Warfarin discontinuation and risk of embolism

Dear Ask The Doctor: Hello! Doctor. My Father (83 Yrs) was admitted in Hospital on 24.03.2010, due to a fall near home. After CT was done, It was found there is a blood clot and got admitted. He is a Arterial Fibrillation patient for the past 12 years (1 1/2 Tab per Day). And he was using Warfarin. After the admition to the Hospital the Neuro Dept. doctors stopped TAB WARFARIN and told us that it cannot be continued till the Blood Clot in the brain is cleared. Now after 4 weeks he develped Embolism in his Left Limb. My Question is (1) Whether it is neccesary to stop TAB WARAFARIN, while treating for Clot in the Brain. (2) Can TAB Warfarin's dossage can be minimised atleast after 2 weeks. Kindly help me out in this regard. As I am preparing to Sue the Hospital in this regards Regards Sheshadri SR

Dear SHESHADRI: The most likely reason that warfarin was discontinued was due to the risk of bleeding within the brain. The reason for the discontinuation may have been guided by the INR level (a measure of how thin the blood is). A clot in the brain resulting from a fall, may be due to a sub-dural haemorrhage (bleed), and if the patient is on warfarin there is a high risk of further bleeding around the brain, resulting in compression of the brain tissue, and subsequent brain damage. If the clot is found in an artery supplying the brain (acute ischaemic stroke) there is also a risk of bleeding around the clot in the initial phase post diagnosis. If warfarin is stopped there is an obvious risk of embolism, and the risk benefit ratio needs to be addressed on an individual basis. I would advise discussing your concerns with your fathers physician or neurologist, regarding warfarin discontinuation specific to your fathers case.