DOACS and clot busters

[Peony4575]

Article in this weeks BMJ. Current guidelines say if you have taken a DOAC within 48 hours of an ischaemic stroke they can’t administer clot busters for fear of causing a brain bleed

Rock and a hard place

[BobD Volunteer]

If you are taking anticoagulants in the first place your chance of thrombotic stroke is greatly reduced for all causes. If you have AF it is about 70% risk reduction. Job done!

[mjames1]

If you need DOAC's, the risk of not taking them outweighs the risk of delaying clot busting meds. So just take them. No brainer.

On the other hand, if you don't need them, DOAC's are not without risk and apparently this is another risk.

That's why it's very important to sit down with your doctor and do a risk assessment unique to yourself.

Jim

[bean_counter27 in reply to mjames1]

"If you need DOAC's....."

The real problem is knowing whether you need to take DOACs. For most of us it's a case of whether we probably should or probably shouldn't.

[Bagrat]

Clot busters inc. the newer ones have to be given within 4.5 hours of symptoms starting.With the present situation in UK, I would be interested to know if stroke patients "medical journey" from first symptoms ensures they arrive in A&E/ stroke unit in a time scale that allows this to happen. Agree that anticoagulants reduce risk of ischaemic stroke so one would think pretty rare for this conflict to occur

[Silvasava]

I had a stroke, rang 111, ambulance arrived, took me to A&E where I was given an ECG and then straight on to a ward. they kept asking me what time it happened, 12 noon, by 3pm I had been thrombolised. Never been seen so fast! Been on AC's ever since

[Peony4575 in reply to Silvasava]

Very glad to hear you had a good outcome . I have a couple of friends who were promptly thrombolysed and left completely unimpaired

[JOY2THEWORLD49 in reply to Peony4575]

Hi

On no meds but with questionable high Systolic Rate my Stroke Ischaemic Clot type happened at 2am. Awoken with a very sore head. I went to toilet and as so tired went back to bed!

Reawoke at 5.30am, didnt make the tolet, had a shower and looked in the mirror.

Then rung 11q in NZ. I wasn't understood - my home address by cell. Sent back into main and used homephone.

In the ambulance 1 hour waiting.

Wasn't given anything because 2am-6.30am.

Flight via helicopter 1 hr but stopover Kerikeri more fuel. Also looking for tablet. Finally found in ambulance. Arrived at 8-9am. Rapid and Persistent AF. Thyroid Cancer discovered on 4th day - Carotid Artery Scan.

Left Frontal Lobe Stroke Clot-type. Carotid Arteries - Clean.

Bad day of storm, wind and rain.

Discharge papers say that aspirin test failed.

Started on PRADAXA 110mg x twice daily on day 2 or three. Metoprolol 23.75 x 3 (didn't want). No follow up, struggled with breathlessness. Demanded Heart Specialist at 1 year 5 mths. Echo showed dilated heart. Some dilation in left atrium. 24hr Heart Monitor showed missed night beats, Day avg 185 - couldn't exert myself. Night 47avg.

Changed to Bisoprolol. 156 Day and 47 Night LEFT.

Went PRIVATE.

At 2 years 3 months introduced CCB Calcium Channel Blocker 180 Diltiazem CD. Within 2 hours 156 dramatically dropped to 51. Day.

Been on Diltizem 120 CD Morning 3 years. Now 60s Day. No missed beats, no breathless.

Bisoprolol 2.5mg Night Fr BP control.

Done. Apart from walking and stoppig through lack of energy now.

cherio JOY. 75. (NZ)

[Peony4575 in reply to JOY2THEWORLD49]

Dear God that was a marathon you could do without ! You sound very stoical ! Hope very much that you are doing ok

[JOY2THEWORLD49 in reply to Peony4575]

Hi

Yes. OK.

Just would like more energy. Used to come 1st at 100yds/metres. Not now.

Thank you for your concern.

cherio JOY