Will Tedy Bruschi need coumadin for his stroke?

From today’s Sunday Boston Globe:

One thing Tedy Bruschi and his doctors will have to decide in the next few weeks is whether the Patriots linebacker should take a blood thinner such as cumadin (sic) for a lengthy period, because, if so, his career will be in serious jeopardy. Patients on blood thinners have to be careful about being cut because the blood does not coagulate easily, making it difficult to stop any bleeding. Obviously, that would be worrisome in a blood sport such as football.

This is sounding more like a carotid dissection (discussed yesterday). Coumadin (Warfarin) isn’t needed for hemorrhagic strokes, nor are they needed for strokes caused by hardening of the arteries. The blood thinner would be indicated in strokes where emboli are coming from the heart (less likely in this case) or in carotid dissection, where the damage to the carotid artery leads to thrombus, which can then break off and shower into the brain (i.e. an embolus). From the NEJM:

To prevent thromboembolic complications, anticoagulation with intravenous heparin followed by oral warfarin has been recommended for all patients with acute dissections of the carotid or vertebral artery, regardless of the type of symptoms, unless there are contraindications such as intracranial extension of the dissection. Although antithrombotic treatment has been advocated since the 1970s, no randomized trials have been reported, and the validity of such treatment has never been proved. However, there is some indirect evidence of the appropriateness of anticoagulation. Imaging studies suggest that more than 90 percent of infarcts due to dissection are thromboembolic rather than hemodynamic (i.e., caused by insufficient flow) in origin, and transcranial Doppler studies show a high frequency of intracranial microemboli. Anticoagulation with a target international normalized ratio of 2.0 to 3.0 is generally used for three to six months.

Being on a blood thinner is not conducive to playing NFL football. If the course is limited to three to six months, then this may not be as big an issue.

Update:
A stroke expert in California agrees that a carotid dissection was likely:

New England Patriots linebacker Tedy Bruschi’s symptoms following his stroke indicate it may have been caused by a torn blood vessel wall, possibly in his neck, a stroke expert in Los Angeles said late Thursday.

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