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I work in Neuro ICU..newbie really...10 yr experience..1 yr Neuro...but my understanding is that the side effects of Coumadin and Heparin are what they are looking at...Nowadays, it seems the favorite SQ is Lovenox,not Heparin even for post-op/post CVA..again, the only thing I can get from the docs is less side effects...hope this helped some...by the way, welcome back!!!

I am a Neuro ICU nurse in East Texas where we have a level 1 trauma Center and a large Neuro-sciences Department.
Of course, as I am sure, American Heart Assoc's. CODE STROKE protocol is followed and TPA is used whenever possible, throughout ths country.
More and more often our patients are being sent for arteriogram and are selectively TPA'd, if a clot is found. We have a great Neuro-radiology Dept. here in East Texas and our Interventional Neuroradiologists are the Best!


As far as the Plavix - Heparin & Coumadin issue is concerend, The Great Neurologist I work with (Dr. George Plotkin MD - Harvard/Boston General) explained the use of Plavix (which is basically just an expensive Asprin Tablet) as that of when you need to stop platelet formation from happening. When you need to use heparin is where you are concerned about the second phase of clotting....ie: fibrin formation and the whole clotting cascade itself.
So, it seems that the source of / cause of the ischemia is when the decision to use Plavix and A.S.A. or Heparin and Coumadin comes into play.
Just think about it and it all makes sense....remember Plavix's action on a non living thing ( Platelet ) and how Heparin works.
So if you have small vessel ischemia or have colts from a cardiac nature (ie a clot thrown from someone in a-fib), what do you want to use?

Hope this helps out.