Okish6er - It is not common (though not impossible) for a piece of clot that breaks off a deep vein thrombosis to cause a cerebral embolism (brain clot). These kind of stroke is known as a paradoxical or cryptogenic. The reason for this is that a clot travels up the inferior vena cava (the larges vein in the body) with the blood. It passes through the right side of the heart and enters the lung. The arteries of the lung get smaller and smaller as they reach the pulmonary capillaries where oxygen and carbon dioxide exchange occurs (blood cells flow through these capillaries in a single file). The clot will only go as far as it size will allow it, causing a pulmonary embolism. The larger the clot, the larger the area of lung that is effected. Large emboli can be fatal. The only way that a clot from the leg can get to the left side of the heart and get pumped up the arteries to the brain is if it bypasses the lung. A very small percentage of people have a hole in the heart letting the blood shunt from the right to the left side of the heart. An atrial septal defect (a real hole between the upper low pressure chambers) can allow this to happen if the pressure in the right atrium is greater in the left (for example when you cough, at high altitude, when bearing down during defecation and decompression sickness). This defect is present at birth and is generally surgically corrected early in life. There are some that are not clinically significant to cause detectable problem, so are not corrected. These tend to be very small and are generally incidental findings in an echocargiogram or at autopsy. There is another mechanism by which this can occur. There is a structure called the foramen ovale in the wall between the right and left atrium. It is important in the fetus before birth because it shunts blood from right to left because the lungs are not yet working and the resistance to blood flow through them is high. This is part of what is known as fetal circulation which is different than after birth. The foaramen ovale fuses close in the vast majority of individuals. Recent studies with echocardiography show that there are more people with incomplete closure then once thought, but most are small, < 2 - 6 mm. and flow through them is intermittent. These numbers are not high. What is interesting is that in some autopsy studies of patients that died of stroke, 25% had a patent foramen. However in the vast majority of these cases, there is no evidence of clot in the brain or there are other causes for a clot if present. So yes there is a chance for a DVT to be the source for clot causing stroke in large atrial septal defects or patent foramen ovale, but these chances are low. The vast majority of traveling clots will end up in the lung.
tommy32-Pushing an INR to 2 - 3 does significantly increase your risk of large bruises with injury or bleeding with cuts, this will include the penis. This does not mean that microinjury in the suspensory ligament or tunica will stir up bleeding. So stretching, sensible hanging and ADS are probably reasonable options. I wouldn’t even consider pumping or clamping as they they have a higher chance of of vein disruption. Jelqing, well, I just don’t know. Again be sensible. Start slow with low intensity. Conditioning decreases bruising (for the most part). If something you do stirs up bleeding, stop doing it and let it heal. In addition, it is a misnomer that coumadin “thins” blood. It doesn’t. Bad term. It just inhibits prothrombin (PT) conversion to thrombin which is the enzyme that converts fibrinogin to fibrin which is the matrix of a clot. Therefore it should have no effect on erection. One last point, diet has an effect on the activity of coumadin on PT. Foods or dietary supplements with vitamin K (broccoli, spinach, etc.) cause prothromin conversion to thrombin to be higher than your doctor wants and will decrease your INR, requiring a change in your coumadin dose. Hopefully your doctor or your coumadin clinic is advising you.
For the purpose of full disclosure, I have a clotting disorder that makes me more coagulable as well. I have not had a DVT (though maybe I had an occult one after traveling on a long air flight). I had a penis thrombosis a number of years ago with aggressive intercourse. It healed nicely. Unfortunately (maybe not?) I can’t take coumadin because I have had a vascular malformation in my head and my risk of cerebral hemorrhage is too high to risk it.