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From the hospital. Dad had a massive nosebleed right before Thanksgiving. We called his VA doctor and were told to pinch his nose and buy him Ocean spray for it. Nothing to worry about.

Last night, he had another one. Bled so bad he was gagging on his own blood. I took him to the hospital and they stopped it with silver nitrate, but the doctor there said it is serious and needs to be looked at by a specialist. I am calling that doctor in a few hours when they open.

One good thing happened. The social worker told me that she will contact social services and see if there is anything that can be done to get us some assistance. She said that she's heard lots of complaints about the homecare available where we live. Apparently, we are one of many who have had problems.

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Have a friend whose husband, J, has Afib. Otherwise he is healthy and active for his age - mid 70s. Their son is an ER doctor. J discussed his condition with his son, did some reading and decided against any meds as the odds were reasonable. So far, several years later, he is fine.
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VStefans, after speaking at length with one of the pharmacists and my niece who's an RN and is familiar with these drugs, I decided not to try any of them. They're just too dangerous.

Dad had been on Coumadin for years, but back in 2004 before he was, he had an episode of hemorrhaging while in a long term care hospital. This was a very good hospital, top notch staff, but it still took a few days to stabilize his blood levels. He was literally "out of it" during that time and didn't even know I was in the room.

It scared me enough, that, combined with the inability to monitor PT/INR with the newer drugs (per the Pharmacist), I decided they were just too risky. He's fallen more than he's stroked, so falls and brain hemorrhage would be the higher of the concerns than strokes.

It's a difficult situation when we have to choose between the lesser of two evils.

I appreciate your insight, and thanks for the information.
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Garden Artist you were right the first time about Plavix versus coumadin. And,
I hope one of the newer ones is covered for your dad! Good protection from clots and probably less risk of active bleeding. If not they could try coumadin but aiming for a slightly lower INR if there is no way to prevent bad nosebleeds otherwise.

Blood stains usually come out with cold water - just plain old cold water. Hot water may set them in.
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Veronica, thanks very much for the very helpful and succinct information on Plavix and a potential antidote. I've bookmarked this post to refer to as I know the issue will be raised again the next time we meet with the cardiologist.

I recall the last discussion we had - literally "six of one and half a dozen of the other" type dilemma. I'm trying to get used to facing more of these dilemmas as I know my father's entering that stage of having to make choices between options, neither of which are completely safe.

I guess the best way to view this is that he's still alive to make these choices, even if they are difficult ones.

And as you note, medicine is not set in stone, so sometimes the answers or options I seek are very fluid, changeable, and obviously dependent on the individual person and his/her co-morbidities. In a year, perhaps, we might have more information.

I'm going to continue some research and will share with you if I find anything worth sharing.

Thanks again.
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GA you are correct in that Plavix is not an anticoagulant but is used in much the same way. I was not aware that Vit K was not used to reverse that.
There is actually a new reversal agent for Pradaxa called Praxbind. It is not yet known how effective it is because there are ongoing trials but the FDA has approved it's use for Pradaxa. It is of course incredibly expensive. Everything may inhibit clotting but can also encourage bleeding so it really is a coin toss. The anesthesiologist i questioned did not go into any detail as I was about to have a procedure. He just said said "same things we use for warfarin"
There still seems to be a lot of discussion among the medical experts on the subject especially disagreement between the neurologists and cardiologists about when and for how long it is safe to stop an anticoagulant.
I can attest to the fact that blood clots do form at least in the heart if warfarin is stopped for two long or the numbers allowed to get out of control.Pieces of this can break off and travel to the brain causing a stroke. These clots usually are gradually reabsorbed but may take many months during which time it is too dangerous to return the heart to normal rhythm using something like cardioversion. In my case it took six months. i was told that reverting to normal rhythm when in Afib for a long period is not likely to occur using medications alone. My cardiologist will only allow two doses to be missed for any procedure which always causes a fight between the two specialists.
I do not claim to be an expert on any of these medications but i did just do a quick search and that is what I came up with. Anyone of course can do the research but coming to a decision about what is best in different circumstances is far more difficult.

As far as nose bleeds are concerned you do have to keep firm pressure on the nose for at least half an hour to bee able to stop it. It can of course be cauterized but that needs a trip to the ER which is not always practical. There is however a product and I can't remember the details that can be used to stop the bleeding which could be done at home if you have the supplies. many years ago they used to pack the nose with a product derived from seaweed but that had to remain in situ for ten days.

As far as the blood stains are concerned I think I would call in the professional on this one unless the carpets were due for replacement anyway. If this is going to be along term problem I would also replace with hardwood or a good quality laminate or tile depending on your local climate.

I don't mind you nitpicking GA that is how we all learn and that is why we are here. Medicine is not and never has been set in stone in spite of what the experts would like us to believe.
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Veronica, I'm interested in the information you shared on the new alternatives to Warfarin. My comments were based on conversations with a neurologist who was treating my father during the last hospitalization, my niece who's a trauma nurse, and a pharmacist at the anti-coagulation clinic we went to.

Each of them said that K isn't used to reverse the hemorrhage that could be caused by the new drugs. I'm interested in this difference of opinion by medical professionals. Perhaps the anesthesiologist is aware of an antidote available for emergencies, as he/she would probably be seeing more surgery than the pharmacist.

Not to be nitpicky, but it's also my understanding that Plavix is not a blood thinner; it's an antiplatelet drug, like aspirin.

I'm not challenging you; I'm concerned that different advice is being given by medical professionals.

And, for Erwin, this could be helpful if the issue is discussed when he meets with the specialist he sees shortly.
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Erwin, i hope you're asleep now! Good luck today, and let us know.

PS, your bother is the jerk.
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You're a star, Erwin

I dilute a little borax and wipe the stains with a wet sponge
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Thanks, dad has an appointment in the morning with the specialist. I am very relieved she is seeing him so quickly. Normally, she has a four week wait.

As for the carpets, I appreciate the thought, but never mind. Dad had another nosebleed last night, and as of now, I think 90% of the carpets in my family room, living room and his bedroom are hopeless. Dad was upset about the mess, and offered to replace them, but I asked him, "With what? You aren't saving ten dollars a month..."

I didn't mean to get angry, but it's hard. I've slept two hours total in past 96 hours. Today I had an accident and nearly put my eye out. I hope the doctor helps him, something needs to give.

Oh, and my brother called again. Said I'm a jerk for not making time and arrangements for him to "visit his family." Good times! :)
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Changing from Coumadin (Warfarin) to one of the newer blood thinners needs careful consideration not least of which is that coumadin is dirt cheap and reversable
The new ones are also incredibly expensive. I asked about reversing it in an emergency and the anesthesiologist said they use the same methods as for coumadin. Reversal not only uses Vit K which may take a while to work and infusions of fresh frozen plasma. I believe there is something in the works as an antidote to one of the new anticoagulants.There is no need for regular blood tests for the newer drugs but there is an instrument similar to those used by diabetics to check their blood sugar that measures the PT/INR at home. The results are sent to the PCG and he/she makes dose adjustments. Even in the very elderly it is worth continuing with blood thinners if there a definite risks rather than using it "just in case" but it is a personal decision after proper information of all the risks are properly discussed.
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If the stains are fresh, just use drugstore peroxide, let it fizz and blot it up.
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There is a product called Resolve. You can get it in spray or powder form. It works wonderfully. We spilled red wine on the carpet and you know how that goes...........but this stuff is great.
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As to bloodstains, there is a solution but I can't remember the name of it now. There's also a laundry detergent with a similar name. Sorry; brain fog has set in.

A friend was able to get blood stains out of the carpet after a similarly aggressive nosebleed. A whitish stain was left, but I had the carpet deep cleaned after that and you can't tell there was any activity in that area.
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Erwin, eliminating Coumadin requires a careful decision on the risks of hemorrhaging vs. the risk of a clot b/c of the A-fib. I.e., which is the more likely to occur and be a major or fatal event? Fall history factors into this.

Competent cardiologists would give this careful consideration, weighing the balance of the one against the other. We've discussed this at length with our own cardiologist.

We also discussed the issue of Plavix and other drugs which at a specific level replace (but not substitute) for Warfarin. If you do consider this, let me share information from two medical professionals.

Plavix is not monitored by the PT/INR standard, as is Warfarin. There is no way to tell if it's leading to an internal hemorrhage, nor is there any way to counteract it as there is with Warfarin (by administering Vitamin K). This is a dangerous drug. If you're asked to consider it, decide if you are comfortable with the high level of risk of taking this drug.

The medical people I consulted were an a ER trauma nurse and the other a technician at the local Coumadin Clinic we used to go to. Neither attempted to influence my decision, but stated the pros and cons (mostly cons). I then decided not to risk having Dad take this very dangerous drug.
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BTW - does anyone know how to get bloodstains out of carpets? Mine look like they were decorated by Lizzie Borden!
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Thanks all!

Dad is on coumadin. I asked the doctor to eliminate the blood thinners completely months ago but they insisted on changing it - said it was their care guidelines. He has Atrialfiv, and they are worried about clots.

We have an appointment with a specialist here in town coming up - she's going to squeeze dad in her first opening - otherwise, it would be five weeks out.

Social services already called and is going to meet with us later this week. We'll see what happens. At least they're trying!
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Erwin, just thought I'd commiserate, my dad started Thanksgiving Day at the ER with a huge nosebleed. He's on Plavix and aspirin as blood thinners, but has had nosebleeds all his life. Luckily this ER visit was early in the day and it wasn't crowded so he was treated quickly and back home, a rare event for the ER. We've seen an ENT about it many times and been cauterized many times. Anyway, glad you met up with a helpful social worker!
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Erwin, is the VA aware of some condition and they haven't told you? Like maybe high blood pressure? You can get a blood pressure cuff at a drugstore, it might be handy to have. If his pressure skyrockets, you call 911.
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Jessie raises an issue that had slipped my mind. Is the air in his room dry? You can buy a hygrometer and measure the moisture level, and add a humidifier if it's too low.

Older folks typically like warmer rooms, and that dries out the air.
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There are a few things that can cause nose bleeds. I'm glad a specialist will be looking to see what it might be.
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Errwin, by chance is your Dad taking blood thinners?

Same happened to my Dad and 911 had to be called since after 5 hours neither Dad nor Mom was able to stop the nosebleed. Dad was on warfarin at the time.

At the hospital the doctor took Dad off the blood thinner because the doctor felt there was a higher chance of Dad bleeding out from falling or bumping into something, compared to falling and hurting himself [without warfarin].
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Keep us informed. I sure hope you get some assistance!
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