How did this happen?

[Patsman07]

Getting my bicuspid aortic valve replaced in a couple of weeks due to left ventricle dilation. Still undecided on a valve but Was researching warfarin and playing football and I came across this story: http://www.dailymail.co.uk/news/art...-dies-brain-haemorrhage-heading-football.html

Basically its about a middle-aged man who was on warfarin who died after he headed a soccer ball. Heart goes out to him and his family, terrible tragedy.

This seems to be completely at odds with the vast majority of posts I have read on this site, so how could this happen? Would his INR have been too high maybe? And is the statement in the article that warfarin 'can weaken the blood vessels in the brain' correct?

 

[chaconne]

I suppose this is just a risk we all have to deal with being on Warfarin. I wouldn't be surprised if there are thousands who play football while on warfarin and haven't had a problem heading a ball. Maybe some members on this site who regularly play while on Warfarin will speak to it. I suppose the risk varies from person to person, how hard the ball was hit, how high the INR etc... I suppose it was a combination of factors that pushed him over the edge.

Personally, I try to avoid any kind of blow to the head myself, big or small. I do mountain biking and riding in light traffic, but I hope to avoid falling and hitting my head.

 

[tom in MO]

"Consultant neurosurgeon Ajit Sofat told the Macclesfield inquest the Warfarin effect was probably the cause of Mr Belk's death, although he could not say for sure." That's a new term "Warfarin effect".

Headers in soccer have been controversial for a number of years. Just like any contact sport, intential brain truama has been found to be bad news, take boxing and US football for example.

Why blame the warfarin and not the doctor that did not tell him that headers are dangerous for anyone, particularly for anyone in their 40s (e.g. neck injuries) and totally not advised if you are on warfarin. Why blame the warfarin and not the man who should have known better than to do a header on warfarin?

When I got on warfarin, I did not stop riding my bike, but now use a helmet.

 

[chaconne]

When I got on warfarin, I did not stop riding my bike, but now use a helmet.

It seems that falling off the bike and hitting one's head, even with a helmet on, can be a lot more dangerous than heading a ball in soccer/football. The difference is that you plan on heading while playing football, but hopefully will never need to use the bike helmet.

 

[Cooker]

Most of us have a choice on valve type and therefore the warfarin or no warfarin choice is ours as well. I chose to try and avoid a second OHS and therefore chose warfarin. I put no restrictions on my activities. Getting out of bed in the morning is taking a chance.

 

[pellicle]

Hi Patsman

I guess I can call myself an Irishman too (I guess you may have seen my post about going back there recently here)

Still undecided on a valve

understandable, when a choice is difficult then it usually means both are good options

This seems to be completely at odds with the vast majority of posts I have read on this site

I'm not quite sure that I see it entirely that way. For instance a person I know (in their early 30's) died the day after having her first baby from a brain hemorrhage and she was not on warfarin. People do die from bleeds and aneurysms and unless they are on warfarin noone says "oh its the warfarin" ... would the same have happened had he not been on warfarin and done the same thing? Hard to know. Perhaps he may have had a lesser bleed, been permanently brain damaged and a vegetable ... which is better?

AFAIK warfarin does not cause vascular disease (I was not on warfarin when they identified my aneurysm) so does not in itself cause bleeds. It only makes them take longer to stop. Depending on the situation that may make no difference at all in the outcome.

As I have also previously written, I've walked away from motorbike accidents without serious injury (bike hit a bridge when I was forced off the road) and was a mangle, I went down the embankment and got a dislocated shoulder. Other friends have simply had a slide at low speed and been killed without a serious mark (leathers, but spine broken).

You just can't predict nature

 

[T in YVR]

And is the statement in the article that warfarin 'can weaken the blood vessels in the brain' correct?

Personally I don't believe this statement about warfarin weakening blood vessels. I have spent a good deal of time lately talking to doctors about the brain, warfarin, internal bleeds, and bad hits to the head and this is not what I have ever read or heard (I took a very bad blow to my head and was knocked out and concussed 3 months ago. Fortunately there was no bleeding near my brain). Perhaps this person had a pre-existing situation, or predisposition to this that unfortunately left him very vulnerable to rupturing a blood vessel if he took a blow to the head. Now, warfarin does not necessarily help the situation in that you may bleed for a more prolonged period of time. But I doubt it would "weaken the blood vessels". Based on what the doctor told me at the hospital, you also do become more susceptible to internal bleeds in the brain as you age due to the normal aging process of your arteries and blood vessels.
T

 

[dick0236]

This seems to be completely at odds with the vast majority of posts I have read on this site, so how could this happen? Would his INR have been too high maybe? And is the statement in the article that warfarin 'can weaken the blood vessels in the brain' correct?

"how could this happen"......who knows. My neighbor, in her early 70s, recently fell in a hospital, hit her head, suffered a brain bleed, required emergency surgery.......and she is not on warfarin. Sometimes "**** just happens"....pardon my crude choice of words.....but it is just life. I have had my share of injury to the head over the years (including being hit in the back of my head by an operating ceiling fan...long story....took 12-14 stitches, I think). Didn't even get a headache...go figure.

"Would his INR have been too high"....maybe, but his was a "vein tear", not bleeding thru the wall of a vein. Just as likely that it was just trauma from the soccer ball.

"can weaken the blood vessels in the brain". I've never had a doctor mention this and after 47 years on warfarin I can say it ain't happened......yet.

 

[Protimenow]

I haven't seen anything about warfarin weakening blood vessels -- it doesn't sound like there would be any particular mechanism for it to do this. i suspect that this poor guy had a week vessel already, and the impact with the soccer ball was enough to rupture the vessel. Whether or not this person was on coumadin/warfarin is immaterial -- at the location in the brain where this rupture occurred, the result would have been catastrophic in any event.

Personally, I got a concussion when a dishwasher that I was helping load into a car was released by the person who I was helping--and hit me in the head. An MRI showed no damage, but it was certainly not a bad idea to check and make sure.

I doubt that the 'warfarin effect' on vasculature exists, and I certainly wouldn't use this article to influence a decision regarding my choice of valves.

When I got my valve - at 41 years old - my only reasonable choice was mechanical. I'm not sorry that I made that choice.

 

[Superman]

There are higher instances of aortic aneurysm in those with bicuspid aortic valve disease. I have also read this is true of brain aneurysms as well. Studies are early yet, and I'd have to play on google to post one, but I believe I've linked them on this site before. Some research indicates that there is a broader connective tissue disorder present in some BAV patients.

Individuals born with biscuspid aortic valve are far more likely to have aortic valve replacement and many of these individuals will choose a mechanical valve. All patients with a mechanical valve will be on warfarin.

The article appears to employ the classic logical falicy post hoc ergo proptor hoc, after therefore because. The individual may have had a broader connective tissue disorder, and the hemorage was a part of that. Not saying warfarin helped here, but accidents do happen.

Right now the instep of my right foot is a very pretty blue and purple from a shin bruise draining into it. My 12 year old pitches, and it's getting to where I can't practice with him anymore unless I invest in full catchers gear. Took one in the dirt and off the shin. I think he's going to break my hand using my regular glove. I'm sure the bruise is a lot more colorful than it would have been in a non-warfarin individual.