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Coumadin and strokes

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  • Coumadin and strokes

    We have 670 members on valvereplacement...just read Darren's concern about being low and having a stroke. (INR).. I would like to many members on coumadin have had a stroke? taking coumadin? I just posted today that I had two Cardiologist yesterday to tell me to hold my coumadin for 3 days..prior to having 2 teeth pulled in a few weeks. They were more concerned with my bleeding than having a stroke.....I am talking about NORMAL taking coumadin other health reasons. Like..did you have a stroke off coumadin for minor invasive surgery????? As..Dental work, Colon work, Women things, skin cancer removal..ect. Bonnie

    Bonnie Anderson
    Date of Surgery..3-25-02
    (Aneurysm) AVR 23 mm St, Jude Valve
    Never stand afar and view with fear and trembling that which lies in your way. Face it boldly and see how very small it is, after all.------------------------------------------------

  • #2

    Albert had 3 strokes when his INR was between 1.7 and 1.8. The first was called minor, nothing more than a brain hiccup, or so the hospitalist said. On December 15, 200, while having lunch with friends, he dropped over and passed out. He remained unconscious for several hours. After being hospitalized from Friday to Wednesday morning, he was released. Two days later, as I watched in horror, he had a second stroke that left him unable to speak, walk, use his hands, or have control of any parts of his body. He did not lose consciousness, but could not communicate. After spending 6 days in the hospital, they decided to do an angeogram on him. That night, as I slept on a cot beside his bed, be began to bleed out. One male nurse held him together with his bare hands for nearly an hour. A priest was called for. After 4 hours and numerous shots of vitamin K, and pain killers, the bleeding finally stopped. The next day I had him moved, by ambulance to the Barrows Neurological Center where he stayed for another 9 days. He was released to undergo months of therapy. He made great progress with therapy and we thought it was all behind us until May 16, 2001, five months after his initial stroke, when he, all of a sudden, could not speak clearly. Upon arrival in the ER, his INR was measured at 1.8. His INR, measured at the lab three weeks prior was 3.5.

    What caused Albert's INR to drop no one knows. He had been taking Coumadin for 10 years, 1 month, and 28 days, with no problem whatsoever. Why did he have an anticoagulation failure three times that resulted in two minor and one major stroke? Who knows? It happened and the results were devistating to him, me, and our family and friends. Albert's strokes had nothing to do with dental work. But, I can't understand why any intelligent person would willingly discontinue Coumadin and risk a stroke, however remote, when it is unnecessary and dangerous.

    If you want information and studies on this topic, I have many, including the one I listed. I also have information from The Austrailan Dental Society, the New York State Dental Socitey, the Nassau County Dental Society, Oral Surgeons in metro Atlanta with affiliations with 21 Atlanta hospitals, the University of Michigan Cardio/Vascular and Anticoagulation Unit, as well as research articles from the British Journal of Oral and Maxllofacial Surgery, the Journal of the American Dental Association, and Al Lodwick's site. Recently I read a letter from a dentist in the United Kingdom that stated, "A paper published nearly 20 years ago in the British Dental Journal demonstrated quite clearly this point (namely that there is no need to reduce warfarin providing the INR is within the normal therapeutic range for dental extractions) and since I have NEVER altered the warfarin doses for well controlled patients undergoing dental extractions." {As qutoed from: British Dental Journal, December 21,2002, Vol 193, No. 2.}

    Al Lodwick has mentioned several times the case of a man who received a medhanical valve and had not taken Coumadin for 10 years, and....he was still alive. Not a chance I would take. I also like the saying, you can run across the freeway many times before being hit. While having a stroke in the dentist chair because coumadin was discontinued is very remote (although Al Lodwick was an expert whitness in a court case a where that did happen), if it does happen your cardiologists, dentists, and coumadin nurses, should know that you will have a very good case of malpractice against them, or at least your relatives will.

    If you would like any of the information and research I have mentioned, first read Al Lodwick's materials on dental on his site, then contact me and I will provide what I have. I do care.



    • #3
      Bonnie, I have talked to my cardiologist about concern over periodic low INR's as well as dental work. His response is that with an aortic valve replacement, the INR is not all that important because the blood flows so fast over the valve that its hard for clots to form in the first place so the general risk is low. With mitral valve replacement however, it becomes more important as the blood comes into the heart at a much slower rate and is easier for clots to be created. He also says there is no good reason to stop the coumadin, once on it, for most dental work including pulling teeth (impacted wisdom teeth would be more "surgical" thus different). I am having 2 wisdom teeth pulled in a few weeks and I'm not going to stop the coumadin. At most, I might take the opportunity to bone up on some Greek salads and make some tea to use the tea bags (applied directly) as a coagulant if needed. I guess what I am trying to say is that since you have an aortic valve replacement, either way, you may not be as subject to risk as you would be if you had a mitral valve replacement. I'm certainly not a doctor and even in spite of my also having a "new" aortic valve (5 years old), I'm still not going to stop the coumadin. Not due to fear of stroke, but aggravation of then getting the INR back in range and all that goes with that! This is just "FYI information" as at the end of the day, we all have to either follow our doctors orders or argue for change! Good luck, but I don't think I would be too worried about a stroke and the reasons noted above are probably also why your doctors suggest stopping it. Susan:cool:
      Sunshine Susan


      • #4
        Please feel free to print out my chart at
        it is adapted from the Journal of The American Dental Association.

        The question to ask your doctor is, "Did you ever take care of a gun shot patient who lived?" If the answer is,"Yes." then ask, "Do you really think that I will bleed more than that from having a tooth pulled?"

        Granted an impacted wisdom tooth is more difficult than a simple extraction, but if your cardiologist or dentist wants to vary from the guidelines, ask why.

        Also ask yourself this question -- what would I rather do, sit up all night holding a tea bag on my socket or have a new valve put in?


        • #5
          Granbonny, I'm glad you asked this, because I'm kind of freaked out now. Blanche says Albert had three strokes at 1.7-1.8 and I'm at 1.7 as of Wednesday. Again, they told me to take 9mg instead of the usual 6mg that night and then the usual 6mg each day from Thurs-Sun and check again Monday. Now I'm worried that is too long to wait. The note about the AVR being less suseptable to clotting made me feel better, but not enough! Does anyone think I should pop an aspirin just to be safe? If the slide is from healing (which was suggested since there were no other obvious factors), then it would likely still be falling, no? YIKES! Should I insist they check me on Saturday or is it too remote to worry about? I keep hearing 1% chance of problems per patient-year, but I feel like I'm playing Russian Roulette right now.


          • #6
            Relax Jet, your new to all of this, so cut yourself some slack. Your o.k. Your not holding doses, so your risk is miniscule compared to what Bon is being told to do. ;)


            • #7
              Thanks Ross. I figured I was blowing this out of proportion; I just needed someone to confirm that.


              • #8
                Aspirin works mainly in the arteries and has little effect on blood clots that form under stagnation situations. Stagnation is the problem around mechanical valves because they are not the same shape as natural ones. Eddy currents tend to form more easily around mechanical valves. This is why aortic valves with the faster blood flow are less likely to form clots than mitral valves.

                I have three places where this is discussed in various contexts on my website.






                • #9
                  Just for the record

                  I had one stroke but I had several injections of Vit K when my second subdural was diagnosed, and was totally uncoagulated when it happened. So far.................

                  3 subdural hematomas
                  1 stroke

                  Was on Coumadin for over 21 years. Off Coumadin for three months now.

                  I think it is a big roulette wheel. Some people are luckier than others.



                  • #10
                    Yeah, you ruined somebody's Quality Assurance records. Either that or your old clinic would now be the safest place to go because you had all of the serious events for the next 100 years!!

                    I have always thought that they should put up a sign in the delivery room warning, "Birth will lead to death" so that the kid will know what he/she is up against. Maybe they know and that is why they start crying right away!!


                    • #11
                      For many of the reasons listed above.....I advocate weekly INR testing with my Coaguchek.

                      It is so easy to swing out of range. Most of the time I am within that range, but why take the chance when technology is at our fingertips.
                      All the best,
                      LuvMyBirman :)
                      MVR, 3/99


                      • #12

                        I guess according to the odds that everyone on the board is now safe for the next 100 years, right?

                        Gina, I was in range when I had my second bleed-I had been testing weekly since my first bleed a few years ago with the Protime machine.

                        What's that saying about luck...............if it weren't for bad luck I wouldn't have any at all? LOL


                        • #13
                          Gisele! At the rate some of us are going.....odds of winning the lottery are great!;)

                          Thinking about you. Wishing you all the best!
                          All the best,
                          LuvMyBirman :)
                          MVR, 3/99


                          • #14
                            thin thinner thinnest

                            Hi all... old member here, reporting in... because the topic was timely. Tested this morning at home, and have a 7.2 INR.... have been as high as 11 before without bleeding.. but still makes one a bit nervous. I think it was Gina that taught me about "fixin'" my INR with broccoli and avocado's and stuff.. and it has worked for me like a charm.

                            I have been on Coumadin at 2.5-3.5 for 26 years! Is that a record, I wonder?? Have had three TIA's.... one episode they termed a "stroke".. I am not the perfect patient, but I do watch my INR's closely.... eat a consistent diet and do NOT avoid ANY particular foods. Now, I don't sit down and drink 3 pots of green tea anymore, or eat boiled onions... but generally I eat 5 veggies a day, 2-3 green, and whatever else I want.

                            I too have had INR's at 1.7 or so, and that makes me more nervous than the 7.2.. Wonder what Al would think about that. I have a rather large bruise (the size of Africa) on my right thigh, which was the tip off. Lodwick mentions somewhere in his information about flu shots and an elevated INR, but my flu shot was about 2 weeks ago. Last year it spiked my INR to 8.9... or maxed out my machine.

                            Good to read all your posts... can surely relate to the problems and stresses.. Just hang in, there are ALOT worse things than Coumadin therapy!!


                            • #15
                              With an INR greater than 5, I would hold 1 or 2 days depening n your dose. Then I would re-start about 10 - 15% lower than you were taking. Chances are that after 25 years you have also been on whatever the new dose will be at sometime in the past.

                              I doubt it was the flu shot after that long. Usually that only has an effect for a few days at most.

                              25 years is pretty long but far from a record. At least 2 members her have you beat out - one at over 30 years and one at 43 years. I have corresponded with someone who has been on it since 1958.