You our not our doctor, this is not real doctor advice, I promise not to sue you, etc. We’re getting conflicting doctor recommendations, so I thought I’d pump your brains for medical opinions.
My SO is a 57yo male. Chronic atrial fibrillation diagnosed Sept 2000. One month later he had an MI with complete blockage of the RCA. A stent was placed and he was put on a holy host of antihypertensives, digoxin and warfarin.
Other health history includes hyperlipidemia, COPD, sleep apnea and diverticulitis (2009) which ruptured, requiring colostomy. In January of this year, he had some left shoulder pain, and the ER docs/cardiologists at the hospital did a chemical stress test (WNL) and ECG (WNL). Dig level was at 0.5 and INR 2.3. They added a daily full strength aspirin to his regimen.
Yesterday, the urgent care doc at the VA (the situation wasn’t urgent other than we needed meds refilled and the VA would do it immediately and free) told us he wanted to take the patient off warfarin, saying that it’s only indicated for a-fib if the patient also has a CHAD score of 2+. His is 1 (MI). So the doc dc’ed the warfarin.
The pharmacist filling the order at the VA seemed awfully concerned about stopping the warfarin, as am I. I was taught that warfarin is indicated for chronic a-fib, period, to prevent the formation of clots behind the valves in the heart which could break lose and cause Bad Things To Happen. But I’m only a nursing student, so what do I know?
We go back in another 3 weeks to have a real intake done with a doc who’s not Urgent Care focused. He has enough warfarin to keep taking it until then, but we’re not sure what to do. I don’t expect y’all to make our decision for us, of course, but I’m wondering what the current recommendations for warfarin use with a chronic a-fib are, and if the CHAD score is really relevant.