cardio dr and pacemaker clinic

Clots

by AgentX86 - 2021-04-07 21:47:58

If the clots form in the RA, they go to the lungs.  While this isn't good, it's highly survivable.  However, if the clot forms in the LA or LAA (Left Atrial Appendage), which is the norm, the clot goes to the brain.  This is an ischemic stroke.  Not good.  Death isn't the worst outcome either.

Anticoagulants aren't perfect but they reduce the chances of a clot forming at the smaller probability of a brain bleed (hemorrhagic stroke).  The Watchman device plugs up the opening of the LAA, where 90% of the clots form.  It's possible to eliminate the need for anticoaguants, and the associated smaller risk of brain bleeds with a Watchman.  My LAA was "clipped" during during my CABG (while they're in there, might just as well) but my EP almost yelled at me when I suggested that I could drop the anticoagulant (expensive stuff).

The need for an anticoagulant

by Gemita - 2021-04-08 06:17:54

Hello New to Pace,

I am glad you have met with your new Cardiologist and hope she is very nice and will take good care of you.  

Yes I too have periods of Atrial Flutter as well as Atrial Fibrillation and even short runs can be dangerous if we have risk factors for a stroke.  I will post a link for you in a moment for you to check although I expect your Cardiologist has assessed your need for an anticoagulant?

https://www.mdcalc.com/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk

The Watchman device was not offered to me, but I am taking one of the newer anticoagulants known as Edoxaban, once daily.  I have absolutely no difficulties on Edoxaban 30 mg (I don't even know that I am taking it and have a very delicate stomach) so have been extremely lucky.  My husband is also on Edoxaban 30 mg without any ill effect and he has major gastric issues.  I am on 30 mg for low body weight, otherwise normal dose would be 60 mg.  My husband has poor kidney function which is why they have given him the lower dose too.  It will be trial and error to find something that suits, or the Watchman?

I wish you well and freedom from your arrhythmias.

Anticoagulation for atrial flutter/fibrillation

by Selwyn - 2021-04-08 06:28:05

Welcome to the club!

In general the risk of a blood clot with atrial flutter and fibrillation is increased. The risk has to be balanced against the risk of bleeding with blood thinners (a number of these are available).   Even if the arrhythmias are intermittent, the risk of a clot is increased. If the clot travels to the brain you end up with a stroke. 

The Watchman device lowers the risk of both clotting, and as you don't need blood thinners the risk of bleeding as from warfarin- the blood thinner that was used for many years as a standard. 

This is not the full story. The clot risk is due to a number of factors and clogging up that part of the heart with a the Watchman does not prevent blood clotting. There remains a reasonable risk of stroke ( about 4%/yr). The Watchman device was compared favourably to warfarin - this is now some what out of date. Personally, I stopped taking warfarin in favour of a more modern blood thinners with better outcomes with regard to the risk of bleeding. 

I believe if the risk-benefits are looked at carefully, modern blood thinners are the way forward. My Mother died of a huge stroke from her paroxysmal atrial fibrillation ( and pacemaker) in spite of being on warfarin. I have seen many clot ( thrombotic) strokes in people taking warfarin at the correct dosage. Warfarin is somewhat of an old fashioned drug.

With a diagnosis of atrial flutter, you certainly need to do something to reduce the risk of clots forming. 

I would advise you to ask how the Watchman compares to the newer anticoagulants ( blood thinners). You need to have an assessment of the risk of bleeding and then make a balanced decision.

https://www.mdcalc.com/has-bled-score-major-bleeding-risk

clotting

by new to pace.... - 2021-04-08 08:38:27

thanks to all.  As i knew would get valuable anwers .   Looked up the indegreints for Edoxaban and discovered one of the inerts cannot tolerate(manitol).

The previous Cardio let me  continue  to use the Turmeric Supplement instead of aspirin. Which suprisingly am able to tolerate. I take 1 a day.  Also use for pain and allergry reactions. then of course take extra.  She  said for now that was  better then nothing.  Also to make sure i did not get dehyrated.

new to pace

Clots

by AgentX86 - 2021-04-08 16:30:48

While tumeric is an anticoagulant to some degree but it's certainly not enough to lower the stroke risk!  It does help with inflamation which is thought to reduce the risk of heart disease but it's not enough to eliminate the stroke risk.

If your CHADS2 score is <2, aspirin may be good enough.  Above that, you need to be on Warfarin or better, one of the NOACs, Pradaxa, Eliquis, or Xarelto (brand names).  Of the three NOACs, Eliquis has the better outcome (lower risk of brain bleed) for those above 70.

<https://www.mdcalc.com/chads2-score-atrial-fibrillation-stroke-risk>