A large number of Americans, most of them elderly, take Coumadin for a variety of reasons, including to prevent problems caused by atrial fibrillation, an abnormal heart rhythm, and to prevent clots from forming on artificial heart valves.
"This is an important study that talks about the risks we are well aware of when we use tPA for ischemic strokes," said Dr. Ralph Sacco, professor and chairman of neurology at the University of Miami Miller School of Medicine. Sacco, president-elect of the American Heart Association and the first neurologist to hold that post, was a member of the group that set the guidelines for tPA use.
"The new updated guidelines that extended use of tPA beyond the three-hour window did exclude all patients taking Coumadin [from being] treated after three hours, regardless of INR level," Sacco said.
He echoed Prabhakaran's list of the new study's shortcomings. "This is a non-randomized study," Sacco said. "All-case studies always raise concerns about some bias."
But attention must be paid, he said. "This raises the alarm level and makes us pause, as we always should, when we consider treating ischemic stroke," Sacco said. "But it should not make us deviate from the guidelines."
Learn more about the use of tPA from the American Heart Association.
SOURCES: Shyam Prabhakaran, M.D., M.S., assistant professor, neurological sciences, and director, stroke program, Rush University Medical Center, Chicago; Ralph Sacco, M.D., professor and ch
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