re: benefits/risk of warfarin - this really would be dependent on the
underlying condition requiring anticoagulation.
eg. if you have afib and elderly, you're approximately 7x more likely to get
an embolic stroke than people your age in sinus and I believe warfarin
reduces that risk by about half (aspirin I gather is less than 50% as good
as warfarin). I guess you are more at risk to develop intracerebral bleeds
(what's that figure? 10 x more than the baseline?) but that risk should be
lower than embolic stroke.
But each patient is different, and one that's oh, having frequent full
seizures sec to a previous CVA - and hence more likely to bang his head, oh,
you mightn't want to anticoagulate him. I don't know really about the use of
warfarin in the cognitively impaired - a lot I suppose depends on what sort
of quality of life the patient has - again quite a subjective assessment.
Personally, when I was in 'medic' land I used to let the patient/family
decide, given the pros and cons of each option
Robert Spykerman
Reg, ED, Cork University Hospital
BTW, what IS this warfarin lite stuff (have I been under a rock somewhere
for too long)?
----- Original Message -----
From: "Paul Ransom" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, February 03, 2002 10:51 PM
Subject: warfarinzed not just head injuries
> Following on the thread of warfarinized head injuries, could I widen it
out
> a little. Most of these head injuries come from falls. We certainly
keep
> a proportion of the warfarinized 'fallers' in overnight for various
things,
> not just for head injury, but also for the large haematoma that might get
> bigger etc, just because they are on warfarin. At what stage, and
after
> how many falls, is the benefit of warfarin outweighed by the risks ?
How
> do haematologists come to a decision to stop warfarin ? Three
> strikes and you're out ?
> I am at the moment auditing the amount of patients attending A&E with
> falls/trauma etc, and have unearthed a fair amount who have recurrent
> falls. The haematology department has no record of these, but would
> certainly be interested in this information.
> Does anyone else have efficient cross-information to the haematologists
> about this group of patients. Seems to be an important gap between A&E
and
> our colleagues.
>
> This new 'warfarin-lite' stuff sounds good, Ray. Any idea how near
it
> is to marketing etc ?
>
> Paul Ransom
> SpR A&E Hastings
>
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