63yodad ischemic stroke 2wks ago. before had a dvt & asymptomatic brain aneurysm. @risk for falls from motor control issues. should he start coumadin (warfarin)?

Bleeding risk: Warfarin isn't only drug to treat blood clots these days. There are 3 new or novel oral anticoagulants (noacs) on the market, altho only rivaroxaban is approved for use in blood clots. Regardless, compare http://www.Mdcalc.Com/has-bled-score-for-major-bleeding-risk/ to (bleeding risk) to http://my.Clevelandclinic.Org/health/tools-quizzes/calculators/stroke-risk-calculator.Aspx (stroke risk).

Bad idea: Having taken care of 4 patients with head bleeds just this weekend who have fallen on blood thinners, i think it is a really bad idea for people who frequently fall to be on blood thinners, especially the newer ones that have no known reversal agent. I would talk to your doctor about the option to have a filter placed in the vena cava to block dvt's from causing pulmonary emboli.

Risk / benefit tool?: Secondary Prevention of Stroke is important in reducing risk of recurrent stroke and potentially severe disability. Warfarin is indicated in Secondary Prevention if the patient has a diagnosis of Atrial Fibrillation. CHA2DS2-VASc and the HASBLED Scores at www.mdcalc.com can give some objective measure to help patient in discussion with doctor assess risk / benefit of anti-coagulation. A guide only