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Warfarin Versus Clopidogrel for Dissection - HELP!

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sally1975
sally1975

Hi Folks,

I had a stroke last year caused by a triple vessel dissection (I don't like to do things by halves!) which they've yet to find a cause for. At 36 this was a total shock as I've always been proud to say I've never really been ill. But I got this cough and I coughed and coughed. Then I thought 'I've pulled a muscle in my neck with coughing' but now I know this was one of my arteries splitting and a stroke followed. I've was put on warfarin and I've been followed up with MRI/MRA's every 6 months.

The most recent one in April 2013 showed that one of my vessels has recovered completely, one at the back is blocked completely and they don't expect it to open up, and my other vessel (the basilar artery) has quite a significant narrowing.

At my last consultation my neurologist has advised me that in his opinion he thinks we should stop the warfarin due to the long term effects of the drug and switch me over to clopidogrel (kind of like aspirin).

I've said I want to have a think about it as so far (touch wood) I've been OK on Warfarin (ie.no other strokes) although I hate the restrictions it has on my lifestyle (diet, alcohol and I really want kids). So I'm scared to rock the boat, but then again I'm worried that if I don't all always wonder why I didn't.

So my questions to anyone who's out there reading this is: Anyone been in a similar situation? Would did you decide? Does anyone know of any evidence recommending one of the above over the other?

I know of one study but the outcome was that they couldn't find any evidence to support using one over the other.

Does anyone know where else I can look for some evidence to support my decision?

I really hope you can help.

Sally

0 likes, 3 replies

3 Replies

  • Tarun
    Tarun

    Posted

    Hi Sally

    Cervical artery dissection is a rarer cause of strokes, and so good quality evidence from trials is going to be lacking. Unfortunately there is no definitive recommendation on using one or the other and national guidance reflects this, as either option is mentioned as a treatment choice. So there's no evidence that if you switch you are going to be at any more risk, but there's also no evidence to suggest clopidogrel will lower your risk. If you're stable on warfarin then I see no reason to change but ultimately this is your decision ! Interested to know why the neurologist wants you on clopidogrel though ?

    Tarun (hospital pharmacist)

  • sally1975
    sally1975

    Posted

    Hi Tarun,

    Thanks for your reply. My neurologist advised me that he wanted me to consider a change mainly due to the long term risks of bleeding with warfarin, as he advised that 36 is quite a young age to commence anticoagulants, but he also advised me that it wouldn't be possible to try for a family whilst on the drug (although he did advise me that I could switch to Heparin).

    I really don't like being on warfarin, but I don't want to do anything that would compromise my health in any way, and if it means staying on it, that's what I'll do.

    I'm super cautious about everything after my dissections and I just want to know I'm making the right decision.

    Sally

  • Tarun
    Tarun

    Posted

    Now I see where he's coming from ! I think it's really difficult to say in this circumstance - if there are personal factors which are relevant such as starting a family or just removing yourself from the restrictions of long term warfarin, then you should consider these. I don't think there's any definitive proof that switching will compromise your control in the future. It may help to discuss the pros and cons of each choice with the neurologist which might make your decision a bit easier.

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