I was a little taken aback when Dr. C. changed my patient from warfarin to one of the novel anticoagulants. And one I seldom use, at that.
I have only worked with her for about three years, and we seem to come from the same mold: seasoned family docs with a penchant for teaching and patient empowerment. I had not imagined she would step in and completely change my treatment plan when she was just covering for one day.
As far as which is safer, warfarin with variable therapeutic effect and fluctuating INRs or novel anticoagulants, which have hardly been studied at all in patients on dialysis, you won’t see test results that may worry you, but the unknowns are still there.
It was a judgment call, and she took it upon herself to change my treatment. She may never see that particular patient again, but that brief doctor-patient relationship has changed my patient’s risk of stroke, to the better or to the worse, I don’t know which way.
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