Blood thinners are commonly used in the prevention of strokes.

This is especially important for people who have suffered a first stroke, as they have an increased risk of suffering a second one. In fact, about 30% of all strokes in a given year are repeat strokes. Thus, stroke survivors must be diligent about stroke prevention. However, even if you have never suffered a stroke, but are at risk of getting one, you are likely to be taking a blood thinner. Here is a list of the most common blood thinners used for stroke prevention, and their most common side effects. For a complete review of these medications please visit the latest edition of the physicians desk reference. Aggrenox: This medication is a combination of aspirin and extended-release dipyridamole. Almost 40% of patients on this medication report feeling a headache. Other common side effects include abdominal pain, indigestion and diarrhea. What to watch out for: You should stop taking Aggrenox and go to your doctor or to an emergency room if you find black or tarry-appearing stools, as this is a sign of intestinal bleeding. Aspirin: Aspirin can irritate the stomach and intestines and cause indigestion, nausea, and vomiting. The enteric coated, or EC, form of aspirin is gentler on the intestines and produces milder side effects. Other less common side effects of aspirin include difficulty breathing and intestinal bleeding. What to watch out for: If you find black or tarry-looking stools this is a sign of intestinal bleeding. This, and any other forms of abnormal bleeding should prompt you to stop taking aspirin and to go to the nearest emergency room. Also go to the emergency room if you develop difficulty breathing while on aspirin. You should never give your children aspirin as they can develop a serious and often fatal disease called Reyes Syndrome. Learn more about aspirin safety Coumadin: Also known as warfarin, this medication is used to prevent strokes in people who suffer from atrial fibrillation, people who suffer blood clotting disorders, and people who have mechanical heart valves. Coumadin can cause serious bleeding. To avoid this, people who take this medication must have routine blood testing to monitor their INR, or International Normalized Ratio. This is an international measure of coagulation 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 likely to form blood clots. Patients with atrial fibrillation must maintain an INR of 2-3 in order to effectively decrease their risk of stroke. Coumadin works by decreasing the amount of vitamin K available for use in the body, which in turn reduces the efficiency of blood clot formation by the body. This is why you should monitor your intake of foods that are rich in vitamin K. Consuming too much of these foods can prevent Coumadin from working properly and may leave you temporarily at a high risk of stroke. Some foods with high vitamin K content include spinach, lettuce, alfalfa sprouts, asparagus, broccoli,

cauliflower, and cabbage. Doctors recommend that you eat the same amounts of these food items every day in order to maintain a steady level of vitamin K in your body. This will both ensure that Coumadin works properly, and that you will have a low risk of dangerous bleeding while you take Coumadin. What to watch out for: By far the most common side effect of Coumadin is abnormal and sometimes profuse bleeding. Often the abnormal bleeding can occur inside the eye, and in the intestines. Because of this, people who take Coumadin must monitor stool color and seek medical attention if stools become black or tarry-appearing. Of course, bleeding and easy bruising can occur anywhere in the body. More about Coumadin Heparin: Heparin is usually given in the hospital directly into a blood vessel (i.e., intravenously) in order to prevent blood clot formation, and to enhance the bodys ability to break down existing blood clots. For heparin to work safely, blood must be drawn periodically in order to make sure that its levels fall within a safe margin. The blood test performed to do this is called the partial thromboplastin time or PTT. The main side effects of heparin are bleeding and easy bruising. Irritation at the site of the injection can also occur. In some rare instances heparin can cause an allergic reaction. What to watch out for: The most common and dangerous side effect of heparin is abnormal bleeding. Therefore, you must be on the lookout for black stools, which reflect intestinal bleeding, or for orange, pinkish or smoke-colored urine, as this indicates there is blood in the urine. More about heparin treatment Lovenox Lovenox, also called enoxaparin, is a form of heparin called fractionated heparin. Lovenox does not require monitoring of its blood levels and it can be injected intramuscularly. People with chronic kidney disease should not use Lovenox as poor kidney function makes Lovenox accumulate in the blood. The side effects of Lovenox include skin irritation at the site of injection and nausea. What to watch out for: Rarely people develop an allergic reaction to Lovenox and develop a rash. If severe, the reaction can cause swelling on the hands and lips, and difficulty breathing. If you develop any of these symptoms while on Lovenox you should go to an emergency room. For further symptoms (bleeding) caused by abnormal reactions to Lovenox please refer to the what to watch out for section under heparin (above.) Plavix: Common side effects of Plavix include stomach pain, muscle aches, dizziness, and headache. Easy bruising and nose bleeds can also occur. People who have stomach ulcers might develop intestinal bleeding, which can be life threatening.

What to watch out for: if you find black or tarry-looking stools this is a sign of intestinal bleeding. This and any other forms of abnormal bleeding should prompt you to discontinue the medication and to go to the nearest emergency room. Heparin Treatment: Basic Information About Heparin and its Uses What is heparin? Heparin is a medication that is used in hospitals across the world to prevent blood clot formation. Heparin can be given either directly into the bloodstream, or as an injection under the skin. No oral form of heparin is available. When is Heparin Used in the Hospital? Heparin has many uses, but nearly all of them aim to prevent the formation of blood clots. Below are some of the most common reasons heparin is used by physicians.

To prevent the formation of dangerous blood clots in people who must stay in bed for prolonged periods of time. This can be accomplished with a low daily dose of this medication which is typically given under the skin, which is known to prevent the formation of deep venous thromboses, or DVTs in the deep veins of the legs, thighs, and pelvis. Such blood clots are known as DVTs for short, and are well known to cause strokes and pulmonary embolisms, (PEs) which can be lethal (see below). To treat pulmonary embolisms: Pulmonary embolisms are blood clots that migrate into the lungs from the heart, or from the deep venous system of the body. Once in the lungs, pulmonary embolisms can block blood flow to large portions of the lung and prevent oxygen-poor, venous blood from being repleted with oxygen. As stated previously, PEs can be lethal. To prevent the enlargement of high risk blood clots found inside the heart, and other parts of the body, as they can cause pulmonary embolisms or strokes. To prevent the formation of blood clots during heart surgery, or during surgery of the large arteries.

When is Heparin Used to Treat Stroke? Heparin is used to treat strokes that are caused by identifiable blood clots. Strokes commonly associated with blood clots, and treated with heparin in the hospital include:

Carotid or vertebral dissection Dural sinus thrombosis When an ultrasound of a stroke patient shows a Deep venous thrombosis When the EKG in a stroke patient shows atrial fibrillation When a carotid dopler test suggests that a blood clot is sitting inside the carotid artery, or an echocardiogram shows a blood clot inside the heart. Intravenous Heparin Dosage Unlike most medications, the dose of heparin must be chosen according to the results of a blood test called the partial thromboplastin time or PTT. Once an intravenous infusion of

heparin is started, its dose is adjusted every 4 to 6 hours in order to ensure that blood does not become so thin that a person runs the risk of spontaneous bleeding. On the average, most heparin treatment protocols call for a one-time "bolus injection" of heparin followed by a slow increase of the dose to a PTT that is roughly twice the normal value. Because there is no oral form of this medication, heparin must be stopped before a person leaves the hospital. People who need long-term therapy with blood thinners are commonly prescribed coumadin, another powerful blood thinner which is available in a tablet form. Coumadin is started while patients are still receiving intravenous heparin, but once blood tests show that coumadin's blood thinning effect is adequate, heparin can be stopped. This is done because coumadin can take up to 72 hours before its desired effect is reached. Heparin side effects The main side effect of heparin is bleeding. For this reason, it is important that physicians follow blood counts when people are being treated with intravenous heparin in order to ensure that blood counts remain stable during treatment. Spontaneous bleeding can occur from several places in the body including:
o o o o

Open wounds or surgical sites The stomach and intestines The uterus and ovaries The gums and mouth

In cases of profuse bleeding due to heparin treatment, a medication called protamine sulfate can be given intravenously to neutralize heparin's blood-thinning effect. In cases of severe bleeding blood transfusions are required to replace the blood lost. Another important side effect of heparin is a condition known as heparin-induced thrombocytopenia (HIT). In this condition heparin induces the body's immune system to develop antibodies against its own platelets. Since a normal level of platelets is required by the body to prevent bleeding, a low level of platelets places people at risk of major bleeding. Paradoxically, this same condition can also cause the inappropriate and spontaneous formation of large blood clots, which can block blood flow through important blood vessels and damage the kidneys, the skin, and the brain, among other organs. Tests Used in Stroke Diagnosis Stroke Diagnosis is relatively straight forward, but it requires the rapid combination of medical personnel, technology, and at times, a little bit of luck so that all the testing can be done on time and appropriate treatment can be offered. Below you will find the main tests used by doctors during stroke diagnosis. The Neurological Examination

This test is performed by a physician in order to uncover deficiencies in brain function which might confirm the suspicion that a person is actually having a stroke. Each part of the neurological exam tests a different area of the brain, including:

Awareness and consciousness Speech, language, and memory function Vision and eye movements Sensation and movement in the face arms and legs Reflexes Walking and sense of balance

Computed Tomography Scan This test is performed in the emergency room to detect a hemorrhagic stroke. Computed tomography (CT) scans are good tests for this purpose not only because they easily detect bleeding inside the brain, but also because they can be performed quickly. CT scans also can reveal ischemic strokes but only 6-12 hours after their onset. CT Scan Basics Lumbar Puncture Also known as a spinal tap this test is sometimes performed in the emergency room when there is a strong suspicion for a hemorrhagic stroke in someone whose CT scan does not show clear blood. The test involves the introduction of a needle into an area within the lower part of the spinal column where it is safe to collect cerebrospinal fluid (CSF). When there is bleeding in the brain, blood can be seen in the CSF. What is Cerebral Spinal Fluid? Lumbar Puncture Basics Magnetic Resonance Imaging (MRI) This is one of the most helpful tests in the diagnosis of stroke because it can detect strokes within minutes of their onset. Its images of the brain are also superior in quality by comparison with CT images. Because of this, MRI is the test of preference in the diagnosis of stroke. A special type of MRI called magnetic resonance angiography, or MRA, lets doctors precisely visualize narrowing or blockage of blood vessels in the brain. MRI Basics Transcranial Doppler (TCD):

This test uses sound waves to measure blood flow through the major blood vessels in the brain. Narrow areas inside of a blood vessel demonstrate faster blood flow than normal areas. This information can be used by doctors to follow the progress of occluded blood vessels. Another important use for the TCD is the assessment of blood flow through blood vessels in the area of a hemorrhagic stroke, as these blood vessels have a propensity to undergo vasospasm a dangerous contraction of the wall of a blood vessel which can block blood flow. Cerebral Angiography: Stroke doctors use this test to visualize blood vessels in the neck and brain. During this test a special dye which can be seen using X-rays is injected into the carotid arteries, which bring blood to the brain. In a person who has a partial or a total obstruction in one of these blood vessels, or in any other blood vessel inside the brain, little or no dye can be seen flowing through it. A common cause of stroke is narrowing of a carotid artery, carotid stenosis, which is usually the result of cholesterol deposits along the walls of these blood vessels. This condition can also be diagnosed by a test called a Carotid Duplex, by which sound waves are used to evaluate blood flow through these blood vessels. Depending of the degree of narrowing and on the symptoms felt by a person, surgery might be needed to remove the plaque from the affected artery. Carotid Stenosis Treatments Cerebral angiography can also help doctors diagnose the following common conditions known to be associated with hemorrhagic stroke .

aneurysms, arterio-venous malformations

Cerebral Angiography Basics After a stroke is diagnosed, a new battery of tests needs to be performed in order to find out the cause of the stroke. Electrocardiogram This test, also known as an EKG or ECG, helps doctors identify problems with the electrical conduction of the heart. Normally, the heart beats in a regular, rhythmic pattern which promotes smooth blood flow towards the brain and other organs. But when the heart has a defect in electrical conduction, it stops beating rhythmically and it is said to be suffering from arrhythmia, or irregular heart beats. Some arrhythmias, such as atrial fibrillation, cause the formation of blood clots inside the heart chambers. These blood clots sometimes migrate to the brain and cause a stroke.

Electrocardiogram Basics Transthoracic echocardiogram (TTE) This test, also known as an echo uses sound waves to look for blood clots or other sources of emboli inside the heart. It also is used to look for abnormalities in heart function which can lead to blood clot formation inside the heart chambers. TTEs are also used to investigate if blood clots from the legs can travel through the heart and reach the brain. Echocardiogram Basics Leg Ultrasound Doctors usually perform this test on stroke patients diagnosed with a patent foramen ovale. The test uses sound waves to look for blood clots in the deep veins of the legs, which are also known as deep venous thromboses or DVTs. DVTs can cause strokes by making a long journey which ends up in the brain. First, a small fragment of a DVT breaks off and travels to the heart via the venous circulation. Once in the heart the blood clot crosses from the right side to the left side of the heart via the PFO, where it is propelled out via the aorta and carotids towards the brain, where it can cause a stroke. Leg Ultrasound Basics Blood Tests For the most part, blood tests help doctors look for diseases known to increase the risk of stroke, including:

High cholesterol Diabetes Blood clotting disorders

Carotid Stenosis Treatments Carotid stenosis refers to a dangerous narrowing of the inner portion of the internal carotid arteries, the two large arteries in the neck which provide the largest portion of the blood supply to the brain. The most common cause of carotid stenosis is atherosclerosis. Narrowing of the carotid artery is diagnosed with carotid duplex ultrasound. A study performed in 1998, the NASCET (North American Symptomatic Carotid Endarterectomy Trial) study, determined that patients who had symptoms such as a TIA or ministroke and more than 70% narrowing of the internal carotid artery, had a three-fold reduction in the risk of stroke if they were surgically treated with a procedure known as carotid endarterectomy. People with borderline stenosis (50-69% occlusion of the carotid arteries) must be followed closely by a doctor in order to evaluate whether surgery needs to be performed in the future. The two most common treatment options for carotid stenosis are the following:

Carotid Endarterectomy This is a procedure by which a surgeon gently removes the atherosclerotic plaque that prevents normal blood flow through the affected internal carotid artery. The plaque is removed in one piece in order to prevent the formation of small fragments that could migrate to the brain and cause a stroke. Multiple studies have determined that this is the safest way to treat symptomatic carotid stenosis. Potential Complications of Carotid Endarterectomy Like most surgeries, carotid endarterectomy carries a small risk of bleeding and infection. Because the surgery is performed inside the very vessels that bring blood to the brain, there is also a small risk of stroke. A risk of having a heart attack during or after the surgery also exists, and this can be a major risk for people with advanced heart disease. Most of the risks of the surgery are low, especially if the surgeon is experienced with this type of surgery. Percutaneous Treatments of Carotid Stenosis: Two Options In this type of procedure, a thin wire called an angiography catheter is inserted into one of the large blood vessels in the groin, and is slowly advanced across the blood vessels all the way into the carotid artery where the stenosis, or narrowing, is located. Once there, the area that is narrowed can be expanded either via angioplasty or stenting (see below). Percutanous procedures have some advantages over carotid endarterectomy because they are less invasive, and because they can be performed under local anesthesia. However, because many studies have shown that carotid endarterectomy is a safer procedure in most patients, most medical centers reserve percutaneous treatment of carotid artery stenosis for patients who have a significant risk of death from carotid endarterectomy surgery. People who should get percutaneous treatments instead of carotid endarterectomy surgery include patients who have advanced heart disease or who have had radiation therapy of the neck during cancer treatment. People who have had a previous neck surgery should be considered for a percutaneous procedure instead of carotid endarterectomy surgery. There are two main percutaneous interventions that are currently performed for carotid stenosis:

Carotid Angioplasty: In this procedure, the angiography catheter has a small deflated balloon connected to its tip. Once the catheter is advanced to the area of the carotid where the stenosis is located, the balloon is slowly inflated causing the narrow portions of the vessel to expand. Normally carotid angioplasty is performed along with stent placement. Carotid Stenting: Carotid artery stenting is a relatively non-invasive procedure by which a stent (a metal mesh-like tube) is placed over the atherosclerotic plaque in order to stabilize it and allow for better blood flow.

Potential Complications of Percutaneous Treatments Percutaneous procedures can accidentally dislodge fragments of plaque and cause an embolic stroke. Catheter manipulation can lead to rupture of the artery and cause serious bleeding. There is also a small risk of infection. Carotid angioplasty has an extremely high rate of re-occlusion which has been reported in up to 15 percent of people. Five percent of people may also be affected by carotid dissection. Carotid artery stents can sometimes cause the formation of blood clots. In those cases, carotid

endarterectomy may not be possible to repair the damage. Intensive research is currently being performed in order to generate equipment and techniques that avoid these complications. Brain Aneurysms-The Basics What is a brain aneurysm? Aneurysms are weak areas on the wall of a blood vessel, usually an artery -- the type of blood vessel that carries oxygen-rich blood to tissues. Over time, these weak areas on the walls of arteries balloon out causing the blood vessel wall to become even weaker as the aneurysm grows. Occasionally aneurysms can rupture and cause a hemorrhagic stroke, the type of stroke that is caused by bleeding inside the brain. Approximately 8% of all strokes are caused by ruptured aneurysms. Why do people develop aneurysms? Little is known about why aneurysms develop in the brains of some people and not in the brains of others. In many cases, aneurysms are inherited through the genes, but high blood pressure and cigarette smoking appear to predispose people to develop aneurysms, too. About 5% of the population in the United States has at least one aneurysm in the brain, but up to 80% of them will never be affected by bleeding in the brain. Brain aneurysms usually occur at sites where arteries divide into branches. The following arteries in the brain are most likely to have aneurysms:

The anterior communicating artery (30%) The posterior communicating artery (25%) The middle cerebral artery (20%)

What are the risk factors for aneurysm bleeding and rupture? When an aneurysm ruptures, it causes profuse bleeding in the brain leading to a hemorrhagic stroke. In general, aneurysms bleed during situations when blood pressure is high. This can happen even to people who do not suffer from chronic high blood pressure. Episodes of high blood pressure that come and go can develop for many reasons, including:

The use of illicit drugs, such as cocaine and amphetamines - More about drugs and stroke High stress situations Orgasm

Aneurysms are also more likely to bleed after they reach a size of more than 10 millimeters, or about a third of an inch. If I have an aneurysm, will I feel any symptoms? Very often small aneurysms do not cause any symptoms unless they bleed. Sometimes, however, the growing aneurysm might push against blood vessels or other structures around it as it grows and cause headaches, double vision, or pain around the eyes when you look to the sides. If the aneurysm bleeds, people often feel a "thunderclap headache" they might call the worst of their

lives, as well as neck pain and stiffness. They might also develop typical stroke symptoms. In some 10% of people with a ruptured aneurysm, bleeding inside the brain is so profuse that they die before ever reaching a hospital. What happens after an aneurysm ruptures and bleeds? The prognosis after an aneurysm bleed is variable, depending on the size of the bleed. In general, up to 50% of people with bleeding in the brain die from the complications of the bleeding itself. There is also a very high risk of bleeding again around the time of the first bleed. Up to 4% of people can bleed again within the first 24 hours after the initial episode of bleeding. By the end of the second week after the bleed, they have a 15 to 20% chance of bleeding again. Definition: Patent foramen ovale, or PFO for short, is an abnormal opening of the atrial septum, the thin membrane that separates the left and right sides of the heart's upper chambers (known as the atria). PFO is thought to be an important factor in the development of paradoxical strokes. Lupus as a Cause of Stroke Systemic lupus erythematosus, commonly known as lupus, is a disease that causes the body's immune system to malfunction, producing antibodies against the bodys own tissues. These antibodies can cause damage to multiple organs leading to symptoms which vary widely and include fatigue, skin rashes, joint pains, arthritis, and seizures, among others. Lupus patients are more likely to suffer a stroke than people without lupus. In fact, some people with lupus suffer from recurrent strokes, especially if they also have high blood pressure. How Does Lupus Cause Stroke? Because lupus affects multiple organs in the body, it has the potential to induce stroke in several important ways:

By triggering the formation of blood clots: One of the many abnormal antibodies produced by the immune system of lupus patients is the antiphospholipid antibody. This antibody is known to attack the membranes of cells that line the inside of blood vessels. The attack causes a "biological cascade" which initiates the formation of blood clots. This can happen in different parts of the body, including the deep veins of the legs, the chambers of the heart, and the large veins of the head. In some cases, these blood clots have the potential to travel to the brain and cause embolic strokes. Other antibodies seen in lupus which have been associated with the abnormal formation of blood clots include lupus anticoagulant and anticardiolipin antibodies.

By inducing the formation of small deposits of immune products inside the heart: A collection of immune deposits can be found inside the hearts of a fraction of lupus patients. These immune deposits can be thought of as small pellets of antibodies, and immune cells mixed with minerals, proteins and other products of the immune system. The immune system is reacting against the bodys own tissues. This condition, referred to as Liebman Sacks endocarditis, can cause strokes when these small pellets travel from the heart to the brain.

By causing inflammation inside the walls of blood vessels: This condition, known as vasculitis, can be seen in many patients with lupus. At times, the inflammation in the blood vessels is so severe that blood flow through the inflamed vessel is completely prevented. This is particularly dangerous when it happens to the blood vessels in the brain as it can lead to stroke.

What is Deep Vein Thrombosis What is Deep Vein Thrombosis (DVT)? Deep Vein Thrombosis, or DVT, is a blood clot in a deep vein. Deep veins are veins that travel deep in the body and are usually surrounded by muscle. Deep vein thrombosis is a more serious condition than superficial venous thrombosis, which is a blood clot in a superficial vein, because of the risk of a pulmonary embolsim (PE). A pulmonary embolism is a life threatening condition. A pulmonary embolism can occur when the blood clot in a deep vein breaks off and travels to the lungs. Blood clots in superficial veins do not travel to the lungs so there is no risk of pulmonary embolism. Deep Vein Thrombosis usually occurs in the legs and pelvis. However it can occur in any deep vein. Deep Vein Thrombosis in the upper arms is referred to as Paget-Schroetter disease. What are the symptoms of Deep Vein Thrombosis? If the clot is small you will probably never know you had it. The body will break it down naturally. If the clot is large you may exhibit these symptoms:

Pain and/or tenderness. This may only be felt when walking/standing. Swelling, warmth in the swollen area Redness of the skin

Symptoms are not always present with deep vein thrombosis. A pulmonary embolism can occur from a deep vein thrombosis without any DVT symptoms present. Symptoms of a pulmonary embolism are:

Chest pain during deep breaths Shortness of breath

How do I know if I have Deep Vein Thrombosis? DVT can be hard to determine. If symptoms are present and you are at risk for developing deep vein thrombosis then you should see a doctor immediately. A pulmonary embolism is a good sign that you have DVT but you never want it to progress that far. An ultrasound may show a blood clot, but the only sure fire method is to undergo an intravenous venography procedure. Symptoms of Deep Vein Thrombosis DVT Symptoms The symptoms of Deep Vein Thrombosis (DVT) are similar to or the same as many other health issues. Deep Vein Thrombosis symptoms can have a rapid onset and when identified in the

presence of Deep Vein Thrombosis risk factors one should take immediate action due to the life threatening risk of pulmonary embolism. Deep Vein Thrombosis most often occurs in the legs, but it can occur elsewhere as well. Symptoms of Deep Vein Thrombosis

Swelling of the affected region (especially rapid swelling) Warmth in the skin of the affected region Flushed or discolored skin of the affected region Pain, soreness or tenderness of the affected muscle Sudden muscle fatigue Visible surface veins

Partial thromboplastin time (PTT) Definition Partial thromboplastin time (PTT) is a blood test that looks at how long it takes for blood to clot. It can help tell if you have bleeding or clotting problems. Alternative Names APTT; PTT; Activated partial thromboplastin time How the Test is Performed The health care provider uses a needle to take blood from one of your veins. The blood collects into an air-tight container. You may be given a bandage to stop any bleeding. If you are taking a medicine called heparin, you will be watched for signs of bleeding. The laboratory specialist will add chemicals to the blood sample and see how many seconds it takes for the blood to clot. How to Prepare for the Test The health care provider may tell you to stop taking certain drugs before the test. Drugs that can affect the results of a PTT test include antihistamines, vitamin C (ascorbic acid), aspirin, and chlorpromazine (Thorazine). Do not stop taking any medicine without first talking to your doctor. How the Test Will Feel When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing. Why the Test is Performed

Your doctor may order this test if you have problems with bleeding or blood clotting. When you bleed, the body launches a series of activities that help the blood clot. This is called the coagulation cascade. There are three pathways to this event. The PTT test looks at special proteins, called factors, found in two of these pathways. The test may also be used to monitor patients who are taking heparin, a blood thinner. A PTT test is usually done with other tests, such as the prothrombin test. Normal Results The normal value will vary between laboratories. In general, clotting should occur between 25 to 35 seconds. If the person is taking blood thinners, clotting takes up to two and a half times longer. Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results. Statin Side Effects and Drug Interactions What You Should Know About Statin Side Effects and Drug Interactions Statin drugs have the potential to induce statin side effects, they also have the potential for drug interactions. Statins are a class of cholesterol-lowering drugs that target all aspects of your lipid profile: They lower LDL cholesterol and triglycerides, while raising HDL cholesterol. Although they are very effective in lowering cholesterol levels, statins may not be for everyone. There are some things you should let your healthcare provider know before you begin statin therapy, such as medical conditions you may have or any medications that have been prescribed to you by another physician. Additionally, if you receive medical treatment from someone other than your healthcare provider, you should let him or her know that you are taking a statin. This is a general list of medical conditions and medications that you should be aware of. For a more complete list, remember to consult the information for the specific statin if you are taking (Crestor (rosuvastatin), Zocor (simvastatin), Mevacor (lovastatin), Lescol (fluvastatin), Lipitor (atorvastatin), or Pravachol (pravastatin)). Medical Conditions You should let your healthcare provider know if you have one or more of the following conditions before you begin taking a statin:

Active or chronic liver disease Pregnancy Statins may cause birth defects. Breastfeeding Statin drugs could cross the breast milk and be ingested by your baby. Alcohol abuse Statins could further increase liver enzymes.

Possible Drug Interactions

Some medications may interact with statins, by either decreasing the effectiveness of your statin or increasing the statin level in the blood to the point where it may become harmful to the body. Be sure to notify your healthcare provider if you are already taking any of these medications below. Just because you are on any of these medications, it does not mean that you are not able to take a statin. However, your healthcare provider may want to monitor you more closely while on these drugs, since taking these medications with a statin may increase your risk of side effects. This list is not inclusive, so if you need a complete list of drug interactions, please read the individual information about your statin (Crestor (rosuvastatin), Zocor (simvastatin), Mevacor (lovastatin), Lescol (fluvastatin), Lipitor (atorvastatin), or Pravachol (pravastatin )) or consult your healthcare provider for further information:

Nicotinic acid, or niacin, in high doses (greater than 1 gram a day) could increase risk of experiencing statin side effects. Bile acid sequestrants may decrease the effectiveness of some statins. In order to avoid this, your statin dose and bile acid sequestrant dose can be separated by at least four hours. Fibrates may increase the risk of experiencing statin side effects. Samdimmune or Neoral (cyclosporine) may increase the amount of statins present in the blood and may also increase side effects. Fluvoxamine may increase the concentration of some statins present in the blood and may also increase statin side effects. Antifungal drugs ending in "-azole, such as Nizoral (ketoconazole), Diflucan (fluconazole), Mycelex (miconazole), or Sporanox (itraconazole), may increase the amount of some statins present in the blood and may also increase statin side effects. Antibiotics ending in "-mycin" such as erythromycin or Biaxin (clarithromycin) may increase the amount of statins present in the blood and may also increase side effects. High blood pressure medications, such as diltiazem and verapramil, may increase the amount of statins present in the blood and may also increase side effects. Cordarone (Amiodarone) may increase the amount of some statins present in the blood and may also increase the side effects of statins. HIV Protease Inhibitors, such as Norvir (ritonavir), Agenerase (amprenavir), Crixivan (indinavir), or Viracept (nelfinavir), may increase the amount of some statins present in the blood and may also increase side effects. Coumadin (warfarin) Taking a statin with this drug could cause the blood to not clot as well. Prilosec (omeprazole) may increase the amount of some statins present in the blood and may also increase the side effects of statins. Tagamet (cimetidine) may increase the amount of some statins present in the blood and may also increase the side effects of statins. Zantac (rantidine) may increase the amount of some statins present in the blood and may also increase the side effects of statins. Oral contraceptives Statins may increase the concentration of these hormones in the body. Lanoxin (digoxin) Statins may increase the concentration of some statins in the body. Antacids containing magnesium or aluminum hydroxide may decrease the concentration of some statins in the body. This can be prevented by separating your statin dose and antacid dose by at least two hours. St. John's Wort may decrease the effectiveness of some statins.

What is a Paradoxical Embolism?

Leg DVT: a common cause of paradoxical strokes Photo A.D.A.M. Definition: A stroke that occurs due to the unlikely, but possible, migration of a blood clot from a large vein (DVT), into the arteries that bring blood to the brain. Typical paradoxical strokes occur in people who have an an abnormal opening between the left and right upper chambers of the heart which is known as a patent foramen ovale, or PFO. The most common sources of blood clots that cause paradoxical strokes are the legs, pelvis, and arms.