Blood Pressure Control in Coumadin-Treated Patients Decreases Bleeding Complications

The risk of embolic stroke in people with atrial fibrillation can be significantly reduced by preventing blood clot formation with coumadin treatment. One of the unwanted side effects of this treatment is an increased risk of intracerebral hemorrhage, or bleeding in the brain.

Clotting is measured using the International Normalized Ratio (INR) which attributes a value of 1.0 to people with a normal ability to clot. As the INR increases, it reflects that a person is less able to form blood clots. In patients with atrial fibrillation an elevated INR is desirable because it prevents the formation of dangerous blood clots inside the heart chambers. These blood clots can later travel to the brain and lead to stroke.

Current guidelines recommend that patients with atrial fibrillation maintain an INR of 2-2.5 to effectively decrease their risk of stroke. However, this elevated INR brings on an increased risk of intracerebral hemorrhage. To prevent this much dreaded complication, some have advocated to lower the goal INR to a value of 1.6-1.9. One of the criticisms of this approach is that while an INR of 1.6-1.9 drops the risk of intracerebral bleeding, it only provides 80-90% of the protection of an INR of 2-2.5.

A recent article proposes a reasonable solution which only requires the control of high blood pressure to effectively decrease intracerebral bleeding in these patients. The authors point out that reductions of as low as 12 points in systolic blood pressure can result in a decrease in the risk of bleeding in the brain by almost 80%.