High INR and Stroke(clot)

[tex4ever54]

Last Thursday, I suffered a slight stroke under some strange circumstances that have my Doctors stumped. First of all I have an AVR from On-X (3 yrs). Last Thursday I flew home from Houston (about 1 hr). When I arrived, I went directly to work out where I ran for about one hour and then went into work for about 4 hours. When I went to my car to go home, my hand went numb and after realizing what was happening got to the hospital. Upon arrival and having the blood work done, we found my INR was 5.75. At this news, I REALLY became concerned because I thought that the stroke was a bleeder which as I understand is harder to recover from. As it turns out though, An MRI/MRA showed it to be a CLOT rather than a bleeder. We did Doppler on my legs and found no clotting from the flight. As I said the Doctors are stumped (INR 5.75 AND have a clot????) and could only theorize on where the clot may have originated with most theories pointing to the valve of course. I picked the On-x valve because (theoretically) it seems to be less prone to clots and platelet damage. Anyway, I am beginning my research on the matter and wanted to start with you since you guys have in the past had better answers than do the Doctors. Have yall (Texas term) come across anything similar? Any other resources to check??

Thanks in Advance!!!
Tracy

 

[Ross]

Hi Tracy, where is the clot? Coumadin will not stop you from making one, but it darn sure is very rare that one would form. I'm wondering if it is really a clot and not a piece of cholesterol that broke free and that's what they're seeing. I just can't see it happening with a high INR and an On-X valve to boot.

 

[Mary]

What about the valvular strands that Arlyss has mentioned happening to her husband with a mechanical valve and INR in range?

 

[catwoman]

Tracy:

Ditto to what Ross said.

Just wondering: When was the last time your INR was checked? Just wondering, since your INR was 5.75.

 

[Ross]

What about the valvular strands that Arlyss has mentioned happening to her husband with a mechanical valve and INR in range?

I suppose anything is possible, but with a high INR and an On-X valve? I really don't think so.

 

[AgilityDog]

Between the travel and the work out, could you have been dehydrated? Could a clot have formed because of dehydration, in spite of the elevated INR (perhaps also resulting from dehydration)?

 

[Arlyss]

If this were my own body or my loved one, I would have a TEE done at a major cardiac center to have a very close look at the prosthetic valve. And at everything else that might be a possible cardiac source of particles hitting the brain.

I would have the TEE images reviewed by additional experts if "nothing" is detected by the first opinion.

Other specialties may be helpful also, like hematology.

In situations where things don't make sense, there is an answer but it is going to be difficult to find.

When the brain is at risk, finding those answers is so critical.

Arlyss

 

[Arlyss]

Regarding valvular strands, so little is known about them that rather than speculate, physicians need to look inside with the best tools they have. They also need to search for answers relentlessly.

Not all embolic strokes are blood clots. If it is not a blood clot, where did it come from?

Again, it is critical to find out. I would not rest until every conceivable possibility was explored.

Locally, the routine tests following my husband's stroke could not identify a reason. When he was well enough to go to a major center, with a TEE they looked for many different things. It would have been very easy to miss the strands - I have seen the images - small white dots that move across the field. There are no guarantees, but the odds of getting an answer are increased in a major cardiac center.

Arlyss



Arlyss

 

[lance]

In-range warfarin management

In-range warfarin management

A neurologist told me that properly managed warfarin (always in range) could still result in a clot/stroke.

I thought the On-X would increase chances of being clot/stroke free.

 

[geebee]

Coumadin helps prevents clots that would normally form on a mechanical valve. It does not prevent all forms of clots which is why some of us take aspirin. I would be curious to find out just where the clot originated but I guess that would be difficult (if not impossible) to determine.

Glad things seem to be okay now.

 

[Nancy]

Was it a full stroke or a TIA (transient ischemic attack)? The symptoms of TIAs go away fast. Some of them leave some residue where they have passed through.

I know that Joe had something like 16 TIAs.

He had them when fully anti-coagulated, when his INR was high, when it was low, and when it was right on target.

When I asked his doctors about how come he could have a TIA when anti-coagulated and even with a high INR, they told me that it could be a clot, but could also be other pieces of bodily debris, like pieces of cholesterol, plaque, etc.

He even had a stroke or TIA on the spleen where it left a couple of ischemic areas.

 

[Marty]

Clot while on warfarin?

Clot while on warfarin?

Tracy, I had a clot while anticoagulated. It was in a retinal vein. Well known condition called naturally retinal vein thrombosis. The retina specialists tried every thing including prednisone injections into the eyeball, laser. etc. I can see a little out of the eye but the thrombosis got the macula so I have no sharp vision. I asked every body including friends at the low vision institute at Indiana University - how do you get a clot while on warfarin? Bottom line- nobody knows! Keep us informed on what they do for you and how things turn out. Marty