Who has the last say

[DrMasochist]

Hypothetical situation: 90 year old patient comes in for a follow up with his

General Practitioner due to previous ischemic heart disease. He was

prescribed both cumidin AND aspirin from his cardiologist. The GP decides

to take him off aspirin without getting permission from the card, and with

the logic that aspirin is ''overkill'' and may do more harm than good.

Can the GP do this WITHOUT the card's consent?

Important note: this is in a VA hospital.

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[jbz24]

He can do whatever he wants.

 

[dragonfly99]

Any doc can do whatever the doc wants. The question is what is best for the patient. Warfarin and aspirin do different things. Warfarin doesn't have antiplatelet activity the way aspirin does. If the only reason(s) for aspirin and warfarin were to prevent CVA from atrial fibrillation, then the GP may have a point. However, if the patient has documented coronary artery disease, then the aspirin was likely being given for that reason. If the patient has had drug eluting stents withint the past year, or a bare metal stent within the past 1-3 months, then stopping Plavix or aspirin is fraught with danger.

There are very few absolutes in medicine. Of course we have to stop warfarin and/or antiplatelet agents sometimes in patients, even those with new stents. Sometimes the patient has active bleeding and we just can't keep giving him warfarin and/or aspirin.

My experience with the VA is that a lot of the primary care providers will punt questions about anticoagulation to the cardiologist, which I think is fine. Whether aspirin plus warfarin is "overkill" or not depends on the patient and the clinical situation, and you basically didn't give us any info on that.

I would say that if a patient isn't actively bleeding, and the warfarin and aspirin was started by a cardiologist, then it's poor form for another doc in another specialty to stop them unless there is consultation with the person who started them (barring emergency situations, etc.).

 

[DrMasochist]

Thanks for the comment DragonFly! Ok so I lied; this was not a hypothetical situation and it actually happened during my shadowing rounds with a GP. The patient had acute ischemia and no stents, and besides that, did not have a history of coronary artery disease.
I was just a little taken aback because the GP did not consult the cardiology before taking the patient off aspirin. I guess it's because I'm a MS1 and know nothing about the real world of medicine. Again, thank you for taking the time to comment!