Two mechanical valves and had a bad head injury

[bratbuz]

Hi ;

My wife has two mechanical heart valves aortic and mitral. She is on Coumudin with INR 2.5-3.5. Two weeks ago, she had an innocent fall on her head. She did not lose conciousness and she was rushed to emergency. She was given Vit-K to reverse blood thinning. They stopped Coumudin. It looks like CT scan revealed that she had small brain bleeding and after 6 hours - it spread extensively. She has brain bleeding subdural hemetoma. Apart from mild headachae , she does not show any other symptoms. She is still in Hospital. Her brain bleeding was stable and doctor was thinking to start Heparin after 2 weeks. But then blood that filled brain broke down and spread became more. They postponed starting Heparin. Finally they are planning to start it tomorrow after 20 days. Both cardiac and Neuro teams are working closely. There is chance of fresh bleeding again when they start Heparin. Doctors are putting various options on the table based how situation evolves - including Brain Surgical drainage or Craniotomy. It looks very scary. I am seeking your views if any of the families have experienced similar situations. I also seek your prayers. Thanks and Regards

 

[vitdoc]

No personal experience. But with two mechanical valves the risk of a clot from the valves or a clot occluding the valves is not insignificant while off anticoagulation . The proverbial caught between a rock and a hard place. My only statement that may be of some use is that each medical specialty sometimes looks at things a bit myopically through their specialty. So the neuro people worry about the brain and may not worry too much about the heart. The heart people visa versa. So it is important that the two groups talk to each other to make sure that everything is taken into account and hopefully come up with the best plan for both issues. In theory after three weeks the initial source of the bleeding should have healed up so dealing with the brain may not be that difficult now. But I am not a neurosurgeon so I would listen to their input but perhaps ask a few questions.

 

[Warrick]

I feel for you immensely and can only hope things improve for your wife.

I know how scary bleeding and worrying about clots happening is when its in front of you. My father who also has a mechanical valve had carotid endartardectomy surgery last month after permanently losing sight in one eye, he had a further 3 surgeries in the space of several days to stop internal and external bleeds from the site. My fathers very forgetful and doesn’t take things in so I made sure I was there every step of the way as it was very touch and go at one point.
Truly best wishes

 

[tom in MO]

Hi ;

My wife has two mechanical heart valves aortic and mitral. She is on Coumudin with INR 2.5-3.5. Two weeks ago, she had an innocent fall on her head. She did not lose conciousness and she was rushed to emergency. She was given Vit-K to reverse blood thinning. They stopped Coumudin. It looks like CT scan revealed that she had small brain bleeding and after 6 hours - it spread extensively. She has brain bleeding subdural hemetoma. Apart from mild headachae , she does not show any other symptoms. She is still in Hospital. Her brain bleeding was stable and doctor was thinking to start Heparin after 2 weeks. But then blood that filled brain broke down and spread became more. They postponed starting Heparin. Finally they are planning to start it tomorrow after 20 days. Both cardiac and Neuro teams are working closely. There is chance of fresh bleeding again when they start Heparin. Doctors are putting various options on the table based how situation evolves - including Brain Surgical drainage or Craniotomy. It looks very scary. I am seeking your views if any of the families have experienced similar situations. I also seek your prayers. Thanks and Regards

Sounds real scary. I don't know much of anything, but I will pray. I agree with Vitdoc, make sure the two groups of doctors talk to each other. I had a friend who wasn't on warfarin but had the same problem from a head injury. It took quite a while for the blood to dissipate, but he had no long term problems.

 

[pellicle]

My wife has two mechanical heart valves aortic and mitral. She is on Coumudin with INR 2.5-3.5. Two weeks ago, she had an innocent fall on her head

may I first ask how old is your wife?

Having lost my wife to a brain bleed (who was only 33 and not on warfarin) I have some concept of how you must feel right now.

My first thoughts are that so far noone has mentioned tPA see that link. Its role is a clot buster and is the first on the list employed by those experienced in managing strokes. Somehow despite being know clinically for nearly 20 years many seem to not have heard of it. From that above link

Use of tPA in the United States in treatment of patients who are eligible for its use, have no contraindications, and arrival at the treating facility less than 3 hours after onset of symptoms, is reported to have doubled from 2003 to 2011.

Heparin is an anticoagulant, and it to my understanding has no role in breaking down clots, simply preventing them, same goes for warfarin. I suspect that the very mention of thinners in "blood thinners" has people (medical people included) thinking as if this acts like "paint thinners" when it does nothing of the sort.

I hope your team works together and I strongly urge you to mention tPA to them, and ask about its use and why it may not be used. I hope your wife recovers and things get back to normal.

Reach out if you need someone to listen.

 

[angiedavis]

I am sorry to hear about your wife. I wish her a speedy recovery.

 

[bratbuz]

No personal experience. But with two mechanical valves the risk of a clot from the valves or a clot occluding the valves is not insignificant while off anticoagulation . The proverbial caught between a rock and a hard place. My only statement that may be of some use is that each medical specialty sometimes looks at things a bit myopically through their specialty. So the neuro people worry about the brain and may not worry too much about the heart. The heart people visa versa. So it is important that the two groups talk to each other to make sure that everything is taken into account and hopefully come up with the best plan for both issues. In theory after three weeks the initial source of the bleeding should have healed up so dealing with the brain may not be that difficult now. But I am not a neurosurgeon so I would listen to their input but perhaps ask a few questions.

Vitdoc, thank you so much for providing so detailed tips and suggestions. Quick update on my wife's status. After 23 long days after the fall, finally docs started Heparin and she has been stable for last 2 days. They are doing blood work and CT scan looks to be stable. She does not show any symptoms. They will slowly ramp up and monitor her for next few days. They may switch to Coumudin in next few days. It is a slow process and we need to be patient. Neuro team really pushed back on starting blood thinners as there was not much of margin of error with brain bleeding. Cardio team wanted to start blood thinners after 2 weeks. In each of my conversations, I requested them to consult other if they are not doing. They were kind enough to listen to me. It looks like this timing was good overall. I will update you folks during her recovery. Thanks very much for all your responses, prayers. This is great support forum with people full of blesses hearts. Regards..

 

[bratbuz]

I am sorry to hear about your wife. I wish her a speedy recovery.

Thank you..

 

[bratbuz]

I feel for you immensely and can only hope things improve for your wife.

I know how scary bleeding and worrying about clots happening is when its in front of you. My father who also has a mechanical valve had carotid endartardectomy surgery last month after permanently losing sight in one eye, he had a further 3 surgeries in the space of several days to stop internal and external bleeds from the site. My fathers very forgetful and doesn’t take things in so I made sure I was there every step of the way as it was very touch and go at one point.
Truly best wishes ‼

Thank you sharing your father's story. Thanks very much for your wishes.

 

[bratbuz]

Sounds real scary. I don't know much of anything, but I will pray. I agree with Vitdoc, make sure the two groups of doctors talk to each other. I had a friend who wasn't on warfarin but had the same problem from a head injury. It took quite a while for the blood to dissipate, but he had no long term problems.

Thanks for sharing your friend's incident. In my wife's case docs say it will take few weeks for blood to get absorbed. We need close monitoring for sure..

 

[bratbuz]

may I first ask how old is your wife?

Having lost my wife to a brain bleed (who was only 33 and not on warfarin) I have some concept of how you must feel right now.

My first thoughts are that so far noone has mentioned tPA see that link. Its role is a clot buster and is the first on the list employed by those experienced in managing strokes. Somehow despite being know clinically for nearly 20 years many seem to not have heard of it. From that above link


Heparin is an anticoagulant, and it to my understanding has no role in breaking down clots, simply preventing them, same goes for warfarin. I suspect that the very mention of thinners in "blood thinners" has people (medical people included) thinking as if this acts like "paint thinners" when it does nothing of the sort.

I hope your team works together and I strongly urge you to mention tPA to them, and ask about its use and why it may not be used. I hope your wife recovers and things get back to normal.

Reach out if you need someone to listen.

Thanks Pellicle for sharing info on tPA. I did not know about it till now and I will try to learn more before I check with docs for sure. This is so timely and valuable. Regards.

 

[bratbuz]

Thanks Pellicle for sharing info on tPA. I did not know about it till now and I will try to learn more before I check with docs for sure. This is so timely and valuable. Regards.

Sorry I forgot to respond to your earlier part of your message. My wife is 50 years old. I am sorry to know about your loss. Regards..

 

[pellicle]

My wife is 50 years old.

ok ... good to know, that helps with survial in this situation. I'm not sure if you know of it (I'm a motorcyclist among other things so I do but the Injury Severity Score (link) has some relationship to age, but the literature is poor. I would say that's because 1) few studies of worth 2) quite a variability with peoples condition vs aging. I see 80y'olds who are stronger than 40 y'olds:
https://www.sciencedirect.com/topics/medicine-and-dentistry/abbreviated-injury-scale

While mortality from injury is correlated with Injury Severity Score and increasing age, prognosis on admission to the ICU is not always clear for every patient.

But I was concerned if your wife was elderly (which would be a bad thing).

Best Wishes

 

[Astro]

Hopefully your wife is now getting back to normal. This event shows the benefit of warfarin‘a reversibility. A scary near miss.

 

[bratbuz]

Follow-up Q ... Since my wife was off Coumudin for 23 days, how do docs find about if there are any clots when there are no symptoms ? Are there any tests ? My wife is also going to ask docs the same Q.

 

[vitdoc]

Again I am not a neuro surgeon but I know a bit about TPA. Tissue plasminogen activator. Basically it breaks down small clots. In neurology it is used in the emergent treatment of ischemic stroke. i.e. strokes caused by a blockage. It is contraindicated in hemorrhagic stokes. So for a brain bleed no TPA. TPA can induce bleeding as a side effect.

 

[pellicle]

Follow-up Q ... Since my wife was off Coumudin for 23 days, how do docs find about if there are any clots when there are no symptoms ?

MRI or CT Scan I thought

 

[pellicle]

It is contraindicated in hemorrhagic stokes. So for a brain bleed no TPA

I'm no vascular surgeon either so I've never looked at it from that angle (just strokes and de-clogging valves). However I looked it up and you're correct, its contraindicated in this situation.

Good thing all we can do here is offer questions to ask not medical treatments ;-)

 

[Warrick]

A transthoracic echocardiogram will show any clots formed on the valve, so your standard ultrasound

 

[sylviayasgur]

Thank you for keeping us updated on your wife's condition. Praying for her continued recovery.