Coumadin for Atrial Fibrillation - the balancing act.
Wed, 2009-10-21 12:01
Using Coumadin for patients with A-Fib does prevent strokes. Recent evidence indicates that the higher the CHADS (CHF, HTN, Age, Diabetes, Stroke) score and the older the patient – the greater the benefit. This is good. Yet, older and sicker patients are at a higher risk for intracranial bleeding (falls etc). Should we draw a line where Coumadin becomes just too risky?
Absolutely. When the patient becomes unsteady and at a high risk for falls then the Warfarin really needs to be addressed. I also think that when an elderly patient is on Warfarin there needs to be frequent checks for adherence meaning that the patient is not on Aspirin, Warfarin, Plavix and daily prn Naproxen. I had this discussion frequently when I was in the outpatient setting.