Re: Dumn Question -warfarin or not

[Guest guest]

Since you're discussing whether to use warfarin, I'll ask in this thread:

when should there be " enough " AF to require warfarin?

I welcome personal experiences and opinions because I'm in a quandry.

If a person has heart disruptions that are some AF and some flutter and some

PACs, should a doctor make an otherwise healthy person take warfarin.....

especially if the high rate episodes are only short and occuring about 7% of

their lifetime????

[Guest guest]

I am VERY concerned about taking Warfarin, Coumadin or any derivatives of that

type. Here's my info:

-50 years old

-Not menopausal

-Excellent cholesterol

-Some age related calcification-not out of the ordinary

-Controlled high blood pressure

-Highly symptomatic AF with 5-10 episodes lasting approx. 15 seconds since my

first which was 10 hours in March '04 due (this was attributed to a potassium

deficiency related to diuretic used for BP control - once potassium level was

ok, AF stopped)

Other than the BP situation, which is low with meds, I am considered healthy. I

have spoken with a number of medical professionals who are amazed that I am on

Coumadin indefinitely. Although my doctor cites the high BP as a good reason to

stay on, (”the benefit outweighs the risk”)I have no personal or family history

that would suggest that is the case.

By the way I am very active but I have avoiding sports I truly love because of

the injury risk. I'm even concerned about bumping my head. I am strongly

considering going off Coumadin.

Sorry for long e!

Re: Dumn Question -warfarin or not

Since you're discussing whether to use warfarin, I'll ask in this thread:

when should there be enough AF to require warfarin?

I welcome personal experiences and opinions because I'm in a quandry.

If a person has heart disruptions that are some AF and some flutter and some

PACs, should a doctor make an otherwise healthy person take warfarin.....

especially if the high rate episodes are only short and occuring about 7% of

their lifetime????

[Guest guest]

Alyce,

I am VERY concerned about taking Warfarin, Coumadin or any derivatives of

that type. Here's my info:

-50 years old

-Not menopausal

-Excellent cholesterol

-Some age related calcification-not out of the ordinary

-Controlled high blood pressure

-Highly symptomatic AF with 5-10 episodes lasting approx. 15 seconds since my

first which was 10 hours in March '04 due (this was attributed to a potassium

deficiency related to diuretic used for BP control - once potassium level was

ok, AF stopped)

Are you taking magnesium?

Are you taking omega 3 oils (I take both Flax and Salmon)?

You don't seem to have experienced much AF. Did they do the Holter monitor?

I can understand why you are reluctant to take anti-coag if you don't experience

lots of AF. I wonder how doctors make these decisions -- since lives are

changed -- and new risks are created by this potent warfarin.

Did you think of asking how much AF is enough to require warfarin?????

LJ

[Guest guest]

we all have to remember that our doctors cannot actually MAKE us take anything.

They can recommend, cajole, plead and even drop us at patients, but they cannot

make us take anything.

With that said, the perscribing of warfarin is very subjective by doctor and

by situation at hand. Some cardios like to perscribe it since I believe it

gives them a cushion of comfort in knowing that their patient is being

protected. There are also new findings that even those of us with highly

symptomatic afib, CAN have periods of asymptomatic afib. One would assume that

those of us who know what it feels like will know when this is happening, but

apparently not always!

I have taken coumadin on and off through my afib history... I used to just

take it for a month after a more than 2 day event, and then stop. Then I had a

6 week event and was on for the first 6 months of 2004.. I got off it as quickly

as I could.. I was afib free from March 04 to Aug 05. I had afib on Aug 24,

Oct 1 and Oct 11. On Oct 11, my doctor suggested I go back on the coumadin, so

I did. I have now had two more events, Dec 18 and just last night, and despite

how much I hate being on it, I find that even I get a sense of comfort from it.

It also helps me personally, since I can waltz into the ER and tell them I've

been theraputic on coumadin for three months, and they'll cardiovert me without

much fan fare. Unless your ER knows you personally, they will not generally

take your word for how long you've been in afib and cardiovert you just for the

asking.

If I were having daily " abnormal " beats and rhythms.. beyond the occassional

PAC, I think I would definitely want to be on something... maybe just aspirin,

though. I don't like coumadin, and I almost don't think I should be on it now,

but I'm waiting for a cryoablation, so I guess I deep down figure I'm not on it

for good, so for a while it's tolerable. I also like keeping my INR at the low

side of 2... usually just 2 exactly.

So, " enough " is really hard to spell out... a history of afib/flutter that

seems to be progressing may warrant blood thinners... an occasssional bout of

short lived afib, probably doesn't. One short lived event to me doesn't, but

one event more than 48 hours certainly does..

stef

" ljlaurent2@... " ljlaurent2@...> wrote:

Since you're discussing whether to use warfarin, I'll ask in this thread:

when should there be " enough " AF to require warfarin?

I welcome personal experiences and opinions because I'm in a quandry.

If a person has heart disruptions that are some AF and some flutter and some

PACs, should a doctor make an otherwise healthy person take warfarin.....

especially if the high rate episodes are only short and occuring about 7% of

their lifetime????

[Guest guest]

I have turned out to be one of those people who just can't take

coumadin. I had an ablation a few months back and was scheduled to be

on coumadin for three months. By the seventh week, I'd made three

trips to the ER for uncontrolled bleeding and was covered with

bruises. At no time did my INR ever go above 2.0. On the third

ER trip my EP took me off and started me back on asprin and Plavix

which I'd been taking prior to the ablation. No problem since.

This stuff is awful (rat poison)and even if I could tolerate it, I'd

never take it if I had your symptoms. Prior to my ablation I was

having weekly AFIB attacks, none lasting over 8 hours, always

self-converting, and was never prescribed coumadin. Some Docs like to

" cover their bases " by prescribing it to everyone who has AFIB,

regardelss of the duration or frequency of attacks while others are a

bit more conservative. In a lot of cases " the benefit outweighs the

risk " just isn't true.

>

> I am VERY concerned about taking Warfarin, Coumadin or any

derivatives of that type. Here's my info:

>

> -50 years old

> -Not menopausal

> -Excellent cholesterol

> -Some age related calcification-not out of the ordinary

> -Controlled high blood pressure

> -Highly symptomatic AF with 5-10 episodes lasting approx. 15 seconds

since my first which was 10 hours in March '04 due (this was

attributed to a potassium deficiency related to diuretic used for BP

control - once potassium level was ok, AF stopped)

>

> Other than the BP situation, which is low with meds, I am considered

healthy. I have spoken with a number of medical professionals who are

amazed that I am on Coumadin indefinitely. Although my doctor cites

the high BP as a good reason to stay on, ( " the benefit outweighs the

risk " )I have no personal or family history that would suggest that is

the case.

>

> By the way I am very active but I have avoiding sports I truly love

because of the injury risk. I'm even concerned about bumping my head.

I am strongly considering going off Coumadin.

>

> Sorry for long e!

[Guest guest]

For this teeny bit of afib, I wouldn't take blood thinnners other than

aspirin. But do make sure that there aren't hidden episodes before you decide

yea or nay.... taking blood thinners is better than having a stroke.

-Highly symptomatic AF with 5-10 episodes lasting approx. 15 seconds since my

first which was 10 hours in March '04 due (this was attributed to a potassium

deficiency related to diuretic used for BP control - once potassium level was

ok, AF stopped)

[Guest guest]

My experience seems a bit different than most of the board members.

I had a mysterious rash, all over my body, and burning sensations,

for one year, and finally after much testing and trying this and

that, my Internist, with the cardio's permission, took me off the

coumadin. My episodes are one or two a month, sometimes no AF for

months, and they last about 6-10 hours and then self convert. Since

going off the coumadin, my burning and rashes have abated greatly!

It seems I somehow had an allergic reaction to the coumadin. It

seems even taking aspirin on a regular basis causes me to react on

my skin, so I take an adult aspirin on onset of an episode, and one

at the end. The rashes and burning sensation was ruling my life,

and making it miserable...

I admit I get nervous during an episode, while not on coumadin, but

at some point, I had to do something, or my quality of life was

miserable..... Maybe at some time, in the future, as my rashes and

all, are completely gone, I will once again try coumadin, but for

now, I am enjoying freedom from that burning itching feeling that

was with me constantly. Maybe not all of us can tolerate coumadin?

MandyofCA

[Guest guest]

I guess the Coumadin/Warfarin experience, like most medications, varies from

person to person.

I'm not taking anything but the prescribed meds (Toprol XL, Diltiazem,

Coumadin). Through this group I have learned about magnesum and omega oil but

quite honestly I will need to do more of my own investigation to decide what

alternate course I will take.

I did wear a holter monitor and no incidents were recorded.

Both my Cardio and EP agree on the Coumadin course as a safety measure despite

the fact that I only had that one major incident. They do scare me when they

talk of stroke but I'm beginning to realize that I need to decide what's best,

not them.

Thank you for your support on this med. I see my cardio tomorrow and plan to

tell him I want off. My guess I'd that we'll do one more holter test just to be

sure.

I'll keep you posted.

Re: Dumn Question -warfarin or not

Alyce,

I am VERY concerned about taking Warfarin, Coumadin or any derivatives of

that type. Here's my info:

-50 years old

-Not menopausal

-Excellent cholesterol

-Some age related calcification-not out of the ordinary

-Controlled high blood pressure

-Highly symptomatic AF with 5-10 episodes lasting approx. 15 seconds since my

first which was 10 hours in March '04 due (this was attributed to a potassium

deficiency related to diuretic used for BP control - once potassium level was

ok, AF stopped)

Are you taking magnesium?

Are you taking omega 3 oils (I take both Flax and Salmon)?

You don't seem to have experienced much AF. Did they do the Holter monitor?

I can understand why you are reluctant to take anti-coag if you don't

experience lots of AF. I wonder how doctors make these decisions -- since

lives are changed -- and new risks are created by this potent warfarin.

Did you think of asking how much AF is enough to require warfarin?????

LJ

[Guest guest]

I was not put on coumadin until I went into persistent afib (i.e.

24/7) at age 51 with no heart disease, good blood pressure, good

cholesterol & otherwise very healthy. Before that (for three years)

I would have 4-5 episodes per year lasting between 1 and 30 hours

and I only took aspirin. After a year of being nsr on Flecainide my

new cardiologist took me off of coumadin and back to aspirin

(325mg). Other than having to get stuck every month I didn't find

being on coumadin a big deal, but I can understand how it could

interefere with an very active lifestyle (which I don't necessarily

have).

That said, everyone's situation is different and there are

definitely doctors out there who are more conservative than others

when it comes to when anticoagulation therapy is warranted or can be

discontinued.

-

>

> I am VERY concerned about taking Warfarin, Coumadin or any

derivatives of that type. Here's my info:

>

> -50 years old

> -Not menopausal

> -Excellent cholesterol

> -Some age related calcification-not out of the ordinary

> -Controlled high blood pressure

> -Highly symptomatic AF with 5-10 episodes lasting approx. 15

seconds since my first which was 10 hours in March '04 due (this was

attributed to a potassium deficiency related to diuretic used for BP

control - once potassium level was ok, AF stopped)

>

> Other than the BP situation, which is low with meds, I am

considered healthy. I have spoken with a number of medical

professionals who are amazed that I am on Coumadin indefinitely.

Although my doctor cites the high BP as a good reason to stay on,

( " the benefit outweighs the risk " )I have no personal or family

history that would suggest that is the case.

>

> By the way I am very active but I have avoiding sports I truly

love because of the injury risk. I'm even concerned about bumping

my head. I am strongly considering going off Coumadin.

>

> Sorry for long e!

> Re: Dumn Question -warfarin or not

>

> Since you're discussing whether to use warfarin, I'll ask in this

thread:

> when should there be enough AF to require warfarin?

>

> I welcome personal experiences and opinions because I'm in a

quandry.

>

> If a person has heart disruptions that are some AF and some

flutter and some PACs, should a doctor make an otherwise healthy

person take warfarin..... especially if the high rate episodes are

only short and occuring about 7% of their lifetime????

>

>

>

>

>

[Guest guest]

In the UK the NHS have set out guidelines. One can argue about the

quality of care provided by the NHS, and generally their treatment

of AFib is pretty abysmal, but their guidelines are a good place to

start. For anti-coagulation for all types of AFib this is as follows:

High risk:

• Previous ischaemic stroke/TIA or thromboembolic event

• Age ≥ 75 with hypertension, diabetes or vascular disease

• Clinical evidence of valve disease, heart failure, or impaired

left ventricular function on echocardiography

- anti coagulate with warfarin if no contraindications

Medium risk:

• Age ≥ 65 with no high-risk factors

• Age < 65 with diabetes, hypertension or vascular disease

- either warfarin or aspirin could be considered. Owing to lack of

sufficient clear-cut evidence, treatment may be decided on an

individual basis, and the physician must balance the risk and

benefits of warfarin versus aspirin. As stroke risk factors are

cumulative, warfarin may, for example, be used in the presence of

two or more moderate stroke risk factors. Referral and

echocardiography may help in cases of uncertainty.

Low risk:

• Age < 65 with no moderate or high risk factors

- aspirin 300mg p.d. if no contraindications

So from this it would seem that anyone with Afib younger than 65

with no risk factors (or even one moderate factor such as

hypertension) should not be on warfarin.

I would challenge your doctor, it may be he's got a good reason.

I play hockey and go cycling, which would be a bit of a no-no if I

was on warfarin due to the risk of uncontrolled bleeding.

Mark

>

> Since you're discussing whether to use warfarin, I'll ask in this

thread:

> when should there be " enough " AF to require warfarin?

>

> I welcome personal experiences and opinions because I'm in a

quandry.

>

> If a person has heart disruptions that are some AF and some

flutter and some PACs, should a doctor make an otherwise healthy

person take warfarin..... especially if the high rate episodes are

only short and occuring about 7% of their lifetime????

[Guest guest]

It would appear that many doctors are still getting the decision wrong

in both directions (giving warfarin when there's no need and not giving

warfarin when they should) see...

Trends in the prevalence of diagnosed atrial fibrillation, its treatment

with anticoagulation, and predictors of such treatment in UK primary

care

http://heart.bmjjournals.com/cgi/content/abstract/hrt.2005.069492v1

--

D

[Guest guest]

Mark,

Thank you very much for sending me the UK warfarin guidelines. According to

that info, I should not be on warfarin.

The very sad fact that is that the cardiologist has refused to see me because

she has determined " there is nothing wrong with your heart " . True, I was in AF

for 28% of my life during 5 months of this summer. Now I'm learning why this

occurred -- and it has been remedied.

Thank you for your support.

LJ