Thank you for your reply.
I will give you a rather long answer, so please feel free to follow-up with any questions you might have.
I would like to explain why it is important for people who have atrial fibrillation to take Warfarin. There are 4 chambers in the heart - 2 ventricles and 2 atria. In atrial fibrillation, the left atrium, instead of having normal beats, it begins to fibrillate. Blood starts to stagnate at the bottom of the chamber. Once the blood stagnates, it forms clots. Once in a while, the left atrium can come out of the atrial fibrillation mode and give a normal contraction. At that point, a blood clot which has been sitting on the bottom of the chamber can get released, travel to the brain and cause a stroke.
We use Warfarin to make sure that the blood sitting in the bottom of the chamber does not stagnate and does not form a clot. 7-10% of people with atrial fibrillation have strokes and unfortunately, most of the atrial fibrillation strokes bring quite devastating results.
When someone begins taking Warfarin, initially their blood work will need to be done once a week, however, once the desired option is achieved, blood draws will need to be done once every 3-4 weeks. One of the options that your mom can consider is having her doctor refer her for home care nursing. In that instance, a nurse comes to her house to draw her blood instead of having her to drive to the doctor.
There is a score which is called CHAD2 score. It measures a risk of someone having a stroke based on their age and medical conditions. Here is a link to the site where you can check out more about CHAD score:
Your mom's score is 2 (her age and history of heart failure). This means her annual risk for having a stroke is 4%.
Now, about small vessel disease...small vessel disease is completely expected for someone her age. All that means is that there is some narrowing of small blood vessels in the brain. This is associated with age and with cholesterol. Yes, it does put people for a risk of a stroke. Anyone over the age of 60 or 65 has some kind of small vessel disease, however, that is not what is putting your mom at risk for a stroke. She has a much higher chance of having a stroke secondary to atrial fibrillation rather then small vessel disease. Warfarin will not prevent a stroke from the small vessel disease, it will only prevent stroke from Atrial Fibrillation. Aspirin, however, we use to prevent strokes associated with small vessel disease. Also, small vessel disease does not cause any symptoms unless your mom is actually having TIAs or strokes (which, based on MRI, I understand she did not have).
If your mom is not at risk for falls, it would probably be wise for her to be on Warfarin to prevent a devastating effects of a stroke.
I know this is a lot of information. Sorry for such lengthy answer. I hope you find this information helpful. Please feel free to follow-up with any questions or let me know if you need any clarifications on anything I said.
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