Trying to make sense of my mom's post-hip replacement TIA
September 14, 2014 9:02 PM   Subscribe

My mom had a full hip replacement on August 22nd. 12 days later, she had a TIA. The ER lab tests (MRI, CAT scan, and electrocardiogram) said there was no sign of a blockage. 2 days later, her primary care doctor said it was probably caused by a blood clot related to her surgery, and she shouldn't make any changes other than taking an aspirin, avoiding alcohol, and monitoring her blood pressure at home. Does this sound like a normal treatment plan for someone who had a TIA most likely caused by a hip surgery-related blood clot?

I'm mostly worried because I read into what a TIA is, and found that people who've had them are at risk of having a stroke, and up to 33% of TIA sufferers have a full stroke within 3 years. However, I'm wondering if this same risk doesn't apply to my mom, since 1) we know the clot was "probably" related to her surgery, 2) there's no sign of other clots, and 3) she won't be as immobile anymore as she was before/after the surgery. Her primary care doctor didn't seem to be too concerned about this happening again. After my mom told the surgeon who performed the hip replacement and my mom's 2 at-home nurses about the TIA, they all said clots related to orthopedic surgery, especially full hip and knee replacements, are common.
posted by daisy77 to Health & Fitness (4 answers total)
Yes. Asprin is the most well known stroke treatment currently that's the first level to take. Anything more and you're putting the lower risk of a stroke against an increased risk of stomach bleeding, bruises and uncontrolled bleeding in surgery from blood thinners. If your mom is a smoker, alcoholic or diabetic, or has a family history of early strokes, maybe that would warrent more intervention but a post-surgical TIA is relatively unlikely to occur again, and the prevention could cause more harm than help. Asprin's good.
posted by viggorlijah at 9:32 PM on September 14, 2014 [1 favorite]

One thing that was recommended for a relative of mine who had surgery on a broken leg last year was to do "toe pumps" if she had to be lying down for any extended period... just point and flex your toes repeatedly for several minutes, every 20 mins, and it helps the circulatory system to keep the blood moving through your legs, reducing the risk of clots. If your mom is still lying down a lot or immobile, might ask her doctor or PT if that kind of thing would be helpful/okay.
posted by LobsterMitten at 9:38 PM on September 14, 2014 [1 favorite]

Immobility is a risk factor for strokes, TIAs and cardiac events. It's also a risk factor for DVTs. When people talk about clots related to surgeries such as hip replacements, they're likely referring to the incidence of DVTs. The likelihood of any venous clot traveling to the heart, then the lungs, then somehow back to the heart and into the brain is, well, rather improbable.

Barring other identifiable risk factors for stroke or TIA, such as cardiac issues (holes in the heart walls, irregular heart rhythms), hypertension, high cholesterol, smoking, genetic disorders predisposing one to clot formation, sleep apnea or obesity, the standard treatment is the use of an antiplatelet drug and a statin. Examples include aspirin and any cholesterol med that ends with -statin.

"Light" alcohol intake is associated with lower incidence of stroke.

Of course, your mother's MDs should have taken into account any/all other medical issues and risk factors, weighing risks/benefits of specific medical therapies. Some people can't tolerate any sort of statin, or can only tolerate specific ones. Some people have a history of heavy alcohol consumption, which is associated with a higher risk of stroke.

tl, dr: Aspirin is standard treatment for people who've suffered a TIA. So is monitoring one's blood pressure.
posted by herrdoktor at 11:07 PM on September 14, 2014 [3 favorites]

Not only does it sound standard for a patient like your mom, people with TIAs not related to surgery/immobility can be treated this way too (and also with a statin as herrdoktor mentioned, it's unclear if your mom is on one or not, as noted, some people can't tolerate them). Was there some specific therapy or therapies that you heard about that you thought your mom should receive in addition? I would also strongly second viggorlijah's point that stronger blood thinners such as Plavix and Coumadin have more risks. They are not something you want to take unless you must.

I also wanted to make sure that herrdoktor's good point was clear re: DVT. His point being that clots from the leg (DVTs) cause clots to the lung rather than clots to the brain because of the way our circulation works, unless there is a hole in the heart or PFO (patent foramen ovale) that lets them shortcut the lungs. Point being that if you don't have a PFO (and an echocardiogram to look for one is part of the usual workup for stroke/TIA) then stuff like toe pumps that LobsterMitten mentioned will not help you avoid a stroke, although they can still be a good idea for preventing DVT.
posted by treehorn+bunny at 1:58 AM on September 15, 2014 [3 favorites]

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