Weigh benefits, risks carefully

Dear Dr. Gott: Is there a connection between heart attacks and a cerebral hemorrhage? If an anticoagulant is prescribed, will this result in more massive bleeding?

Dear Reader: Heart attacks are caused by blood clots that block one or more coronary arteries, resulting in damage to (or death of) part of the cardiac muscle.

Cerebral hemorrhage – so-called “hemorrhagic stroke” – is caused by bleeding into the brain, often the result of a weakened blood vessel.

The two afflictions are not related, except in one special circumstance. Anticoagulant drugs (notably aspirin) are routinely prescribed for people who have had heart attacks, to prevent more blood clots. This therapy, although generally safe, may predispose some patients to brain hemorrhage.

In most cases, however, the risk is small compared to the potential benefit (protection against future heart attacks).

If a patient on anticoagulant drugs were to have a hemorrhagic stroke, the bleeding would be more massive and more difficult to control. Also, patients with hypertension are more likely to have cerebral hemorrhages; the therapy usually involves lowering the blood pressure to stop the bleeding.

In the presence of anticoagulants, merely reducing the blood pressure may not arrest the bleeding. As in most medical situations, doctors and patients must carefully weigh the risk/benefit ratio.

To give you related information, I am sending you copies of my Health Reports “Stroke” and “Heart Disease.” Other readers who would like copies should send a long, self-addressed, stamped envelope and $2 per report to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title(s).

Dear Dr. Gott: How do you view the book “Worst Pills, Best Pills”? I suffer from arthritis, heart problems and diabetes. When reading about my medications, the book indicates that certain drugs should be taken with extreme caution.

Dear Reader: Like any reference manual, “Worst Pills, Best Pills” (Public Citizen Inc.) should be used as a guide – not as a bible. Many people are quite correct to be concerned about their medicines, both singly and in interactions. For these patients, “Worst Pills, Best Pills” can provide really useful information; I encourage my own patients to read the book and use it as a resource to ask me questions.

However, I don’t advise patients to take as gospel everything they read in that (or any other) book. Use the book and your doctor to sort out and clarify issues.

To give you related information, I am sending you a copy of my Health Report “Consumer Tips on Medicines.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.