Finding the right balance between treating brain bleeds & preventing blood clots, when a blood thinner can increase intracranial hemorrhaging
It seems like a real conundrum for doctors: simultaneous treatment of bleeding in the brain while taking measures to prevent blood clot development. But it can be done effectively, says a new study.
Blood thinners are used to prevent deep vein thrombosis (DVT). However, what might happen if a person with bleeding in the brain is put on a blood thinner? It could increase the bleeding.
Nevertheless, University of Missouri School of Medicine researchers have discovered a new protocol that uses anticoagulant drugs to prevent blood clots from forming, in patients with traumatic brain injuries — without increasing the bleeding within their brain.
This makes me think of when my father passed out and struck his head, suffering a concussion with neurological symptoms. He was on the blood thinner coumadin at the time, due to very recent knee replacement surgery.
Though the CT scan showed no bleeding in his brain, he was at high risk for developing this due to:
#1. A fall bad enough to produce neurological symptoms
#2. Elderly age
#3. Being on coumadin
After he was admitted to the hospital for a cardiac workup to find out if a cardiac problem had caused the blackout, the doctor reduced his dose of coumadin for several days, for the very reason of not encouraging a brain bleed in those critical days following the fall.
This was simultaneous treatment for DVT prevention (from joint replacement surgery) and prevention of aggravation of any inevitable brain bleeding that might occur from the fall (which never did, ultimately).
The Centers for Disease Control estimates that 1.7 million traumatic brain injuries happen every year, creating a risk of DVTs (blood clots) elsewhere in the body.
“Our study found that treating traumatic brain-injured patients with an anticoagulant, or blood-thinning medication, is safe and decreases the risk of these dangerous clots,” notes N. Scott Litofsky, MD.
Dr. Litofsky explains in his report that the patients who received the blood thinners had a reduced risk of DVT, yet also no higher risk of the intracranial hemorrhaging.
That sweet spot, that perfect balance, is a challenge, continues Dr. Litofsky. The study involved 107 TBI patients not on blood thinners and 129 TBI patients given these medications.
Six patients, in that first group not on the anticoagulants, developed a blood clot. None in the second group did.
However, in that first group also, three developed increased brain bleeding, while in the second group, only one did.
Dr. Litofsky believes his protocol is effective and that the results would apply on a larger scale across the nation.