A Fib and UTI

saltom

DH fainted in the kitchen yesterday morning, ambulance to the ER where he was diagnosed with A Fib and UTI and admitted to the hospital.  He's still in the hospital for tweaking of meds and getting the right UTI antibiotic. My dilemma now is low dose aspirin or blood thinner for the A Fib. The hospital doctor told me to check with DH's pc doctor. Our daughter who is a licensed nurse but no longer doing hospital work and I both are leaning toward the aspirin as DH has fallen three times in the last five months and needed lift assist or EMTs in yesterday's incident  when he banged his head quite hard on the floor. He also has a history of quite severe nose bleeds. I'm afraid of  internal bleeding with a blood thinner. The hospital doctor was concerned about a stroke with the aspirin.  He has a pronounce heart murmur and stenosis of the aortic valve  - heart at 45% function. He's 89 years old.  I must say the ER and hospital staff have been very patient and good with his dementia and called me twice when DH wanted to speak to me on the phone. He says he's going out of his mind with boredom and wants to come  home.  I'd like him home, but not  until the doctor's have him stabilized.  Anyway, any thoughts on aspirin vs. blood thinner? Know most of you are not trained in medicine, but most of you also have had a wealth of dealing with medical issues, and I value the information from you.  Thanks.

M1

So sorry saltom.  With my medical hat on:  absolutely, aspirin only.  It's unusual for atrial fibrillation to cause passing out like that--I would worry that the aortic stenosis may have contributed, and it doesn't sound like he's a surgical candidate at all.   Meaning:  it could easily happen again, and he could hurt himself badly with blood thinners on board.  I would ask the docs frankly for a discussion about how long he has and whether comfort measures are in order.  I would highly suspect that they might be.  And again, I'm sorry.

Ed's wife just died recently of a massive GI bleed--and I believe she was on blood thinners for atrial fib (not sure which one).  He may well have an opinion for you here that's relevant.

saltom

Thank you M1.  I appreciate your straightforward opinion and suggestions.

Quilting brings calm

M1-  as a person who had 1 Afib episode after a hysterectomy 7 years ago, thank you for your answer.  My heart beat  was way too fast that time.   I’ve been on aspirin and cholesterol meds  ever since. My NP at the cardiologist is all up in my face about  going on blood thinners when I turn 65.  According to her, Afib, being  female, and turning 65 makes blood thinners mandatory. My PCP told me I don’t have to if I don’t  want to - and I don’t.  I bruise easily enough as it is with the aspirin.

Not sure what my NP will do when I tell her no next year. 

Ed1937

Saltom, I'm sorry you have to make a decision on this. I know first hand it's not easily done. When covid first hit hard, I made the decision to stay in the house as much as possible. My wife was on coumadin for afib, and we had to get her blood checked about every month. I asked her doctor if she could just go on aspirin, so we wouldn't have to go out to get checked. At that time he told me he would rather she take a very low dose of coumadin, 2 1/2mg daily. We did that for over 2 years, without getting her checked. There were no problems, and since she had several falls at home, I would leave it as is.

While she was in the hospital for possible TIA (uncomfirmed), one of the doctors increased her coumadin dose, without my knowledge. After an 8 day stay in the hospital, mostly waiting for a bed to open in MC, she finally was accepted to MC. It wasn't until a day or two later that I found out they had increased her dose of coumadin. I wanted it to go back to 2 1/2mg daily, but after lengthy discussions with the doctor and DON, I was assured that they would keep checking on her INR levels, and they convinced me it was best for her.

So after approximately one month of increased coumadin dose, she was found in the morning with blood coming from her mouth, and she was non responsive. They had her taken to the hospital, but by the time I got there, she was acting like nothing happened, and was very lucid. We talked for several hours, then she had a massive GI bleed, and the nurse told me she would not make it. I did everything possible to make sure she was comfortable (and she was), and seventeen hours after being told she would not make it, she passed with our family around her.

After 2 1/2 months, I still shed a lot of tears, but I'm glad she did not have to endure death from dementia. I remember M1 saying I was between a rock and a hard place when making decisions about blood thinners. He was right. If she was on a small dose of coumadin, she might have had a stroke, and be totally dependent. MAYBE. Although I questioned my decision when she died, I am now totally comfortable with it. I don't think there is a right or wrong decision to be made. Again, I'm sorry you have to make the decision. 

MaryG123

Personally, I’d go with aspirin or no treatment at all.  What is your long term goal?

saltom

Thanks Ed and MaryG.  I have a message into the pc doctor. DH's older sister and brother both with some kind of dementia died shortly before their 90th birthdays.  I would really like DH to go peacefully before dementia gets more debilitating.  He's sort of in a moderate stage now.  It's easy to say I want him comfortable and at peace (nice and abstract), but making the actual decision seems too concrete and sudden.  Your comments are really helpful for me.  He called me from the hospital last night demanding I come and take him home right away. I went through when the doctor says it's OK, I will come get you.  I miss you and love you.  He responded. Ditto that. I love  you, too.  That gives me a positive memory to cherish.

John_inFlorida

My DW had been on blood thinners for years. But started having some issues with bleeding. She has a pacemaker, the appendage on her heart had been removed. And she had no arythmias  for a year. So in talking to the cardiologist, he was afraid that a brain bleed could be a big problem and took her off the blood thinners and started low does asprin. She was off the thinners for 9 months no problem, then had a mini stroke. So back on blood thinners. Cardiologist said we just need to evaluate the risks and act accordingly. luckily she has never fainted. I would suggest discussing with the cardiologist.

just my 2 cents   

John_inFlorida

I see some talking about coumadin, that's what we started with. We were told that she needed enough to be thereputic, so had to have her blood tested all the time. That was a real pain, but it was very cheap. But for the last 8 or so years, she has been on Xarelto. expensive, but 1 pill a day and no need to test her blood