Hemmorhagic stroke and warfarin

[Marty]

There is an interesting article in Neurology this month.( by Flaherty, out of U. of Cincinnatti) Analysis of over 250 warfarin patients who had hemorrhagic stroke. Bottom line.. If INR over 3.0 , they had increase in bleeding and increased mortality. Valvers like me were told to keep INR 2.5-3.5. I sometimes drift up into the 4's. This article encourages me to try to stay 2.5-3.0

 

[geebee]

Marty,

Was the article implying that an INR over 3.0 caused the stroke or merely made it worse?

 

[Marty]

Marty,

Was the article implying that an INR over 3.0 caused the stroke or merely made it worse?

Warfarin does not cause strokes ;but, if one of the blood vessels in your brain ruptures ( lets say, due to arteriosclerosis,aneurysm, etc.) warfarin contributes to increased bleeding and delayed clotting.Fortunately, about 80% of strokes are thrombotic (ischemic) and here warfarin can only help.

 

[warrenr]

neurology

neurology

Here is the link to the abstract: http://www.neurology.org/cgi/content/abstract/71/14/1084

There were 258 patients with ICH. Only 51 were taking Warfarin. Of the 51 patients taking Warfin "Patients with INR >3.0 had greater hematoma volume (p = 0.02)." That is one person in 51.

Am I reading this right?

p.s. Hi Marty and everyone here. Sorry I haven't posted for a while.

 

[Ross]

Here is the link to the abstract: http://www.neurology.org/cgi/content/abstract/71/14/1084

There were 258 patients with ICH. Only 51 were taking Warfarin. Of the 51 patients taking Warfin "Patients with INR >3.0 had greater hematoma volume (p = 0.02)." That is one person in 51.

Am I reading this right?

p.s. Hi Marty and everyone here. Sorry I haven't posted for a while.

As long as we haven't lost you, I'll find it acceptable.

That's the way I'm reading it too.

 

[Marty]

Here is the link to the abstract: http://www.neurology.org/cgi/content/abstract/71/14/1084

There were 258 patients with ICH. Only 51 were taking Warfarin. Of the 51 patients taking Warfin "Patients with INR >3.0 had greater hematoma volume (p = 0.02)." That is one person in 51.

Am I reading this right?

p.s. Hi Marty and everyone here. Sorry I haven't posted for a while.

Warren, so nice to hear from you. Hope all is well. I think all we can learn from this article is- warfarin can lead to excess bleeding in cases of hemorrhagic stroke i.e. delays clotting.. This only makes sense. To me this suggests I should keep my INR in the lower therapeutic range- below 3.0 but above 2.5. Does an article like this prove anything? Definitely not!

 

[Lisa in Katy]

So Warfarin inhibits clotting. We already knew this, didn't we? 2.5 - 3.0 is too tight a range. It will be close to impossible to be that stable. Like many "studies", the data size is insufficient. You're right, it doesn't prove anything, and shouldn't give anyone another moment's thought.

I'll never forget the study several years ago where some graduate student surveyed several kids who had leukemia, asking them what their favorite food was. Many said hot dogs. Others said pizza. Conclusion? Pizza and hot dogs might contribute to the incidence of childhood leukemia.

 

[zipper2]

So what happened to my bleed on the angiogram
could of pretained to this? I haven't done any reading
up to the vessel bleed that turned my whole leg purple
and sore once they put wires in the vessel,the bleed went
under skin of my leg and still there,but i was on heparin
at the time,just when they did it my inr was at 3.6
So is this a hematoma i got,then and what should i
be watching for if anything,or is this totally i am out
to lunch???? I'm back on warfarin since i came home
the heparin was removed last tues they want inr between
2 and 3 which it is,so cant or can go from a leg bleed to
a brain bleed right or can it because of the inr?
If totally out to lunch on this matter,i'll leave now
Anyhow it,s an interesting topic Marty,Thanks

zipper2 (DEB)

 

[Eva]

My goodness! Thanks for the info. My INR is in the 4s and yesterday was 7.7 I am still battling to have it stabilized since the surgery and I know it shall, hopefully soon. I was asked to skip the dosage yesterday and today, and have blood tested again on Thursday. I am trying to stay

 

[warrenr]

Ich

Ich

Another way to look at this study is that 80.23% of the patients in the study were not on warfarin when they had intracerebral hemorrhage.

 

[Ross]

So what happened to my bleed on the angiogram
could of pretained to this? I haven't done any reading
up to the vessel bleed that turned my whole leg purple
and sore once they put wires in the vessel,the bleed went
under skin of my leg and still there,but i was on heparin
at the time,just when they did it my inr was at 3.6
So is this a hematoma i got,then and what should i
be watching for if anything,or is this totally i am out
to lunch???? I'm back on warfarin since i came home
the heparin was removed last tues they want inr between
2 and 3 which it is,so cant or can go from a leg bleed to
a brain bleed right or can it because of the inr?
If totally out to lunch on this matter,i'll leave now
Anyhow it,s an interesting topic Marty,Thanks

zipper2 (DEB)

You had an INR of 3.6 AND heparin? No wonder you bled. You shouldn't have been given heparin if your INR was 3.6. You had a major double whammy of anticoagulants.

 

[Karlynn]

Another way to look at this study is that 80.23% of the patients in the study were not on warfarin when they had intracerebral hemorrhage.

This is how I look at it. IMHO - keeping your INR on the higher side of the range is still the way to go. As it was previously mentioned - warfarin doesn't cause hemoragic strokes, but it does help the bleeding along if one occurs for another reason.

We had a member (running a blank on her name) who had several brain bleeds due to a condition that went undiagnosed prior to her getting her mechanical valve. She had her valve for quite a while and was dealing with the brain bleeds. She ended up getting the valve replaced with a tissue valve.

If you read the article, you'll also notice that where the ICH took place also affects the size of the bleed.

Maybe I'm construing this incorrectly, but the risk % isn't any greater for an INR >3.0 than the overall risk factors for bleeding and stroke with a mechanical valve - small.

 

[Mary]

This is how I look at it. IMHO - keeping your INR on the higher side of the range is still the way to go. As it was previously mentioned - warfarin doesn't cause hemoragic strokes, but it does help the bleeding along if one occurs for another reason.

We had a member (running a blank on her name) who had several brain bleeds due to a condition that went undiagnosed prior to her getting her mechanical valve. She had her valve for quite a while and was dealing with the brain bleeds. She ended up getting the valve replaced with a tissue valve.

If you read the article, you'll also notice that where the ICH took place also affects the size of the bleed.

Maybe I'm construing this incorrectly, but the risk % isn't any greater for an INR >3.0 than the overall risk factors for bleeding and stroke with a mechanical valve - small.

Giselle was the member you're referring to, Karlynn.

 

[Ross]

Madame Giselle, we we.