Dad has just done an EKG and Echo and the cardiologist told him he was a prime candidate for a stroke (A-fib, 92 years old) and that he should consider rivaroxaban. Cost is not an issue because it is VA. Dad is still in a wheelchair because he fell 2 months ago and is trying to walk but balance is an issue. He rolled out of bed last week.
Dad is also beyond making decisions for himself, so its my decision. I am not highly motivated to start him on this, because he's already so scared of falling that he hesitates to try to walk. I have tried to do research but I cant find any hard numbers or anything that just a Pro or a Con.
Does anyone have any opinions or experience? the doctors don't want him to take warfarin and he's always turned it down even when it was offered. But ribaroxaban's side effects are limited to falls, it seems. but falls are also what he has experienced that has gotten him into this state....
in other words...yes...no...yes...no .... maybe....
any words of experience or advise?
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Just wanted to lend you my support and experience. Good luck
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She's been on Warfarin for years and years. She gets her levels checked monthly (more frequently if she's out of the normal range). So she's done fine on Warfarin. She hasn't had falls, so I can't speak to that part of your situation. Good luck, it's hard to know sometimes what the right thing is to do!
Then one day he fell in his own driveway and broke his nose, had a nasty nosebleed... he was sent to the ER and stayed a couple days overnight.... the attending heart physician decided that Dad was MORE at risk of falling and bleeding out, and LESS at risk for having another heart attack. Thus, Dad was taken off of warfarin. Understand, this is a case by case decision.
Dad does make sure he takes a baby aspirin daily.
I would hesitate to add any extra medication to a 92 year old.
A fib is extremely common in the elderly and I assume your dad's is not due to a heart valve problem.
I have been taking warfarin for a couple of years with no problem. The down side is that the blood levels have to be checked at least monthy and more frequently if his levels are unstable. This of course is inconvenient as it means a trip to a lab. The test is a simple finger stick similar to diabetic testing. Depending on the result the dose may need to be adjusted. It is possible to have the testing equipment prescribed so the test can be done at home. Above a certain level blood has to be drawn for a lab test. That may be easier with the VA who seem more generous with their equipment than Medicare.
I was advised that ribaroxaban or similar meds were not a good idea because there is not antidote for these drugs. In case of a bleed with warfarin Vit K can be given to counteract the blood thining.
Your father's greatest risk may be more from bleeding associated with his frequent falls rather than strokes or heart attacks. In addition at least for the present he is confined to a wheelchair which increases the risk of a deep vien thrombosis in the leg or lung. You can look up all the side effects of riberoxaban the most important being allergies.
To sum up
He is of advanced age.
He is an extreme fall risk so warfarin would be a better choice because there is an antidote if he bleeds.
There are some dietary restrictions with warfarin.
Blood levels have to be checked with warfarin.
No dietary restrictions or frequent blood tests with rovaroxaban. Although the blood does need to be checked for kidney and liver problems but not as frequently as with warfarin.
Given your father's risks a blood thiner would be indicated but at his advanced age he has to die from something.
It would be a very different decision if he was a fit 70 year old.
My personal decision would be not to treat but I stress this would be a personal decision. It is however important to get him up and walking and sitting with his legs up. Has anyone suggested just using Asprin either 81 mg or one big one.
Hope this helps rather than confuses.