Stroke is not pretty. My mother-in-law, who had suffered from CLL (chronic lymphocytic leukemia) for
almost ten years, began to experience atrial fibrillation. It was discovered that she had a damaged
mitral valve, probably from rheumatic fever as a child. Because of her CLL, her platelet count was
low and her white count was high, i.e. she was a complicated case. She messed around with putting
off treatment for most of the summer, and, after collapsing in the back yard in early August of '95,
finally went in to the hospital. She was put on Coumadin preoperatively, I believe (it was back in
'95 so it's hard to remember) and she was given platelets, I believe, so she could have the valve
replacement surgery, which did not take place until September..
The surgery went fine. She was weaned from Coumadin to heparin post-operatively, and was ready to go
home. The story as far as I understand it, was that she was being weaned from heparin back to
Coumadin when she threw a clot and had a massive stroke on the left side of her brain, which affects
the right side of your body.
Since she was still in a step-down unit, and her doc had JUST been in to see her (was even out in
the hallway when this happened) they rushed her to Neuro ICU and we, the family, were called. It was
not pretty.
Strokes that affect your right side affect your ability to talk and walk. She was totally paralyzed
on her right side and never spoke words again. She eventually could point to things and say "nee nee
nee" and "ah" (for yes, I think) but that was all. It was months before she could even do that, and
then only after a lot of therapy. She was stuck in a wheelchair for the rest of her life. She was 71
when this happened.
Without the Coumadin and the valve surgery she surely would have died. The atrial fibrillation was
still there, even with the new valve. She was in a rock and a hard place. She would have surely had
a stroke and died without the surgery or the Coumadin. She screwed around too long, I think, by
trying to hide the fact from us that she was having problems, as she was a stoic who could "overcome
things" somehow by not resorting to medications, whatever, Her stoicism might eventually have cost
her her life, although it's hard to say whether the same thing would have happened had she had the
valve surgery sooner.
She lived for a little over a year and a half after the stroke, but in a nursing home. My inlaws in
another state agreed to take her into their house and care for her around the clock, and, after a
little over a year, and many complications, she was well enough to move. She was there for about a
month when she developed a bowel obstruction. No surgeon would touch her, considering her history
and the ongoing CLL, and she passed away in March, '97.
My take on this is, don't screw around debating about Coumadin. I think if she had started on some
sort of therapy sooner, and gotten her valve replaced before she was in such bad shape, she may not
have thrown the clot. Her doctor said she was the first patient of his who had had a stroke
post-surgery in over two years, and this was a large hospital and a very busy group.
I don't think it's the Coumadin killing off patients so much as the underlying condition that made
them have to go on Coumadin in the first place. Please keep that in mind. Serious conditions like
atrial fibrillation don't give one a whole lot of choices other than Coumadin in the way of
anticoagulation. Without anticoagulation, you get clots - it's as simple as that. Clots = strokes.
Without Coumadin and the valve replacement, my mother-in-law would surely have died much sooner.
Statistically, there was only a 3-5% chance of her having a stroke post surgery. All you can do is
play the odds in situations like this. Unfortunately, she lost.
Once your father decides on Coumadin, it is important that he go to the same laboratory facility
each time to get his protimes done, as it's best to have the same equipment perform the testing each
time. Each laboratory may use a different brand of reagents or equipment, and when you're
calculating INR's, consistency is the watchword.
Good luck.
Judy Dilworth, M.T. (ASCP) Microbiology
Mick Williams said:Hi
My father has just been informed by his Dr. that he will need to start taking this drug for atrial
fibrillation. He is 64 and deathly afraid of taking coumadin. Several people he knew (including
his brother, whom I believe died of complications while on coumadin) have not had much luck on
this medication.
