Need Examples of STROKE after going off Coumadin

[ALCapshaw2]

I find it hard to understand why so many Doctors are more concerned about a bleeding risk for relatively minor procedures than they are about the possibility of having a STROKE.

I'd like to compile a list of examples of patients having a STROKE after going OFF Coumadin to show to my Doctors.
Anybody recall such examples and where I can find the relevant posts?

I recall one example where the 80? year old father of one of our members had a stroke after being taken off Coumadin for a colonoscopy but don't remember the name or date.

Thanks for your help.

'AL'

 

[Ross]

Al it's Warrenr

Here is his profile, click on view all posts by user.

http://www.valvereplacement.com/forums/member.php?u=1179

 

[Guest]

I can remember one of my patient's who went off for a colonoscopy and had a stroke. She went from being an independent person driving her own car to living in a nirsing home. The colonoscopy was negative.

My talk at the October reunion was about people who went on bridge therapy. The ones who had the worst outcomes were the ones who had bleeding episodes. Several went on to heart attacks because they had to stop all anticoagulation. It would seem to me that the best bet would be to have an ingrown toenail removed at the low end of the normal INR range without stopping warfarin. It actually presents a low risk of bleeding.

I went upstairs to ask the podiatrist in our building but I forgot that he doesn't work on Friday's.

 

[Blanche]

Al Capshaw:
It has been my experience that doctors pay little attention to ancedotal information. However, for what it is worth, Albert had two strokes and both times his INR was well below his range. ( INR=1.7 and 1.8) His doctors stated the cause of his strokes was "Coumadin malfunction," meaning that his INR was too low to stop a clot from forming.

I would suggest that you explore the research on dental surgery and anticoagulation, with specific attention to the article by M. J. Wahl, "Myths of Dental Surgery in Patients Receiving Anticoagulant Therapy," Journal of the American Dental Association, January 2000. Doctors may dismiss this research and others of its like because it is descriptive, that is the research describes what has happened in a group of people, rather than experimental research where there is a control group and an experimental group. I have included the conclusions from the Whal study for you. I do believe that this is on point. Hope this helps.
Regards,
Blanche


"Conclusions. Serious embolic complications, including death, were three times more likely to occur in patients whose anticoagulant therapy was interrupted than were bleeding complications in patients whose anticoagulant therapy was continued (and whose anticoagulation levels were within or below therapeutic levels). Interrupting therapeutic levels of continuous anticoagulation for dental surgery is not based on scientific fact, but seems to be based on its own mythology."

 

[Guest]

Doctors (like other people) dismiss anecdotal information when it does not serve their purpose but will put great faith in urban legends to prove their points.

After you gather the information about people having strokes when the went off warfarin, try finding examples of people who bled to death from medical procedures when they were on warfarin. Surley somebody either forgot to tell their doctor that they were on warfarin or purposely hid that fact. This drug has been out for 50 years, somebody must have bled to death - I just can't find any reliable report.

Looking at the National Library of Medicine for articles with the words warfarin, death and laceration produced no articles

Warfarin death and wound give 16 articles

An article by Mina in the Journal of Trauma in 2003 states We conclude that the preinjury use of warfarin does not place the trauma patient at increased risk for fatal hemorrhagic complications in the absence of head trauma.

Ferrera in American Journal of Emergency Medicine in 1999 found that almost all fatal outcomes associated with warfarin in level I trauma center were from head injuries. Most of the complications of treatment came from reversal of warfarin therapy.

These were the only two articles that seemed to fit our interest. The rest were concerned about hip replacement surgery, a Japanese man with a mechanical valve who died after being hit by a truck - they evidently didn't measure his INR on admission and detailed the technique of finding out how much warfarin was in his body by examining specimens from his cadaver. OOPS.

It looks like any technique including removal of the toenail by shotgun blast should result in your living to tell about it, Al.

 

[danielgilboa]

I must say the trend on this thread, suggesting NOT to stop anticoagulation therapy before procedures is revolutionary, at least to me.

The next question would be - what length of "dip" in INR poses a risk greater than haemorage? If they could drop the INR one day, say with vit K and lift it the next with heparin, does this patern also pose a stroke risk?

 

[Guest]

You can do the vitamin K and heparin routine. Everything has some risks. Doctors tend to give to much vitamin K so the person needs heparin for up uo two weeks in some cases. In the US if the person does not have insurance or the insurance won't pay for the low-molecular weight heparin then it costs the person about $100 per day.