How can blockages be prevented post-ischemic stroke?

Question

Hello doctor,

My 71-year-old mother suffered a couple of ischemic strokes nearly two months ago. Following this, she was given a strong blood-thinning injection, which resulted in episodes of vomiting blood and a hemorrhage. During her hospitalization and afterward, she has been taking Dabigatran 110, among other medications (prescription attached). She was hospitalized for about a month and was discharged at the end of that period.

Everything was going well until last week when she complained of severe pain in her lower right limb. We conducted a CT aortogram (report attached) to identify any blockages since the limb was turning green, and no pulse could be detected. The blockage was found to be located behind the stomach area. She underwent surgery the same day, and the clots were removed; however, the cleaning occurred on a dead vessel.

Now, following the blood-thinning medication, another clot has been identified in her brain in today's MRI. Her blood thickness has risen to 35, and she has started an injection to address this. She underwent a mitral valve replacement 12 years ago, and she has also had a knee replacement in her left leg and both retinas replaced.

I am seeking your advice on how to prevent the formation of clots and blockages, which seem to persist. Any additional advice or suggestions would be greatly appreciated.

Answer 1

Hello,

Welcome to icliniq.com.

I have reviewed the attached files (attachments removed to protect the patient’s identity). The clots found in multiple areas of the body primarily originate from the heart, as she is post-mitral valve replacement (MVR) for a heart valve issue. Therefore, appropriate treatment involves anticoagulation or blood thinning. Currently, she is on Dabigatran, which is insufficient and not the recommended anticoagulant for post-MVR patients. This medication could predispose her to clot formation and may also lead to heart valve dysfunction.

She needs to switch to another type of blood thinner, such as Warfarin or Nicoumalon). It is essential to visit a cardiologist to initiate treatment with one of these alternatives instead of Dabigatran. Please consult a specialist, discuss the options with them, and start the new medications with their approval.

While these alternatives may slightly increase the risk of bleeding, they do not carry the same risk of bleeding as injectable blood thinners. The benefits of switching medications will certainly outweigh the risks. I strongly recommend making this change and consulting a cardiologist if you are not already under their care.

I hope this information is helpful; please feel free to reach out if you have any questions.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

Yes, this should help, and it is important to ensure that the INR (International Normalized Ratio) values remain between 2.5 and 3.5. An INR below 2.5 will be ineffective, while an INR above 3.5 increases the risk of bleeding. Initially, the INR should be checked weekly for four weeks, followed by twice weekly for two weeks, and then once every two to three months.

The diet should remain relatively consistent each day in terms of green leafy vegetables. Aim to consume approximately the same moderate amount of leafy vegetables daily, as excessive intake may hinder their effectiveness.

Thanks and regards.