Coumadin is a potent blood thinner, so how effective is it at preventing a transient ischemic attack, also known as a TIA?

“The only time that I would recommend Coumadin for TIA or stroke prevention would be if the patient has atrial fibrillation, which is a cardiac rhythm abnormality,” says Rob Lapporte, MD, board certified in emergency medicine and chief medical officer of Physician 360, a telemedicine service.

Dr. Lapporte continues, “Studies show that in most other instances, the risks of hemorrhage while on Coumadin outweigh the benefits.  Antiplatelet drugs like aspirin, Plavix and Aggrenox are better choices.”

But risks aside, from the standpoint of preventing a TIA, just how effective is Coumadin (also known as warfarin)?

The verdict isn’t clear-cut on this. Some studies show that Coumadin is more effective than aspirin at preventing a stroke, and other studies indicate that aspirin is the winner here.

Bottom line, nobody really knows the answer to this question.

The standard of medical practice is that in elderly people with atrial fibrillation, they are often (not always) prescribed Coumadin.

In these patients, the benefits of this blood thinner outweigh the risks (internal bleeding).

That’s because when old age is combined with atrial fibrillation, the risk of stroke or its forerunner, TIA, is greatly amplified.

Transient Ischemic Attack Symptoms

  • Vision problems
  • Slurred speech
  • One-sided facial or limb paralysis or weakness
  • Confusion, cognitive change
  • Clumsiness
  • These symptoms are all sudden-onset

A-fib can cause pooling of blood in the heart, leading to clots that then travel by way of carotid arteries into the brain, where they can lodge in a blood vessel and shut off oxygen to the part of the brain that the vessel supplies: anything from a 10-second TIA to a massive stroke.  Coumadin thins the blood and hence reduces its ability to form clots.

Dr. Lapportedr. lapporte has been practicing evidence-based clinical medicine in emergency rooms and urgent care centers for almost 20 years.