Jul 15 2014
George is seeking advice on behalf of a colleague. A 78-YO male patient with atrial fibrillation on Coumadin >20 years experiences a large bruise following a fall. The INR is 1.8. The patient also has Parkinson disease >10 years. Would you discontinue Coumadin? Would you propose alternative antithrombotic therapy? Thank you.
Comments (1)
Anticoagulant Therapy
Hello, www.uptodate.com suggests do not change anticoagulati
Hello, www.uptodate.com suggests do not change anticoagulation in case of (multiple) fall: “A risk of falling, with the potential for the development of a subdural hematoma is often considered a contraindication to the use of anticoagulation in the elderly, although this risk is often overestimated by clinicians.”
“A Markov decision analytic model demonstrated that, regardless of the patient’s age or baseline risk of stroke, the risk of falling was not an important factor for determining the optimal antithrombotic therapy (i.e., aspirin, warfarin, or no therapy)…The risk of a subdural hematoma from falling is so small that patients with atrial fibrillation with an average risk of stroke (5 percent per year in the absence of anticoagulation) would have to fall approximately 300 times in a year for the risk of anticoagulation to outweigh its benefits.” more details in the chapter, “Risk of intracerebral bleeding in patients treated with anticoagulants” at uptodate.com.