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Stroke v Bleed risk.

BobD profile image
BobDVolunteer
34 Replies

I was just reading an article about MTR. Mechanical Thromboectic Retrieval which is available at a few hospitals in UK and although under development is showing great results in recovery from serious thrombotic strokes. What it did say is that sucess falls by 5.7% PER HOUR delay . (The article is in our local air ambulance news letter as they are corrently working with our local hospital to save on average nearly and hour and a half transfer time to the nearest MTR centre. )

Now we know that AF makes us five times more likely to have a stroke.( per year that is) and that anticoagulation reduces that risk by around 70%. We also know that whilst 20% of all strokes are AF related, these account for 80% of the least recoverable ones.

We see on this forum a trend for newly diagnosed patients being terrified of bleeding when told they need to take anticoagulants. I have always believed that a lot of this fear is generated by the missuse of the term blood thinners which lazy way of descrbing these drugs can lead the un initiated to think that blood may become so thin as to leak spontaneously. Obvously this is not the case but we have to acknowledge that any injury which causes bleeding may take longer to stop. For this reason people on anticoagulants are recommended to seek medical attention in the event of a head injury.

What I learnd today was that only 15% of all strokes are haemorrhagic (bleeds) and this does include all the thousand of people who take anticoagulants. I always knew that the numbers were low compared to clots but had never seen any numbers to back that up.

Now I know that there are lies, damned lies and statistics but that particlular one seems comforting.

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34 Replies
Lilypocket profile image
Lilypocket

Thank you for the information Bob. It is very annoying that Doctors who should know better and even medical articles still refer to anti-coags as blood thinners. But your post will set a few minds at rest concerning the risks.X

Cavalierrubie profile image
Cavalierrubie

Very good and comforting news. I am sure we all think the same re. bleeding and it’s always a concern, so thank you for sharing that valuable piece of info.

baba profile image
baba

I know someone who had this done in Leeds, several years ago. The stroke/clot was from an undiagnosed congenital "hole" in the heart, not sure of the details. This person was lucky that the stroke was witnessed and got to hospital in very short time. Left hospital a week later with none of the usual stroke effects. Time is crucial, clot retrieval must be done asap after stroke, I think it was said within the hour.

NHS information link:

nhs.uk/conditions/stroke/tr....

Camelia23 profile image
Camelia23

Thank you, Bob. When I go to the surgery for jabs I'm asked whether I'm on blood thinners. I don't like to say, actually they're anti coagulants, in case I come across as the class swot and get an extra sharp jab. I suppose I could rephrase it and say that I was told they're not blood thinners but anticoagulants.

Nick1957 profile image
Nick1957

Stroke v bleed risk. Recently my mum was admitted into hospital suffering from an uncontrolled bleed from her back passage. Consultant/doctors immediately halted her aphixaban! The bleeding stopped after various treatments however after 3 days after discharge she was told to restart Aphixaban which she did. Almost a day later she suffered a stroke on left side of brain which resulted from that open window when advised to stop taking aphixaban. We're all perplexed that there were no safeguards in place when aphixaban was halted ie soluble asprin as a substitute! I understand that the bleed was priority but what about stroke risk. Mum has suffered some memory recall function but is now home after being sent to Neurology Queens Sq London she is doing very well but can't help thinking about consequences of stroke v bleed risk

wilsond profile image
wilsond in reply to Nick1957

Does seem odd,when my dad had his various operations on warfarin,he had clopidogel injections to bridge the gap

BobD profile image
BobDVolunteer in reply to Nick1957

Aspirin has little benefit in stroke prevention and in fact can exacerbate internal bleeding. The only ever nose bleeds (uncontrolled swim out of bed type) I have had have been whilst in hospital and taking clopidogrel or aspirin as prescribed despite my warnings to doctors as to likely conseqeunces. Some things happen sadly and there should be no blame.

john-boy-92 profile image
john-boy-92 in reply to BobD

I attended an initial meeting about the gene that metabolises clopidogrel. Some people have a mutation of that gene that means clopigrel is less effective. The study evaluates the economics of gene testing, and the alternative medication whilst waiting for thg e results. How many medications do we take without knowing whether we metalbolise them?

Nick1957 profile image
Nick1957 in reply to BobD

Not looking to blame anyone Bob - trying to get my head around it!! I want to know if there are any safeguards in terms of medication which reduces the risk of blood clots when anti - coags are halted. Mums only new change after the stroke is soluble aspirin and is still taking them whilst still off aphixaban. Apixaban restarts on 7th December! Is there a risk of more blood clots.? Can we quantify the risk?

Singwell profile image
Singwell

This is very interesting Bob, thanks for sharing. I'm not clear about the difference between a stroke and a bleed. I thought they were one and the same. Could you say more? Sorry if I'm being dim, but I bet I'm not alone!

BobD profile image
BobDVolunteer in reply to Singwell

A stroke or brain attack is when for whatever reason the blood supply to part of the brain is cut off causing death of that area.

Most strokes 85% are caused by blood clots whch is why anticoagulation is so important for people with AF. These are Thrombotic strokes (Thrombus = clot).

Bleed or Haemorrhagic strokes are caused by a burst blood vessel in the brain depriving an are of blood supply. Same result different cause.

Hope the helps. B

Singwell profile image
Singwell in reply to BobD

Yes, it does. The haemorrhagic bleed factor is what we fear re anticoagulants but the thrombotic strokes are what they address. And out of all strokes only 15% are the former type. Have I got it now?

BobD profile image
BobDVolunteer in reply to Singwell

100%

john-boy-92 profile image
john-boy-92 in reply to BobD

I recal that my bleed became a haemorragic transformation four weeks after the stroke. The symptoms were the same as a subarrachnoid stroke but the two GPs who attended, didn't diagnose / recognise that. When my excellent neurologist returned from holiday, she immediately called me in for an emergency CT, but that delay meant the results were inconclusive.

Eighteen months earlier, I thought that I could have AF and asked an EP about anticoagulation. No, came the reply, your heart rate is due to your high level of cardio fitness (I was a runner) and, had been through pulmonary toxicity. I try through this forum and in sessions with medical professionals and medical students, to emphasise the importance of anticoagulants. As to bleed risk, I am a volunteer in a nature reserve, and I use a billhook, a slasher, a bow saw with a rip blade, and a commercial hedgecutter. I don't know if my local hospital stocks Praxbind (the antidote to Pradaxa). My only bleed problem was a colonoscopy that removed a 20mm flat polyp just below the exit from the stomach. The scab gave way seven days after the colonoscopy and I passed what seemed a lot of blood. That said, I'm still here being a pain in the ****, long may it be so!

wilsond profile image
wilsond

Thank you Bob,thats reassuring news for those people who are nervous of AC.

I agree,the term blood thinners is used through laziness and is also an insult ( implying we are too thick or disinterested to know the difference)

secondtry profile image
secondtry

Nick 1957 raises an example of what I imagine is a common concern not much discussed.....if you have to stop anti-coags for whatever reason you are at greater risk due I presume to the reaction of the body in fighting against the drug, which when the drug is removed results in a clot forming more easily than otherwise would have happened ie if you start best not to stop unless essential.

I am NOT saying that if you need ACs you should not take them, just postpone a start when the need is only borderline, particularly if your lifestyle involves above average impact risks.

Also I now put very little credence on any studies financed by Big Pharma. My confidence has been shot to pieces the more I read about how the results from the Covid vaccine were presented with one side reporting by so called reputable medical journals.

Auriculaire profile image
Auriculaire in reply to secondtry

Look up the shenanigans at the Argentina trial centre for the Pfizer trial - a real eye opener.

secondtry profile image
secondtry in reply to Auriculaire

Boy am I praying the truth will out but I am not holding my breath!

Ppiman profile image
Ppiman

When I studied statistics years back for what proved a very tough exam, it became clear that the media and politicians misuse this invaluable science for their headline grabbing or rhetorical purposes and do this by ignoring the real-world numbers involved. For example, how many of the "20%" of strokes occur in very elderly people and how many of these are already ill with other severe cardiovascular illnesses? Also - how many were suffering "silent" AF?

Regarding DOACs, two important issues for me are that they prevent the use of everyday pain killers and add to the risks of surgical procedures.

Steve

RoyMacDonald profile image
RoyMacDonald in reply to Ppiman

How do they prevent the use of everyday painkillers? I take paracetamol and co-codamol. Both everyday pain killers. Both prescribed by my GP. I'm 79 and very active. On Apixaban.

All the best.

Roy

Singwell profile image
Singwell in reply to RoyMacDonald

Aspirin and (I think) Ibuprofen are known to cause bleeding. For this reason singers avoid them - might cause a bleed in the VF. Bleeds can also occur in the stomach. I presume this is what Steve means.

Ppiman profile image
Ppiman in reply to RoyMacDonald

As Singwell says, they increase the risk of major intestinal haemorrhage, sadly - and all NSAIDs such as naproxen, ibuprofen and aspirin can cause some bleeding, even a single tablet. We seem pretty much stuck with paracetamol.

Steve

RoyMacDonald profile image
RoyMacDonald in reply to Ppiman

Do you think there is something wrong with paracetamol and co-codamol? Why would you even consider a drug with known bleeding conflicts like NSAIDs as worth taking over a regular pain medication? Paracetamol is know to be very well tolerated in the general population with no side effects.

All the best.

Roy

Ppiman profile image
Ppiman in reply to RoyMacDonald

For me, it’s because for many conditions, paracetamol is almost useless at relieving the pain. Codeine is generally okay but causes quite bad constipation and can cause strange effects in the mind.

Steve

RoyMacDonald profile image
RoyMacDonald in reply to Ppiman

Guess I'm lucky as I have IBS-D and co-codamol fixes it just great. Stops my insides feeling like they are falling out all the time. Have a dry mouth but do not mind that. Take it at night so the effects on the mind I just sleep through. By the time I wake up those effects are over and I'm raring to go.

All the best.

Roy

Ppiman profile image
Ppiman in reply to RoyMacDonald

I would say very lucky! I have IBS (C) so can’t cope with codeine.

Steve

john-boy-92 profile image
john-boy-92

The decline in success rate due to delay is important. An ambulance crew talked to me for an hour before realising that I had a stroke. I didn't have FAST indicators. They didn't know that a stroke that affects vision (a common effect) doesn't necessarily manifest in FAST. I'm a mystery patient for medical students, and it was surprising that a group of third years had never heard of FAST. Fortunately, the medical community in Bristol, and the Stroke Association actively encourage the involvement of stroke survivors. in their studies.

BobD profile image
BobDVolunteer in reply to john-boy-92

People are ignorant which is why these reminders are so important John.

Some years ago my sister in law phoned to ask if I could pop round as her husband was feeling poorly. When I arrived maybe 1/4 hour later I found him slumped half in a chair and half on the floor and when I spoke to him he was slurring his words and a little dazed. It took me all of three seconds to suspect a stroke so asked her how long ago she phoned for the ambulance. She hadn't even thought about it!

Eventually after frantic phone calls paramedics arrived and took him to hospital where a week later he died from a pulmonary embolism. I'm not saying he could have been saved but any delay is bad.

Ppiman profile image
Ppiman

I took a close friend to his GP with an obvious stroke to be scoffed at and told that he was suffering from depression.

I was shocked but asked the GP to tell him to smile. The GP’s next words were, “This man’s had a stroke”. It was, in fact, a benign brain tumour. He did survive it, but later died from bowel cancer having been told that he had IBS and was a malingerer. It was the same GP.

Steve

CliveP profile image
CliveP

Little comfort to my mother in law who died aged 54 from a haemorrhagic stroke after years of taking Warfarin. One might also consider my 92 year old aunt who’s had AF for years and despite refusing all meds, continues entirely unperturbed and thus far stroke free. 🤷‍♂️

riffjack846 profile image
riffjack846

I asked my cardiologist one time about this subject and this is what he had to say about it. You take Eliquis which is an anti-coagulant, it doesn't thin your blood in any significant way, however, it helps keep your blood from clotting internally. But on the other hand take for example, Aspirin, it is a blood thinner....as a matter of fact I would recommend you stay away from any NSAID's they are more harmful than beneficial for people with Afib and the general public as a whole. There ya go.

BobD profile image
BobDVolunteer in reply to riffjack846

Exactly what we have been telling people for years.

Jumper profile image
Jumper

It would be interesting to know of the 15% of haemorrhagic strokes was there a split given of those on antocoags and those not?

As a point of interest I was recently informed that the figure was between 15 and 20%. I should have pursued the %'age spread but at the time was not of a mind to query it.

BobD profile image
BobDVolunteer in reply to Jumper

Not in the info I had but as I explained in the original post it does include those.

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