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Atrial fibrillation question for Cardiologist M.D.
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Atrial fibrillation question for Cardiologist M.D.

About a year ago I had a cataract surgery on my left eye, and I found out that I was in atrial fibrillation. A week later I checked into a hospital for 3 days, and they gave me blood thinners and tried getting my heart in rhythm, by means of oral medication, a ibutilide IV drip, and on the last day a electrical cardioversion shock treatment. Only after the electrical cardioversion did my heart go in rhythm, but it only lasted 6 hours, and I went back into atrial fibrillation. The emergency room Cardiologist who proformed the electrical cardioversion, put me on Atenolol and (1)325mg aspirin per day.

I know that some cardiologist believe that you must be on warfarin, while others may feel aspirin therapy is better for younger people. I am 52 years old, and that doctor felt aspirin therapy would be fine for me. I am taking 25mg of atenolol, which keeps my heart rate down, and have not ever had any symptoms of having A-Fib.

My cousin who works at another hospital recently told me she talked to a number of cardiologist (because her dad has a-fib and been on warfarin for many years) and they told her that aspirin does not thin the blood in your heart chambers, and that if I ever went back in rhythm, that I could have a stroke.

1) Are these doctors correct in what they told her?

2)Is this the truth that a-fib should not be treated by aspirin?



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66068_tn?1365196781
Hi. I'm not a doctor.. just another afib patient. This is not the board to post questions to the cardiologist.  This is the patient-to-patient board.

I'm also in chronic afib at the present time and do take warfarin, so I may be able to help you with your question. It's my understanding that warfarin is far better at preventing strokes than aspirin (about 3 times as effective). Not everyone has the same risk of blood clotting in the atrium and so aspirin is a good compromise for some. Medical researchers have performed several studies assessing overall risk and have come up with CHADS guidelines.  In this ratng system, points are given for various risk factors. For example, you are scored two points if you've had a prior stroke, one point if you are over 75, one point if you have high blood pressure, a point for diabetes and a point if you have congestive heart failure,  If you have 0 points, which based on what you've written above seems to be your case, it's recommended that you take aspirin daily.  With one or more points, cardiologists recommend taking warfarin.  In my case, I take meds for high blood pressure (1 point) and have an enlarged atrium and mild mitral valve regurgutation (so my doc gave me another point). So it's best for me to take warfarin daily.

The probability of your having an afib stroke varies roughly between 2%/year (with a 0 score) and 18%/year with 6 points . With one point the risk is about 3%/year so by taking warfain, the probability can be reduced to about 1%/year. While 3% a year sounds low, the risk after 10 years is about 26% and after 20 years is close to 50%. So if you plan to live a long time in afib, it pays to take every precaustion to lower long term stroke risk. On the other hand if you plan to have an ablation witin the next year, the overall risk (with or without aspirin or warfarin) is not too bad.

If you'd like to read more about the CHADS guidelines, google "CHADS atrial fibrillation" (without the quotation marks). There will be a number of links on the subject.

Best of luck

Tony
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196674_tn?1306505756
Tony,

Thanks for your reply.

Where is the a forum to ask a doctor questions?
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66068_tn?1365196781
Cajun

To get to the doctor forum:

Click "home: on the blue banner above
On the home page. click on "Heart disease" in the list to the left.
That will take you to the Heart Forums page.
Click on the Doctor-to-patient" Heart Forum link
Then click on the "Yes, I agree with the terms below" link.. and
you are finally on the Doctor-to-patient Heart Forum.
To ask a question, click on the "Post a Question" button.
UNfortunately, medhelp only accepts two questions a day and at random times. So most of the time you will get the following message:

"We are very sorry, but this Forum has reached its limit for new questions today. Med Help has to limit the number of questions we accept on a daily basis. Our forums 'reset' to new questions at a different time every day. We do this in order to give people in all time zones a chance of getting their questions answered. In the meantime please feel free to:

Try posting again at a different time.
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I've had good luck posting questions over the years by trying to post a question at exactly 8:00 am est, and if that doesn't work then again at 8 am CST, the agiain at 8 am MST and finally at 8 am PST.

If you succeed, keep in mind that you are only allowed two questions in a 6 month period (and even then at lest two months between questions).

Good luck on getting a question posted.

Tony

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196674_tn?1306505756
Tony, I read that CHADS study.

Did you read what was at the bottom of the website?

Here is what it says:

Precautions in using the CHADS model.

"The CHADS model was developed by studying the records of 1733 Medicare beneficiaries aged 65 to 95, and in this age group the model appears very accurate at predicting stroke risk.

How well the CHADS model works for younger patients is not entirely clear, however, since the data was gathered for elderly patients.  The model is not valid at all for individuals with the valve disease called mitral stenosis - these patients have a very high risk of stroke, and virtually all of them should take anticoagulation therapy."



It will be 13 years before I reach the age of 65, and that was the youngest person in that 1733 person CHADS study.  

I scored 0 in the CHADS study, and when you consider 1% of every 100 people who have a stroke DO NOT even have a-fib, 1.9% from a 0 CHADS score, is still a very low number.

Treatment with Coumadin reduces the risk of stroke in atrial fibrillation by about 2/3 (66%,) and treatment with aspirin reduces the risk by 1/4 (25%).  

I think the .9% of risk I have on getting a stroke by having a-fib, is not worth going on Coumadin at such a young age. Reducing my .9% chance of a stroke from 25% on aspirin, to 66% on Coumadin is certainly not worth making a switch to Coumadin. Besides the many side effect I might have to face being on Coumadin. Also, I have NO heath insurance, and you know what it cost in doctor fees by being on Coumadin.

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66068_tn?1365196781
The bottom line is that with a CHADS score of 0 and being in your 50's, the odds of you having a stroke is fairly small. So taking aspirin should be an adequate precaution.  Anyway, I hope this puts your mind at ease.  What your cousin told you is not exactly incorrect --- but it's applicable if one has a CHADS score of one or greater.

Good luck

Tony
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196674_tn?1306505756
I agree Tony,

  But remember the CHADS study was done on people between the ages of 65-95 (which are in a much higher risk class to get a stroke) then I would be at the age of 52. If the CHADS study would have been done to guys at my age, I would be at even a substantially lower risk, then those studied at those older ages.
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