Struggling with medication

Ed1937

My wife is in the hospital with possible TIA, but there is no conclusive proof there was one. She has been taking 2 1/2 mg warfarin since the pandemic began, and there was no reason to think that it was not working for her. A doctor in the hospital increased her dosage to 5 mg, and they were running pro times. I'm not sure I'm comfortable with the increased dose because of increased chances of bleeding from falls, which she has from time to time.

I understand that the increased dosage lessens the chances for blood clots and strokes, but it also increases chances for bleeding. I'm sure she would rather die from a massive heart attack or stroke, then to die from dementia. But there's no guarantee that a heart attack or stroke would be fatal, either. She would not want to be paralyzed from a stroke, and have a further loss to deal with. There are no easy choices, but your input would be appreciated, especially from the medical community.

Lynne D

Oh Ed, I have no constructive  input, but my thoughts are with you.

M1

Ed this is a really tough one.  Whether to use anticoagulants --be it warfarin or an alternative--gets really hard when you've got someone with dementia and a fall risk.  With atrial fib, it's going to be more stroke risk than heart attack that's of concern.

Things to consider:  is her atrial fibrillation intermittent or continuous?  Intermittent would theoretically carry less stroke risk, but it's not zero, and in the absence of dementia, anticoagulation would definitely be recommended.

There are alternatives to warfarin; there are now direct oral factor X inhibitors (Xarelto, Eliquis) that may have less bleeding risk than warfarin and that don't require monitoring like warfarin does.  This is probably worth discussing with her docs.  

If she were truly end-stage, probably not anticoagulating at all would be reasonable.  Might even be now, but that's a really, really hard call.  She has fallen a number of times, as I remember.

Wish there were something more definitive, but i would at least inquire about the warfarin alternatives.  Especially if she is going to memory care, monitoring the protimes is very tedious as you probably know.  There are fingerstick machines that can do it, but Medicare won't approve them (that's another saga altogether).

Ed1937

Thank you for the info. I'm at the hospital now. She'll make the transition tomorrow. I'll talk to her docs. Thanks again.

Bob in LW

Ed- Just for comparison, my SO is on Warfarin, taking 5mg 4 days a week and 7.5 mg 3 days a week.  She bruises easily and gets a blood test every couple of weeks. She hasn't had any excessive bleeding. After each test, she is advised of any changes to her dosage needed to keep her in the desired range.

I had a small TIA several years ago and my doctors put me on Plavix, 75 mg daily.  I do have some bruising, which clears up after a few days.

shardy

Just our experience....

Jim was in afib in January with a 3 day hospital stay.. Eliquis was recommended but after talking with his cardiologist, pharmacist and PCP and considering where he is at in his journey we made the decision to only take a baby aspirin instead of another prescription.

Jo C.

As M1 commented, I too wonder if there is not another approach to your wife's anticoagulant needs.  May be worth asking about.  

What is part of the dynamics, is that the cause of falls in someone with your wife's issues is not always tripping or losing balance, it is not at all unusual that the falls are secondary to very small TIAs.  This happened often with my MIL as well as with my own mother a few times.  As said before, TIAs do not always show up on a scan.  No way to know, but it is something to be watchful for.

This must be very difficult Ed; it seems it is about risk versus benefit, (an expression I have come to dislike), and what is best for your wife at this stage of her disease.  I do agree with what was said, the lingering effects of a stroke would be terribly devastating; I am sorry you are put into this decision making predicament, so much to think about with no guarantees.  You are doing a wonderful job of it all; really and truly Ed, you are.

Is it today that your wife transfers to MC?  If so; my deepest wishes for a smooth transition is being sent your way.  May she feel she is going to "rehab," to lessen her anxiety, and may she find it a good and happy place to be and benefit from the setting and care.

Best and warmest thoughts and wishes being sent your and your wife's way,

J.
 

M1

Yes Ed if today's the day--my heart is with you.  Please let us know when you can.

toolbeltexpert

Ed that is a hard call.  Prayers for you and those that are caring for your dw.

Joydean

Ed my thoughts and prayers are with you and your dear family!