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tazi0
@tazi0

Posts: 1
Joined: Oct 03, 2016

Balancing risk: Hemorrhagic stroke and Afib

Posted by @tazi0, Oct 3, 2016

I am 70 year old woman who temporarily lost the ability to grasp with the fingers of the left hand. A CT scan and MRI showed a small brain bleed in the middle of the right hemisphere. Function returned quickly but an event monitor that was worn for 20 days showed two confirmed instances of Afib but no symptoms of the condition. Follow uo MRI after the blood had been reabsorbed showed no abnormality in the region of the bleed. How to balance the risk of taking blood thinners for Afib to prevent a stroke caused by a clot with the risk of causing another hemorrhagic stroke?

REPLY

Hello @tazi0 and welcome to Mayo Connect. I’m sure that you will find this a supportive community to share your questions and concerns. I’m glad to see that your follow up MRI was good and no abnormality showed up in the area of the brain bleed. The question of taking a blood thinner for stroke prevention is a question you should address with your doctor. Undoubtedly stroke survivors will probably weigh in on your posting and will offer their own experiences as to what they have done for stroke prevention. As strokes can be very debilitating and result in both physical and cognitive impairment it is my hope that you think through the matter and make a decision that is in your best interests.

@tazi0, I can fully understand your quandary about a-fib and blood thinners. My a-fib showed up on my annual EKG two years ago. I had no symptoms then or, in fact, since then — other than the somewhat irregular heart beat that has been with me for 20 years or more. But on the urging of my primary physician and my cardiologist, I immediately began Coumadin therapy to reduce the risk of clots forming in the atrium of my heart and getting sent out to my body. I’ll not regret accepting their advice, although I have no conscious recognition of any symptoms.

So why Coumadin? Because its blood-thinning can be stopped with an antidote that is readily available while drug companies have not yet marketed antidotes for any of the other blood thinners. Coumadin therapy involves regular lab tests (mine occur once every six weeks now) to check my blood for its coagulation index. The inconvenience is minimal and the peace of mind is priceless. I have to avoid eating excess amounts of food with Vitamin K in them, but that too is easy to do.

I have no personal experience with a brain bleed, so I’ll give only two recommendations: 1) list your best questions about the risks of anticoagulant therapy and have a long talk with your medical team about them; 2) as to which anticoagulant to consider, give special attention to Coumadin, its benefits, and its challenges until an antidote comes on the market for one of the other drugs.

@taziO,
this is a very, very difficult question you ask. there are no guidelines for this problem. I read in a german medical paper (februar this year), that the decision should be taken by the neurologist AND the cardiologist together,, in particular as to the reason for your hemorrhagic stroke. I would recommend you to stop thinking about it and leave the decision to the doctors who are involved .
this is a problem that is discussed in the meetings of several cardiologist societies, all over the world. until now there is no agreement, but it is clear that every patient needs an individual approach.

Hi Tazio,
As fellow members @hopeful33250 @predictable and @yoannehave pointed out, this is not an easy question to answer. In fact, we took your question to a Mayo Clinic pharmacist and this is what she recommends:

“The title of your question sums it up pretty well. It’s all about balancing risk. There is no good answer for this. It’s important to have very in depth conversations with your health care provider to determine if you are at greater risk for either a clot or a stroke and where to go from there.”

@colleenyoung

Hi Tazio,
As fellow members @hopeful33250 @predictable and @yoannehave pointed out, this is not an easy question to answer. In fact, we took your question to a Mayo Clinic pharmacist and this is what she recommends:

“The title of your question sums it up pretty well. It’s all about balancing risk. There is no good answer for this. It’s important to have very in depth conversations with your health care provider to determine if you are at greater risk for either a clot or a stroke and where to go from there.”

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@tazi0
hello!
nearly one month has passed, since you posted your difficult question. did you discussed it with your medical team in the meantime? I would be very pleased, if you could let us know.
a couple of days ago I read an article about a preventive measure in your left atrium for A-Fib. it is called LEFT ATRIAL APPENDAGE CLOSURE (LAAC). in the heart center, where I was treated, this is becoming more and more popular. the great advantage is that patients no longer need oral bloodthinners. did your medical team discussed this option with you?
yoanne

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