AFib blood thinners or not.

Need advice people. Had my PM check October13. All ok but episodes of Afob increased to 6 or 7 a year. Often average lasting a day. I take Flecainide 50 mgs "pill in pocket" approach until sinus rhythm. Often takes 2nd pill to revert back to normal. My PM was for Sick Sinus Synd.
Saw my heart Dr today who thinks it's time I went on blood thinners. Only problem there is I take medication for inflammatory arthritis increasing likelihood of a bleed.
He said, go home think about it & talk to GP.
Hate taking more medication. Another alternative is to take small dose of flecainide all the time. Can't take Sotolol, (tried that, made me ill).
Appreciate any comments or advice.
Happy New Year folks.
Lizzie in Oz

12 Comments

Me too..

by Duke999 - 2014-01-09 02:01:34

Hi Lizzie,
I'm somewhat in similar situation as you. After my PM implant back in March 2013, my EP prescribed me Flecainide, but I'm not taking it nor any medications. I end up taking magnesium (like you) plus taurine. Occasionally, I get an episode of irregular heart beats (not sure if it's afib or PVC or PAC episodes). Anyway, one time, my EP mentioned to me that I might have to get on blood thinners in the near future. I'm debating about it like you because it appears that my afib is under control by consuming magnesium & taurine. Recently, I add good quality fish oil to my supplements because I read that fish oil is a natural blood thinner. I'm trying hard to not taking any meds at all if possible because I'm very afraid of any side effects. How much magnesium are you taking a day?
I suggest you might research taurine as well. With the right combination of magnesium & taurine, you might be able to control your afib depends on how bad is your case. If your afib can be greatly reduced, perhaps you might not have to take blood thinners and just do fish oil. I know you had question about supplements to Roys before. Roys and I also talk about this subject when I first join this site. I wish you well.

Duke

Afib & anticoagulation

by golden_snitch - 2014-01-09 04:01:08

Hi Lizzie!

If you have Afib episodes that last a whole day, even with just a few episodes over the whole year, I'd definitely go on a blood thinner. Only if you were able to feel every episode, and immediately convert it back to sinus rhythm using your pill in the pocket approach, I'd probably not see the need for the blood thinning med. But with episodes lasting a whole day it sounds like you did not feel it or were not able to convert it back to sinus rhythm quickly.

Regarding the blood thinners, you have more options today than you had a few years ago. I'm not sure, but maybe one of the new oral anticoagulants, like Dabigatran, Apixaban or Rivaroxaban, does go together with your other medications. I had severe bleeding issues during my period while taking Rivaroxaban, but I'm absolutely fine with Apixaban now.

Regarding daily Flecainide: I have been taking Flecainide every day several times during my long history of arrhythmias, and always tolerated it well. Flecainide and Propafenone are very well studied in the treatment of Afib, and they are very effective. So, taking it daily and thereby reducing the number of your Afib episodes and/or their length is probably worth a try, too.

Best wishes
Inga

Hi Lizzie

by IAN MC - 2014-01-09 04:01:53

Working out relative risks isn't easy !

I imagine that your life would be pretty miserable if you stopped taking the anti-inflammatories for your arthritis, but as you've said they carry a risk of causing bleeds . It seems to me , that if you thin your blood with ANYTHING then an anti-inflammatory induced bleed would be made worse ; thinned blood flows out more easily than normal blood !

Anti-inflammatories are made slightly safer if you take them together with a drug such as omeprazole or lanzoprazole ( known as proton pump inhibitors ) .This combination makes a bleed less likely to occur. If you're not doing that already it may be worthwhile discussing it with your doctor.

and then, the other side of the risk equation is the increased chances of having a stroke if you have fibrillation and which thinner you should take, if any.

I think Inga is right that some of the newer thinners MAY be less of a risk in combination with your anti-inflammatories but you really need do your researches n this and maybe get advice from a Pharmacologist at your local hospital ( not the pharmacist , you need advice from the Clinical Pharmacologist ! )

Best of luck

Ian

Info

by Lizzie - 2014-01-09 05:01:05

Thanks again everone who has posted. Such a wealth of information from you all. I didn't know about the reversal effects of the newer thinners, it is good to know.
Difficult making decisions, the Drs seem reluctant to make them & leave it to us.

The cardio guy is going to write to my rheumatologist suggesting Celebrex instead of Naprosyn.
I have no probs taking Flecainide 50 mgs when in Afib & another 50mgs 4 hrs later if still not gone.

Previously, I have also taken a low dose 25mgs twice say as sort of a preventative when playing in a sports team at top level. It worked. (I think) you never know if you would've had an Afib episode or not.
I guess with aging, I am now 67 I will probably have to give in to a blood thinner.
Thanks again people, you are great.

Afib & blood thinners.

by Lizzie - 2014-01-09 06:01:18

Thanks everone. Given me food for thought. Sometimes Afib goes for hours. I am always aware of it. Exhausted, drained of energy.
I am sure there is a pistural element to me Afib. 40 yrs ago only happened if I vomited. Few more yeas add sneezing. Now bending seems to aggravate things. I have turned over in bed & literally felt "something" gone into A fib.
Dr's all say posture nothing to do with it, but I believe there is some extra stimulus of vagus nerve. Which controls stomach & heart rate.

I take magnesium 500 mg day.
I am going to try leaving off Naprosyn for a couple weeks before GP visit & see what happens.
It seems to me the more drugs the more problems but alk research seems to say blood thinners is way to go.
Many thanks. Great not to feel alone in this.
Lizzie

A-FIB and blood thinners

by Roys - 2014-01-09 07:01:59

Why I used Clexane when I got A-fib.
In 2009 I had been on warfarin for 1 year, and was getting some side effects. When I had a long episode of AF some years before
, and had gone to the ER, the first thing they did was give me a shot of Clexane to stop a blood clot, and even though I converted to sinus rhythm that night at 2 am I was given a shot in the morning, and also a pre-filled syringe of Clexane to take home and used in 12 hours.

So in 2010 I went to my local GP and told him that i don't want to take warfarin any more and can I use Clexane injections. I was taking 4000 mg of fish oil daily, which is some help as a blood thinner. My doctor said it was a novel idea, checked his computer for the dose and gave a scrip for 50 pre-filled syringes of Clexane, which i was to use only when I got AF. And he said he would e-mail my EP and tell him.

From 3/2010 I had 13 episodes of AF and used 40 Clexane injections.

I had a PM put in, and with the use of mineral supplements am now free of AF
Roy

A somewhat contrarian view...

by donr - 2014-01-09 08:01:28

... I take Flecainide 2X per day for anti-arrhythmias (PVC's) & Warfarin (Coumadin) daily for anti-coagulation.

I have done so for several yrs now.

Realize that EVERY med has its side effects, some of us just feel them more than others. Then there are interactions. Only YOU can determine which combo is most tolerable. Consider the following:

1) the side effects of Flecainide. You take it now occasionally. How does it affect you? Anything at all? You did not specify dose you take as a "Pill in the pocket." Probably more than for the "Small amount daily." (The minimum daily dose is probably 50 mg 2X daily) If there's no untoward side effects, try it for a few weeks at the low dose & see what happens. BUT - before you do, clear it w/ your cardio. There are some messy side effects that only show in your ECG. My Cardio has me undergo a quarterly ECG to confirm that I do not develop that one. Flecainide is an old drug but very good at what it does, but it is NOT fore everyone due to the side effects - so check them out carefully before making a decision.

2) Interactions - yep! Anticoagulants do increase the probability of spontaneous bleeding. Throw them into the pot along w/ the anti-inflammatories & you have a serious pair of similar side effects.

You need to examine the relative ease of REVERSING the anti-coagulation properties of the meds. Warfarin/Coumadin can be reversed relatively quickly & easily. A whopping shot in the butt of Vitamin K will do it. I've had it done & it worked for me. Apparently the same cannot be said for the other, newer "Blood thinners." MY cardio is now converting all his patients on the newer meds to Warfarin just for that reason. I am not an expert on which of the new meds are bad in that way. Talk to a Dr who is really in the know about such things as Ian suggested. A good start is your pharmacist/chemist. Do they give you the full information sheet on a med in Oz as they do in the US? If so, get them for all the alternatives (or get them off the web) to read & see which one among the candidates recommended by your cardio are viable options. The cardio is also a good source of info on this subject.

Your cardio sent you to your GP to discuss the issues because that's where you were prescribed the anti-inflammatories & he HOPES that the GP can/will discuss the problems of interactions.

You will have to bring up the issue of intreractions yourself - Dr's won't do it unless unusual or prodded w/ questions.

Good luck

Don

a-fib and medications

by Theknotguy - 2014-01-09 10:01:08

I sometimes wonder about the doctors. It seems they all work in a silo and no one ever goes out of their silo to see what the other doctors are doing. Hence you have to be your own advocate.

The reason for the blood thinners is if you go into an a-fib session and you get a blood clot in your heart. When the heart goes back into normal rhythm it sometimes gives a good, hard squeeze. Part of the clot breaks off, goes to the lung or brain, and you either get a stroke or heart attack. Not good.

Question in my mind is if your arthritis meds thin your blood enough so you won't necessarily need to take an extra blood thinner. There's a blood test that will check that. You need to be your own advocate between the two doctors to find out what meds will solve your problems. It may take some time going back and forth, but well worth the time and effort. After all it's your body and you should want to feel better.

I was on coumadin (rat poison). The doctor would read his chart, get the numbers he wanted, and I'd go to the hospital because of internal bleeding - seven times. So they took me off coumadin and put me on heavy doses of aspirin. Not as good, but it held me.

I was on Metoprolol and Felcanide. The Flecanide seemed to be working until I collapsed on a hiking trail and woke up six days later in the hospital. When Flecanide goes to the dark side it's really bad.

My a-fib sessions were lasting 12 to 24 hours and would pretty well wipe me out. Hence the Metoprolol and the Flecanide. But - and this is a big BUT - at sometime the a-fib will get worse and you're going to need an ablation. Sounds like you're almost there.

So....
1) I would find out what drug combination will thin your blood enough, take care of arthritis, and hopefully mitigate your a-fib for the present.
Then ....
2) Start seeing what will alleviate your a-fib long term.

When you tell me about the a-fib sessions, I know because I've been there. What you don't want is what happened to me. Collapsing on a hiking trail. Having your heart stop in the ambulance. Not being able to get it started in the ER. Being in a coma for six days. Then starting your life over.

Your PM will keep your heart going so you won't have to worry about that. But your PM won't fix the a-fib. So unless you love your life where the a-fib knocks you down for days at a time, you need to address that. I got really tired of gasping for air, seeing stars, getting dizzy when I stood up, and being tired all the time. My collapse fixed that but it was a hard way to go.

Hope you get some help soon.

Theknotguy

Warfarin & test yourself.

by JerryG - 2014-01-09 10:01:45

I had 'permanent' afib until successfully electro cardioverted in March last year (prior to PM implant). My cardio here in South Africa put me on warfarin prior to cardioversion and I am still on it at my cardio's insistance. I asked him about using Pradaxa or similar rather than warfarin and he strongly advised against it for reasons Don explained.

I live in the bush a long way from medical help and also a long way from blood labs. I researched the problem and found that Alere Healthcare manufacture a machine to test your INR at home using their INR test strips. I bought a machine and test strips and now test both my and my wife's INR at home. The machine is clinically accepted as accurate and I have gone as far as comparing the machine results with lab results (on the same day but a few hours apart) and found the machine to give the identical reading to the lab.

I think there are several manufacturers of INR test machines but I chose Alere as they have an office here. My medical aid (health insurance) paid for the machine in full and pays for the test strips as required.

I know the problems with NSAID's and bleeding as I have had lots of spinal problems in the past. I originally got a scrip from my neurosurgeon for Celebrex 200mg (active ingredient celecoxib) which doesn't burn holes in your stomach like diclofenac & friends can do. I don't take it every day but rather only when inflammatory pain is bad and it works very well. I haven't had any bleeding problems while taking it but even if I did, a big shot of vitamin K will reverse the warfarin effects.

JerryG

For the sake of accuracy

by IAN MC - 2014-01-09 11:01:09

Theknotguy ;You have got it totally wrong ! ARTHRITIS MEDS DO NOT THIN THE BLOOD.

Non Steroidal Anti-Inflammatory drugs such as Naprosyn, which Lizzie takes can cause ulceration and bleeding in the stomach by a totally different mechanism. They do in fact inhibit the production of prostaglandins and a side-effect of this is that you can lose the protective effects on the stomach lining which prostaglandins give. If the stomach lining ceases to function properly , the stomach acid can then cause ulceration and bleeding.

This is the reason many doctors give drugs like omeprazole to patients who take N.S.A.I.D S. because these drugs switch off the stomach acid and reduce the chance of bleeds developing.

Ian



Jerry ?

by IAN MC - 2014-01-09 11:01:27

i'm curious , why are you still on warfarin if you have been successfully cardioverted. ? " Successful " to me means no more afib and no further need for blood thinners.

The best words I ever heard were " You can come off warfarin now " after a successful ablation to get rid of atria flutter. Could it possibly be that your cardiologist is being ultra-cautious ?

Ian

Still on warfarin

by JerryG - 2014-01-10 03:01:26

Answering your question Ian, my cardio is very conservative. My two PM checks so far haven't shown any sign of a-fib but I do know that even successful electro cardioversion doesn't guarantee that the afib wont return within a year. My cardio feels that continuing warfarin until my next visit to him wont do any harm and could well prevent a stroke. I am due to see him again in March which will be a year after the electro cardioversion.

JerryG

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