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Stroke, Mechanical Valve, restarting Coumadin
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Stroke, Mechanical Valve, restarting Coumadin

Our mother/grandmother had a massive stroke on the right side of her brain, 2 weeks ago today. This happened after having been taken off of coumadin, for a 24 year old mechanical heart valve, during a bypass surgery. Following the surgery, her doctors, thinking she had a biological valve, kept her off the coumadin due to an increased risk of GI bleeding.

To prevent a second stroke, and to accelerate her recovery, we've tried explaining to her doctors that she has a mechanical valve. But for 2 weeks, they have insisted that she has a pig valve. Finally, we've been able to hunt down sufficient evidence that she has a mechanical valve, and the doctors have acknowledged they made a mistake. But now the doctors are saying that they still don't want to put her on coumadin, due to the recent problem with GI bleeding during the bypass surgery. The doctors are calling this a history of GI bleeding, though she has never had a bleeding problem in her life.

Everything I've read from academic journals stresses the importance of being put back on anticoagulants within a week after stroke. This is supposedly necessary to sustain recovery, and we are worried that her slow (though steady) recovery is due to a lack of blood flow to the brain; this obviously raises the fear that she will have a second stroke.

How long would it be appropriate to wait to be put back on coumadin, given a mechanical heart valve, and a single incidence of bleeding?

Thank you.
Avatar_dr_f_tn
Hello and hope you are doing well.

Is the stroke ischemic or hemorrhagic? Therapy with Coumadin is a balance between bleeding and clotting. All the pros and cons need to be weighed, if the blood is too thin at present, it will further aggravate the bleeding episodes. It’s unfortunate that after 24 yrs, withdrawal of Coumadin has triggered an episode of stroke. Right now the progress with Coumadin has to be based on the INR status. Patients on warfarin should have an INR of 2.0 to 3.0 for basic "blood-thinning" needs. For some who have a high risk of clot formation, the INR needs to be higher - about 2.5 to 3.5. Only monitoring can help decide when  she needs Coumadin therapy.

Hope this helped and do keep us posted.
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