My mother is 91 requires anti-coagulants, need second medical opinion?
My mother is 91 and lives in Aged Care. She is wheelchair bound and cannot walk by herself at all. Two days ago a locum advised that she has Cellulitis in her leg and started her on a course of antibiotics. Today her regular doctor advised that he thinks it might be DVT instead as the swelling goes from her groin to her ankle. He advised that we could do a test to check if it is DVT but there is no point if we are not prepared to put her on anti-coagulants. I have done some googling and there seems to be differing opinions about giving anti-coagulants to the elderly. I am looking for a second opinion as this is a very difficult decision for me to make.
In my opinion you should get INR ,platelets count , PT ,testing done , vascular duplex so you can diagnose first what is exactly the current problem ,then the decision can be taken,..since it is impossible to treat such cases online as there is no two cases are similar and decision should be based on full examination and history ..
What other diseases she has?
Any history of strokes?
Htn diabetes ?
Heart condition ?
Please reply so I can help you better .
I think the best place to start is to have the blood test done to see if it suggests the possibility of a DVT in the affected leg. The diagnosis will then have to be confirmed with an ultrasound to see if there are clots in the venous system of the leg.
If there are no clots, or if the D-dimer blood test is negative, then your mother’s diagnosis is most probably the cellulitis which should resolve with the current treatment. You will therefore not have to worry about considering anti-coagulant treatment.
If the tests are positive for a DVT, then you have to weight the benefits of the treatment against the risks involved with using the medication. Only then will you be able to make an informed decision on behalf of your mother.
If it will benefit her, then starting her on the anti-coagulant medication will be better. There are treatment options available now that won’t cause prolonged bleeding and side-effects like warfarin does, and you can speak to her doctor about these new age medications.
My opinion you need to first confirm if it is a DVT, yes anticoagulants are considered contraindicated in old age yet some doctors do consider the use of warfarin
It’s not an absolute contraindication
I recommend you to do your father the confirmatory tests for DVT as it is a serious condition, if confirmed , other blood tests will be needed to adjust the needed doses, the suitable medication in relation to her medical condition
First of all get confirmation done that whether she has Deep vein thrombosis or DVT or not then you can worry about the anti coagulants..
So first get tests done like D dimers test, ultrasound, venography etc..
If it is confirmed then you can discuss about new generation of anti coagulants and appropriate dose titration can be done so that she does not suffer complications like excessive bleeding..
Hope this helps..