Warfarin for the very elderly?

[irene75359]

My mother, who is 95 this year, was diagnosed with AFib after a fall last year.  Her doctor at the time said the dangers of being on warfarin outweighed the benefits and her new doctor (she has since moved to sheltered accommodation) seems to feel the same.  He visited only a couple of days ago and told my mother of the risks.  She had a TIA three years ago and her previous doctor didn't bother to visit.  My mother is very frail and housebound, but very cheerful and totally content with her lot. Mentally she is extremely alert and fills her days reading and doing puzzles (we were deprived as children, my family never had a television!)

So her risk of stroke is very high.  She is relatively stable on her zimmer and we have removed all obstacles and danger points, and she has thick carpet throughout the flat. Carers visit four times a day.  There are alarms in every room at ground level, and she wears one on her wrist.  

My fear is that she will suffer a massive stroke and possibly having to live with the results, albeit maybe only for a short time.

I would really appreciate hearing if anyone knows of a similar situation and the treatment offered.

[CDreamer]

Hi Irene - from what I know, which is questionable for sure - treatment with anti-coagulants is always a risk assessment because you can stroke from both clots and bleeding,  It seems that your Doctors have advised against treatment because they consider the risk of bleeds to be greater - all anticoagulants will increase the risk of bleeds - which can also cause strokes as our blood vessels weaken and become fragile with age, as does the rest of our body.

It sounds like you have done everything possible to ensure that your Mum is as well and provided for.  I understand your fear, believe me when I say every person on this site will as it is something we live with, but unfortunately life comes with risk and none of us know what is about to happen.  

Your Mum sounds content and living the best she can and long may it continue.  Enjoy the time you have with her.  

[BobD Volunteer]

Irene anticoagulation is always a balance. In addition to the CHADSVASC score system for stroke risk calculation there is also a HASBLED scoring system to assess the risk of bleeding. Strokes can be either Thrombotic (clots) or Haemorrhagic (bleeding into the brain) and there comes a point when the risk of bleeds exceeds that of clots. (You can look all this up if you need more information).

This is not just about soft carpets and reducing the risk of falls Irene this is about the reduction in elasticity of blood vessels as we get older. I do feel that you need to accept what the doctors say, although you could if you wish look up these scores on AF Association website and do your own calculations. On balance I fear the decision may not change.

Bob

[cassie46]

Hi Irene

My dad will be 94 this week an he is on warfarin.   I did ask 6 months if he could go on the new noacs (I'm on Rivaroxaban) but was told no.   He has been on warfarin for 3 years or more.   This was because he has had a few tias very minors, he also has a pacemaker, he does not have AF.    The care that you have been giving at home with carers ect is what we had but 4 weeks ago he had a few falls so is now in a care home.

It was to worrying if he fell at night or knocked himself out, and his walking was getting very bad even with a frame.   He in fact said he wanted to go into the care home as he did not feel safe, he is a very stubborn man and held out to the end.   So the warafin thing I donn't what is best.    I would hate to see him have a bad sroke (but the pacemaker would probably keep him going!)

Cassie

[irene75359]

Thank you all for your replies - much appreciated.  I will leave well alone I think!  But it just got me interested thinking of all us people with AF and if we are fortunate enough to reach a grand old age, at what point will they say stop the warfarin - the risk is too great?

That said, my mother's AF is asymptomatic and in spite of her frailty she enjoys her life very much.  And yes, we all enjoy the time we have together!

[MarkS]

Hi Irene,

I have a very elderly neighbour who is on warfarin. I have taught his daughter how to get and use a Coaguchek and she does weekly readings. As a result he is very well controlled and his HASBLED score is correspondingly lowered. I would recommend this.

Mark

[irene75359]

Thank you Mark - unfortunately I live 540 miles away and only see her every six weeks or so.  If her GP had prescribed warfarin (big if) and I was local I could test her using my own Coaguchek.  But the distance makes this impossible.