://www.warfarinfo.com/aspirin-warfarin.htm

    http://www.warfarinfo.com/aspirinwithwarfarin.htm

    and

    http://www.warfarinfo.com/aspirin-platelets.htm
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  9. #9
    Gisele Guest

    Default Just for the record

    I had one stroke but I had several injections of Vit K when my second subdural was diagnosed, and was totally uncoagulated when it happened. So far.................

    3 subdural hematomas
    1 stroke


    Was on Coumadin for over 21 years. Off Coumadin for three months now.

    I think it is a big roulette wheel. Some people are luckier than others.

    Gisele

  10. #10
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    Yeah, you ruined somebody's Quality Assurance records. Either that or your old clinic would now be the safest place to go because you had all of the serious events for the next 100 years!!

    I have always thought that they should put up a sign in the delivery room warning, "Birth will lead to death" so that the kid will know what he/she is up against. Maybe they know and that is why they start crying right away!!
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  11. #11
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    For many of the reasons listed above.....I advocate weekly INR testing with my Coaguchek.

    It is so easy to swing out of range. Most of the time I am within that range, but why take the chance when technology is at our fingertips.
    All the best,
    LuvMyBirman :)
    MVR, 3/99

  12. #12
    Gisele Guest

    Default

    Al,

    I guess according to the odds that everyone on the board is now safe for the next 100 years, right?

    Gina, I was in range when I had my second bleed-I had been testing weekly since my first bleed a few years ago with the Protime machine.

    What's that saying about luck...............if it weren't for bad luck I wouldn't have any at all? LOL

  13. #13
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    Gisele! At the rate some of us are going.....odds of winning the lottery are great!

    Thinking about you. Wishing you all the best!
    All the best,
    LuvMyBirman :)
    MVR, 3/99

  14. #14
    ticktock Guest

    Default thin thinner thinnest

    Hi all... old member here, reporting in... because the topic was timely. Tested this morning at home, and have a 7.2 INR.... have been as high as 11 before without bleeding.. but still makes one a bit nervous. I think it was Gina that taught me about "fixin'" my INR with broccoli and avocado's and stuff.. and it has worked for me like a charm.

    I have been on Coumadin at 2.5-3.5 for 26 years! Is that a record, I wonder?? Have had three TIA's.... one episode they termed a "stroke".. I am not the perfect patient, but I do watch my INR's closely.... eat a consistent diet and do NOT avoid ANY particular foods. Now, I don't sit down and drink 3 pots of green tea anymore, or eat boiled onions... but generally I eat 5 veggies a day, 2-3 green, and whatever else I want.

    I too have had INR's at 1.7 or so, and that makes me more nervous than the 7.2.. Wonder what Al would think about that. I have a rather large bruise (the size of Africa) on my right thigh, which was the tip off. Lodwick mentions somewhere in his information about flu shots and an elevated INR, but my flu shot was about 2 weeks ago. Last year it spiked my INR to 8.9... or maxed out my machine.

    Good to read all your posts... can surely relate to the problems and stresses.. Just hang in, there are ALOT worse things than Coumadin therapy!!
    Mindy

  15. #15
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    With an INR greater than 5, I would hold 1 or 2 days depening n your dose. Then I would re-start about 10 - 15% lower than you were taking. Chances are that after 25 years you have also been on whatever the new dose will be at sometime in the past.

    I doubt it was the flu shot after that long. Usually that only has an effect for a few days at most.

    25 years is pretty long but far from a record. At least 2 members her have you beat out - one at over 30 years and one at 43 years. I have corresponded with someone who has been on it since 1958.
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  16. #16
    ccrawford Guest

    Default

    The thread seems to have gotten off the point. Bonnie - Forget about holding the Coumadin. A couple of teeth being pulled is not a big thing, but the ramifications of holding Coumadin for three days is more than a big thing. If your dentist is not comfortable with this, find a new dentist.

  17. #17
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    Default Chris

    Thank you for your concerns..But, if I fire my dentist..then I would have to fire my 2 Cardiologist.First, my dentist was the one that cured me from my gum bleeding..by recommending that I rotate between he and the Peridontist every 3 months...3 months after my AV..I was bleeding every morning on pillow..scared me so bad..I went to ER.. Found out that it was the coumadin causing my gums to bleed. That was over a year ago..and never had another problem with bleeding gums. My dentist told me the first time I saw him..that I had 2 loose teeth that would have to come out someday..He told me this last visit..it was time..and to hold my coumadin..because he did not want to do it twice.........a few days later. I spoke in person to my Cardiologist (who saved my life by finding my aneurysm..after many tests by other doctors who could not detect it. I told him what my dentist wanted me to do..and he said it was the Correct thing. Then a few minutes later..I also asked his partner (who was looking after hubby) and he also said..it was the correct thing to do....I had a PM from our new member..Dr. Steven Khan..a cardiologist from California..telling me that it was..what he would have told me..basing on I have an aorta valve..my INR is always in range..I have never had any other heart problems, ect.....Of course..I will take my INR on Friday morning before surgery on Monday morning...should be in range at 3.0) then on Monday morning before I go in to dentist..will take it again. If I have no bleeding at dentist office..will come home and start coumadin up again.....If it drops low..on Monday a.m. will take a double dose and resume normal dose on Tuesday..I read that is what Al recommends to do(Lorraine's thread..Oct. 31st) IF INR is below 2.0.........I do not want to put you on a spot..but what if you were in my shoes ..and your Cardiologist ( 3 of them) had told you to hold your coumadin?Do you think mine would really risk me having a stroke? They have too much invested in me..and don't want to lose my business. Also, my dentist and my Periodontist have kept me on coumadin..even with the deep cleaning. Ouch. (no bleeding)..but he feels this time I need to come off.Bonnie
    [img]http://banners.wunderground.com/banner/gizmotimetempbig_both/language/www/US/GA/Sautee_Nacoochee.gif[/img]

    Bonnie Anderson
    Date of Surgery..3-25-02
    (Aneurysm) AVR 23 mm St, Jude Valve
    Never stand afar and view with fear and trembling that which lies in your way. Face it boldly and see how very small it is, after all.------------------------------------------------

  18. #18
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    Do you think mine would really risk me having a stroke?

    Do what you feel is necessary, but I still think they are wrong. It's not them that could potentially stroke out. The key word here is POTENTIALLY. Don't get mad at me. I just can't see justifying the risk however large or small it may be.

  19. #19
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    Whenever this discussion comes up, I always think of one of my patients who was told that there would be no problem going off of her warfarin for a colonoscopy. Well the colonoscopy was negative but before the INR went back up into range she had a stroke and never lived independently again. When I mentioned it to her cardiologist he just shrugged his shoulders and walked away. He soon left town.

    Look at the American Dental Association guidelines again and see where you fit.

    Only you can decide how important getting the tooth out is for you.
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  20. #20
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    I'd like to add one other incident that happened to my wife and I. We went to our dentist one day and he was sick, so his partner was seeing his patients. The partner looked in my wife's mouth and told her that she needed braces and needed to have every tooth capped or else she was going to have severe headches from TMJ. He estimated to cost to be $30,000.

    At the time our son was going through the braces thing so we decided to have the orthodontist look at her mouth. We paid his consultation fee out of our own pocket. He said that he could fix her mouth with braces and that no capping would be necessary. The cost would be $20,000.

    Our son then needed oral surgery. My wife asked the oral surgeon for a consultation. We paid his fee out of pocket also. He was one of the people who fixed the worst of the worst broken up faces from injuries in Denver. He told my wife that it was possible that she could develop TMJ and might have headaches but that this usually developed slowly and there would be warning headaches. He said that she appeared to be able to chew food since she was well nourished (but not fat).

    That was 25 years ago and she still has not developed a problem. We saved $29,900 by seeking second and third opinions.

    Then we moved to a new town and on her first trip to the dentist the new guy said, "You need ... and it will cost about $30,000 or you will soon develop TMJ." It is up to you to guess whether or not we ever went back to him.
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  21. #21
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    Bonnie:
    Any cardiologist, dentist, or medical person who tells you you must go off Coumadin for 3 days for dental work is putting you at unnecessary risk for a stroke. No ifs, ands, or buts. I don't think that your doctors or dentist or the cardiologist who PMd you are bad, dumb, crazy, or stupid. But, in fact, they are WRONG. And I defy anyone to provide scientific or research evidence to the contrary.

    The people here care about you. You've read the posts, more than a dozen over the past year or so, from people who were in the sampe position you are in now. They refused to go off Coumadin. Many of them educated their doctors and dentists by providing copies of the research and scientific studies. Most of the dentists agreed and were glad to have the most current, scientific information. Some people did change doctors.

    You asked our resident coumadin "guru"for advice and his response was counter to your doctors. Heed his advice. Read the American Dental Association Guidelines and send a copy to all of the medical people involved. I have many articles that I will gladly send you. Most, like "Stop the Nonsense Not the Anticoagulants: A Matter of Life and Death," written by three dentists, and published by the New York State Dental Association, contain statements like the following:

    "There are no well documented cases of serious bleeding problems secondary to routine dental procedures in patients receiving therapeutic levels of oral anticoagulant Coumadin...There are, however a number of documented cases of serious thromboembolic complications, including DEATH, from stropping Coumadin therapy for dental procedures." "SCIENCE SAYS STOPPING THERAPEUTIC LEVELS OF COUMADIN FOR ROUTINE DENTAL PROCEDURES PRODUCES A LIFE-THREATENING RISK TO THE PATIENT." (New York State Dental Journal, Nov. 2002).

    So, you asked, "Do you think mine would risk me having a stroke?" The dentists who wrote the article for the NYS Dental Association said it loud and clear....."a life-threatening risk to the patient." Sunshine Susan, in another post, said something really important. "At the end of day, we all have to follow our doctors orders or argue for change." Now you know the risks. If you want to share information that I have mentioned with your doctors and dentist, contact me. At least make a copy of the American Dental Associations on Al Lodwick's site, along with the information he has provided, for your dentist.

  22. #22
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    I had a doctor tell me once that he was afraid that a patient would bleed to death after getting a tooth pulled.

    I asked him, "When you were in training did you ever take care of a gunshot patient who lived?"

    He answered, "Yes."

    Then I asked, "Do you really think that this person is going to lose more blood than that?"

    No answer.

    Another woman who came to my clinic was very upset with me because I recommended that she not go off warfarin for an extraction. She was mad because she was up all night holding a gauze pad on her socket. I asked her how she would feel toward me if she were not able to move her hand up to her mouth. I also asked her if that was worse than getting a new valve.

    She decided to go to the rival clinic in town. Was I glad?
    Al Lodwick, R.Ph.
    Certified Anticoagulation Care Provider
    [URL=http://www.warfarinfo.com]Go to my website for warfarin information[/URL]

  23. #23
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    Default Thanks for your concerns

    Ross. ...Mad at you never.. I love you like a son ....Blanche..I did a google search today..Coumadin ..Dental extractions...The first one that came up was the NYS...Dental Association. Read the entire article...but also read all the following ones...Space Coast Medical Assoiates in Fla......The Heart Surgery Forum...Wilford Hall Medical Center.Coumadin Clinic....more..but all the above said to hold your coumadin for a few days for MULTIPLE extractions..which I am having 2 pulled. Al..also read all yours..where you stated 2 days would be plenty. I have decided to hold Sat. a.m. 5mg and Sunday a.m. 2 1/2 mg. and Monday a.m.'s 5 mg. Appointment at 10 a.m.... Like choosing a valve. this is my personal choice and feel comfortable with it... My PCP also wants me to have a colon test done in the near future. So, this will be a trial run..in case Doctor Moore wants me to come off it.....I'm sure I will have a Happy story to post after my extractions for other's on the board..and not a scary one. Bonnie
    [img]http://banners.wunderground.com/banner/gizmotimetempbig_both/language/www/US/GA/Sautee_Nacoochee.gif[/img]

    Bonnie Anderson
    Date of Surgery..3-25-02
    (Aneurysm) AVR 23 mm St, Jude Valve
    Never stand afar and view with fear and trembling that which lies in your way. Face it boldly and see how very small it is, after all.------------------------------------------------

  24. #24
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    Default Blanche

    In my first post..I asked for members who were on coumadin and had dental procedures. So far, none have responded..Did you say..at least a dozen? Is there anyway I can pull up their threads. Do you remember any of them..Would like to PM them and see if they had any complications staying on it...Bonnie
    [img]http://banners.wunderground.com/banner/gizmotimetempbig_both/language/www/US/GA/Sautee_Nacoochee.gif[/img]

    Bonnie Anderson
    Date of Surgery..3-25-02
    (Aneurysm) AVR 23 mm St, Jude Valve
    Never stand afar and view with fear and trembling that which lies in your way. Face it boldly and see how very small it is, after all.------------------------------------------------

  25. #25
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    Bonnie:
    Will send a PM after this post. I read your first post on the thread "First Time" and thought you were asking Al Lodwick (You said, What do you think Al?). That's why I did not respend to your first post. Perhaps others thought that way too. I suggest that you begin a new post that is more specific. Maybe something like, "WANTED Members Experiences With Coumadin and Dental Work."
    As far as dental procedures and anticoagulation, I don't recall anybody who went off Coumadin without Lovenox or heperin. Some of the people who have reported on staying on Coumadin were: Marty and Ross for root canals, and Shezagirlie for removal of a wisdom tooth. Both ccrawford and Sunshine Susan responded to you on this thread. I can't remember all of the people who discussed dental work and Coumadin but Kim, MarkU, Dick V, Al Capshaw, John and Joanie, and Gina come to mind. You might want to do a search of the board on Dental and Coumadin. You might also want to search colonoscopy and Coumadin. Again, if you would like any scientific, research based, or evidence-based dentistry articles, let me know.

    I do agree that, in the end, it comes down to personal choice. For me, it's important to be informed and be completely aware of and willing to accept the risk involved. In the benchmark Wahl study I quoted before, of the 526 patients who experienced 575 interruptions of anticoagulant therapy, only 5 suffered serious complications. That's less than than one percent. However, four of those patients died.



    Blanche

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