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Question
Posted by: Concerned | 2006/10/31

Warfarin and related ailments

Hi Doc

My dad has been diagnosed with a severe heart condition,(30% functional) high colestrol, diabetes, 40% odd kidney function. Since hsi last episode about a month ago, he was put on Warfarin 5mg and Carlock was stopped. He takes half of the warfarin instead of the full tab as prescribed beacuse he feels that whilst in hospital they only gave him half so why take the full one now... He does same thing with the lasec (water tab) he was lower dose now he's on 40mg, he take half. he feels that the doctor is over medicating and that this will make his condition become worse much sooner. He suffers with a painful swollen left leg, can this be beacuse he does not take the warfarin as prescribed?

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Our expert says:
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Dear Concerned,

Please get your Dad back to see his cardiologist as soon as possible. Unless you dad is a doctor, he cannot know or decide whether he is overmedicated or not.

Warfarin dosage is determined not by what was used in hospital or what was prescribed, but is determined by the result of the INR test which each patient must have regularly. If your Dad is only on a half dose, he could have developed a clot in the deep veins of his leg – if a piece of this breaks off and gets into his circulation, it could cause a fatal pulmonary embolus. Also, on only half a dose of Lasix, he could be overloading his heart with fluid he can’t get rid of,( because of both heart and kidney failure) and this would also contribute to his swollen leg/s, and make his heart function even worse.

However, the bottom line remains that the patient has the right to choose to accept or reject the treatment offered. Your Dad clearly does not agree with the treatment proposed. Would he rather stop all treatment and decide for himself? If he does want to be treated by his doctor, then his job is to be the patient, let the doctor do the treating and co-operate with him.

Good luck, I hope you can persuade your Dad to take his meds.

HeartDoc

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