Samuel A. Kojoglanian, MD, FACC, FSCAI
It was an innocent adjustment. The chiropractor took a hold of her neck and directed the muscles and bones in a way that was unfamiliar to her body. A loud crack was heard and there was silence by both parties. She said she felt better and he was pleased.
Mrs. T then contacted me regarding a severe headache after her adjustment. Because she was taking Coumadin, a notorious blood thinner, I was concerned. An MRI was done and bleeding was noted on both sides of the brain. The cause of her bleed could be assumed but not with certainty.
The neurosurgeon wanted the Coumadin held due to the bleed. I cautioned that Mrs. T had a mechanical heart valve and the blood thinner was essential.
We could continue Coumadin and chance to worsen the bleeding, which would require burring holes in the scalp for drainage. Or stop the Coumadin and take a chance that the mechanical heart valve may form a clot and cause strokes and heart failure. No pressure!
The medical literature was scant. It said you could hold the Coumadin or you could continue it. Hello! At times books, experience and education don’t have the answers.
I then had to weigh the situation. The valve was in an area with enormous pressure, in the aortic region, which was to our patient’s advantage. The pressure generated would hopefully provide enough “lubrication” that we could chance being off the blood thinner. I tapped into my colleagues experiences and asked for their advice. Above all, I asked the good Lord to help me provide the best care for my patient.
During the tough moments in life I encourage you to do 3 things. Weigh, Stay, and Pray. Weigh the situation, give the pros and cons, and attempt to find a resolution with what seems to tilt the balance. Stay the course; don’t despair, don’t give up, don’t turn back, ask (the right people) for advice. Pray, above all, pray that the God of mercy, goodness, and love will guide you to make the appropriate choice for the given situation. Coumadin was held for 2 weeks, a small dose of aspirin was given daily, and by God’s grace, our patient did well.