coumadin - colitis - lower gi bleed

Mom is 81 and has been on Coumadin for 5 yrs.   Approx 1 yr ago, she had an upper GI bleed  (dark stool) and required several units of blood.  She was taken off Coumadin and stroked; symptoms .     She was treated within 30 minutes with intravenous TPA, with near 100% recovery.    Coumadin was restarted.   11 months later, Mom experienced trace bright red blood with diarrhea.    INR/PT within normal range, and blood count was good.    She was admitted and diagnosed with colitis.  Four days later she was discharged with Coumadin and Plavix, but unable to stand or walk at discharge because her left foot was red and severely swollen.   Mom had extreme pain with only a slight finger touch to her left lower extremity.      She did not leave the hospital and was treated the next day for gout.   GI consult continued and suggested a colonoscopy.     Coumadin and Plavix was d/c for a few days for the test, and ischemic colitis was confirmed.   Slightly weak from the now 10 day hospital stay, d/c to sub-acute rehab was ordered.     Coumadin was not on the transfer order and I raised this fact as a concern to the nurse at rehab admission.    Mom stroked the next day.    I have had 5 different conflicting reports about what was to happen regarding Coumadin, ranging from total d/c, to hold for 1 week, to hold for 1 day, to resume.      TPA was withheld after this stroke, because of GI bleed.    Why would it have been OK to give TPA last year after an upper GI bleed when many units of blood were needed, but it was NOT OK for TPA this stroke following  colitis with trace blood?     Why would Coumadin have been held at all after the colonoscopy?   If it was due to the colitis, why was her first d/c plan inclusive of Coumadin?    Can anyone make sense of the conflicts here?    Please help me understand.

[Kevin Pho, MD]

This is a difficult case in which there is no clear-cut answer.

One one hand, holding coumadin leads to the strokes.  On the other, continuing it causes GI bleeding.

Both situations may lead to dangerous conditions.  I would sit down with your personal physician and assess the risks and benefits of both treatment courses.  Once the risks are understood, then it would be easier to plan an appropriate treatment course.  

However, there is a possibility that either decision may lead to a potentially serious complication and there may be no way around that.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com

[TheDaughter]

Hi,
Thank you for your answer above.  I do realize that every case is different.  There must be some average for risk of stroke if an A-Fib patient has Coumadin held.     Would that average risk be closer to 1% or closer to 90%?   Again, I realize that every patient will be different.   But, there must have been studies that assess averages.

[sassie11]

A related discussion, coumadin was started.

[mikie2]

A related discussion, colitis/coumadin was started.