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Can One Discontinue Taking Warfarin Over The Weekend Before Consulting A Doctor For Muscle Weakness?
Question: My 91 year old father had a TIA two weeks ago and was given Lipitor at the ER, even though he was taken off it in 2015 for muscle and sugar concerns. His blood sugar was stable, now it is running at 250-380 since adding Lipitor. He is showing signs of muscle weakness and has fallen twice. The ER could find no evidence of new Neuro problems. He's on warfren and is at risk of head bleeds and I'm worried about a fall with his weakness. Is there a problem with taking him off it for the weakend until I can reach his HMO primary doc on Monday?
Brief Answer:
Warfarin changes should be done after talking to your doctor. Lipitor is important for long term prevention of brain events (attacks) but few days of stopping it if the patient has side effects till he sees his doctor might not cause major issues.
Detailed Answer:
Hello,
There are several issues i will try to address:
1. Are neuro problems ruled out with a brain MRI? TIA is diagnosed if a patient has neurological symptoms that last only few hours and the brain MRI shows no problems. If no MRI is done than it is not sure if it is a transitory or a more stable event and the weakness might be due to this as well.
1. the risks and benefits of Lipitor in TIA
TIA is a condition that is transitory but is a warning for more stable and important event. This is the reason why the doctors try to prescribe statins (Lipitor) to reduce lipids as recommendations say that it reduces the risk for future events.
On the other hand it is true that Lipitor increases risk for high sugar levels and also muscular pain and weakness.
To be able to connect the muscle pain/weakness with Lipitor, he might have a blood test called CK (creatin kinase). CK should be increased several fold from normal levels to be considered due to Lipitor.
Lipitor will help if taken long term, meaning that the effects for a few days use or not use might not be noticeable.
3. Warfarin- is sometimes given to prevent thrombus formation especially if the patient has an irregular heart rhythm. Decision to continue, reduce or stop it should be taken with a doctor and depend also on the INR levels. If INR is under 3 than the risk for hemorrhage due to its use is very small.
To conclude i would say:
- Muscular weakness can be caused by Lipitor but also by a possible brain event (more stable than transitory events), to make the difference a brain MRI and CK level in blood is needed
- Stopping lipitor for a few days might not cause visible effects on risk for brain events soon as it is more a drug that works long term
- Changing warfarin dose or stopping it is a decision that needs to be done with a doctor unless allergic reaction to it and even in this case it is important to see your doctor soon.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Antoneta Zotaj, MD
Warfarin changes should be done after talking to your doctor. Lipitor is important for long term prevention of brain events (attacks) but few days of stopping it if the patient has side effects till he sees his doctor might not cause major issues.
Detailed Answer:
Hello,
There are several issues i will try to address:
1. Are neuro problems ruled out with a brain MRI? TIA is diagnosed if a patient has neurological symptoms that last only few hours and the brain MRI shows no problems. If no MRI is done than it is not sure if it is a transitory or a more stable event and the weakness might be due to this as well.
1. the risks and benefits of Lipitor in TIA
TIA is a condition that is transitory but is a warning for more stable and important event. This is the reason why the doctors try to prescribe statins (Lipitor) to reduce lipids as recommendations say that it reduces the risk for future events.
On the other hand it is true that Lipitor increases risk for high sugar levels and also muscular pain and weakness.
To be able to connect the muscle pain/weakness with Lipitor, he might have a blood test called CK (creatin kinase). CK should be increased several fold from normal levels to be considered due to Lipitor.
Lipitor will help if taken long term, meaning that the effects for a few days use or not use might not be noticeable.
3. Warfarin- is sometimes given to prevent thrombus formation especially if the patient has an irregular heart rhythm. Decision to continue, reduce or stop it should be taken with a doctor and depend also on the INR levels. If INR is under 3 than the risk for hemorrhage due to its use is very small.
To conclude i would say:
- Muscular weakness can be caused by Lipitor but also by a possible brain event (more stable than transitory events), to make the difference a brain MRI and CK level in blood is needed
- Stopping lipitor for a few days might not cause visible effects on risk for brain events soon as it is more a drug that works long term
- Changing warfarin dose or stopping it is a decision that needs to be done with a doctor unless allergic reaction to it and even in this case it is important to see your doctor soon.
Hope I have answered your query. Let me know if I can assist you further.
Regards,
Antoneta Zotaj, MD
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Above answer was peer-reviewed by :
Dr. Raju A.T
Answered by
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