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March 9th, 2010
Stroke Drugs May Increase Risk of Excess Bleeding

Patients who have been taking the anti-clotting drug Coumadin as treatment for a stroke caused by a blocked brain artery have been found to be considerably more likely to have excess bleeding after treated with tPA, new research suggests.

A small study was recently completed, wherein researchers noticed a 10-fold risk increase among the patients taking Coumadin [warfarin]. Study author Dr. Shyam Prabhakaran, an assistant professor of neurological sciences and head of the stroke program at Rush University Medical Center in Chicago says “I think we have raised a doubt that hasn’t been looked at before and should make us be sure that tPA is safe for these patients before we move forward.”

The clot-dissolving drug tPA, or tissue plasminogen activator, is currently the first treatment option used to dissolve a clot that is blocking a brain artery. The drug is given within three hours after the first symptoms and can only be given as late as four and a half hours in special cases. However, guidelines say that the drug is only meant for situations when a measurement called the international normalized ratio, or INR, which is used to measure the tendency of blood to clot, is 1.7 or lower. Higher INR rates mean a greater likelihood of bleeding.

The study reported on the effects of tPA in 107 patients who had suffered from ischemic strokes caused by a blocked artery, since 2002. From the 13 people who had been taking Coumadin before their stroke, 30.2% experienced excess bleeding, compared with 3.2% of patients not taking the drug.

“This is an important study that talks about the risks we are well aware of when we use tPA for ischemic strokes”

However, Prabhakaran was fast to focus on the faults of the study. “It is a single-center, retrospective study and not large enough so that it could be affected by sample size,” he said. “We need a larger data set from more centers.”

A substantial amount of Americans, many of them elderly, take Coumadin for various reasons such as preventing problems from atrial fibrillation, an abnormal heart rhythm, and to prevent clots from forming on artificial heart valves. Experts agree that more attention must be paid when considering treatment for ischemic stroke, but it should not make medical professionals deviate from the current treatment guidelines.

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