If The Most Disabling Strokes Are Preventable...

If The Most Disabling Strokes Are Preventable...

...why are we not preventing them? Over the course of my 15-year career as a neurologist practicing in hospitals, I have never seen anyone experience an atrial fibrillation stroke, while taking the most effective blood-thinning medications appropriately.

Stroke remains of the most common disabling medical problem there is for adults. The condition affects more than 3-quarter million Americans yearly and ranks among the commonest causes of death.

The 2 major categories of stroke involve:
1. Blood Vessel Rupture
2. Blood Vessel Blockage

The "Blockage" category is by far more common, while "bleeding" strokes due to vessel rupture contribute to roughly 10% of events.

Of the "blockage" variety, the most dangerous type, because of the degree of disability associated, occurs many times, due to the tendency that some people's hearts have to beat irregularly. Irregular heart rhythms are noted as "fluttering" or "fibrillating," hence we refer to these rhythms as atrial fibrillation and atrial flutter.

What is unfortunate is that a heart which beats irregularly has a tendency to develop clots. These clots can travel through the vessels and cause death and major disability, if they find themselves lodged in distal branches, depriving respective brain tissue of newly oxygenated blood. This is the mechanism of stroke for all too many individuals.

The traditional approach to prevention is the use of an anti-coagulant, called warfarin. It's a cheap medicine which causes blood thinning. The goals have been to use warfarin, such that there is blood-thinning twice to three times normal. Irregularity of heart beats increases clot-development potential and stroke, but warfarin-induced blood-thinning limits this potential.

But, the original point - warfarin doesn't just limit the potential - it obliterates it. Again, in 15 years of being on the front-lines of stroke treatment and management, I have never seen a person experience an event if their INR (the index of blood-thinning) is 2.1-3.3
Recently, I came across a patient, who actually monitors her INR at home and checks it, just as a person with diabetes monitors their blood glucose level. She's never too high or too low; if she gets too close to 2.0 or over 3.3, an adjustment is readily made.

NOW, after selling the effectiveness of treatment, it's only fair to mention the potential drawbacks, right... Check it out:

1. Patients may have tendency to spontaneously bleed
2. During a traumatic accident, more bleeding would be expected, leading to greater difficulty getting it controlled
3. Skin-bruising during minor trauma
4. People must maintain regularity with leafy-green vegetables; sudden increases or decreases (in vegetable consumption) changes the medication's metabolism and the INR. Vitamin K, from vegetables inhibit warfarin's function.

I totally love treating stroke, when it occurs, and when people get themselves to medical attention, but shouldn't we use the best approaches to prevent them? People develop atrial fibrillation in advanced age and other times, as result of hypertension and heart disease. The strokes which result can be devastating.

If you know someone with atrial fibrillation, make sure you help them to do the math and consider the risks and benefits of warfarin use, over the alternatives. Ask their physician if he/or she has seen any of their patients have a stroke with warfarin, if the medication is managed appropriately.

The opinions herein are intended for maintenance of health and prevention of potentially devastating disease. This message will hopefully not be interpreted as pro-medicine, but rather as pro-health.


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Saturday, 24 February 2018
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