Dr. Sagar Ramesh Makode
Cardiology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
My 71-year-old mother got a couple of ischemic strokes nearly two months ago. She was then given strong blood thinning injection, which led to a couple of blood vomits and a hemorrhage as well. During the hospitalization as well as afterward, she has been taking Pradaxa 110, etc. (prescription attached). She was hospitalized for about a month and relieved at the end of the month. Now, all went well until last week, when she complained of severe pain in the lower right limb. We did a CT aortogram (report attached) to identify the blockage since the limb was turning green and there was no pulse identified. The blockage was found to be behind the stomach area. She was operated on the same day, and the clots were removed, but the cleaning happened on a dead vessel. Now, again after the blood thinning medication, there is another clot identified in today's MRI in the brain. The blood thickness has risen to 35, and so an injection has been started. She went through a mitral valve replacement 12 years ago. She has undergone a knee replacement on the left leg and has got both her retinas replaced as well. I am requesting your advice to be able to stop the formations of the clots and blockages, which continue regardless. Any other advice or suggestion is welcome.
Hello,
Welcome to icliniq.com.
I have gone through the files attached (the attachment was removed to protect the patient's identity). The clots which are found at so many places in the body are basically originating from the heart and being thrown into the body as she is post-MVR (mitral valve regurgitation) for heart valve problem. So, the adequate treatment is anticoagulation or blood thinning. Currently, she is on Pradaxa (Dabigatran), which is not sufficient and not the recommended anticoagulant medicine for post-MVR patients as it will predispose her to clot formation and may also lead to heart valve dysfunction. So, she needs to take another kind of blood thinner called either Warfarin or Acitrom (Nicoumalone). So, you need to visit a cardiologist and get her started on either of these two instead of Pradaxa. Consult a specialist doctor, discuss with him or her and start taking the medicines with their consent. Although it can slightly increase the risk of bleeding, it does not cause bleeding to the extent of injectable blood thinners. So, certainly, the benefits will be more than the risk. I strongly recommend switching over to these medications and visiting a cardiologist if you are not under the follow-up of same. Hope this helps you and get back if you have any doubts.
Patient's Query
Thank you doctor,
Yes, the dose of Warfarin has been started. Hope this helps her.
Hello,
Welcome to icliniq.com.
Yes, this should help, and care should be taken that INR (international normalized ratio) values should be between 2.5 to 3.5. Below 2.5, it will be ineffective, and above 3.5, it will increase the chances of bleeding. Initially, the INR should be checked weekly for four weeks, then two twice weekly, and then two to three months once. The diet should be roughly the same every day in terms of green leafy vegetables. Take daily approximately the same (moderate) amount of leafy vegetables. Excessive vegetables will hamper their effectiveness. All the best.
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Cardiology
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