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What happens during a stroke? What increases your chances of having a stroke? Stroke basics and info on the two types of stroke here....
Strokes can happen with virtually no warning signs. Learn the symptoms of stroke so that you can take immediate action in case of emergency....
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Q: Strokes
asked by: DoctorQuestion on May 28th, 2008
When we went to the hospital in Las Vegas (Sunrise - very good for stroke patients), the specialists thought my Dad should be on Coumadin, due to his dvt and atrial fibrillation. Even though he had a past hemorrhagic stroke, they felt that this was the best course of action. Now that he is discharged, his primary doctor (they live in a small town about 1-1/2 hours out of Vegas) says he should be off Coumadin, as it could cause another stroke. My Dad did get a filter put in when he was in the hospital. The primary says that is enough, if he goes back on lipitor. My Dad is a fall risk, but I like to think we can manage that with help during the bathing process. What are your thoughts? thanks much


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Dr. Nikola Gjuzelov , MD
replied on May 30th, 2008
Stroke Answer A4216
It is not clear from your question which type of stroke your father had – ischemic (infarct) or hemorrhagic (bleeding). Why they gave him tPA and what happened after that?


Brain infarcts (85%) happen more often than brain bleeding (15%). Brain infarcts occur when thrombosis happens in a brain artery or a thrombus, created outside the brain (embolus), sticks in a brain artery. People with atrial fibrillation (like your father) are susceptible to develop brain infarcts because a lot of blood clots are created in a heart with atrial fibrillation.


Anticoagulant therapy (including Coumadin) is used for treating and further prevention of ischemic strokes. Anticoagulant therapy mustn’t be used in case of hemorrhagic stroke because it can worsen the condition. After the acute phase of hemorrhagic stroke, anticoagulants can be given but with great caution. One year after hemorrhagic stroke I don’t see a reason not to give Coumadin especially when your father still has atrial fibrillation plus deep vein thrombosis (DVT). Basically, hemorrhagic strokes are not due to blood’s decreased coagulation ability but to high blood pressure or brain artery aneurism (weak vessel wall).


Lipitor can be given anyway if your father has increased blood cholesterol.


You may want to consult a neurologist and transfusiologist about this problem.





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