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Discussion

Please, take your Warfarin!

Sad case on our floor this weekend. Homeless guy, chronic Afib, non-compliant with meds, Hx drug and ETOH abuse. Admitted for Afib with RVR, and infected surgical wound from toe amputations.

Yesterday he spontaneously converted to NSR and threw a clot down his LAD. STEMI, Cath code, thrombectomy and he's all better, right?

Wrong. Despite starting on IV heparin and warfarin, he starts to moan and c/o abdominal pain and nausea tonight. Curled into a ball and puking his guts out. Hospitalist not impressed, orders maalox and protonix. Cardiologist called for increasing HR and BP, orders IVF and metoprolol IV. Does not think a abd Xray or CT is necessary. Drug counselor comes by. "Oh, I know this guy, it's probably W/D, he needs Valium." One bottle of IV Valium in the house, have to wait an hour and a half for it to be drawn up and delivered to the floor.

Hospitalist shift change and new guy orders stat labs and CT angio of abd and pelvis which shows ischemic bowel. Probably threw a clot down his SMA. Surgeon consults, plans to wait and see, but doesn't want him to have pain meds that will mask the pain.

So this guy is going to suffer and possibly end up with a colostomy or worse, all because he didn't take take his warfarin.

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    Ive taken care of a few pts, A & O, seemingly well educated, except they refuse to take Coumadin for their A-fib. Ticking time bombs is what they are. I get so tired of non-compliant pts who seek sympathy for what they could have prevented.

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    It's the same as rat poison...no surprise they don't want to take it. And Pradaxa isn't any better.

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    It's the same as rat poison...no surprise they don't want to take it. And Pradaxa isn't any better.

    So if you had A-fib you would rather take your chance of throwing a clot rather than taking Coumadin?

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    Yanno, Coumadin isn't all bad and this is coming from someone who has had to take it on a daily basis for the last four years. I like it a whole lot better than the alternative for me...death without warning. The upshot is that I get to give better pt education about the medication...stuff like get a medical alert bracelet, really good diet info and random ADL information from someone who lives with taking the stuff.

    People fear what they don't know and hearing information from someone who is actually using something rather than rattling off knowledge can help those few individuals who are hold outs. I don't know how many times I've heard "nurses don't get sick!!" Sure they do!!

    For what it's worth, Pradaxa works for a-fib but not for DVT prevention because there is no antidote (like vitamin K). If the level of Pradaxa gets too high, it's just a really bad oops.

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