Coumadin vs. 81mg aspirin

[Ruth143]

I have a-fib, but it is under control with sotalol.  I have visited the Cleveland Heart Clinic in 2007.  I was put on coumadin because I had a small stroke after 12 hrs. of a-fib (prior to being put on sotalol).  I no longer have a-fib on sotalol.  I would like to get off coumadin and take 1 or 2 81 mg. aspirin instead.  Do you think this would be prudent?  Thanks

[Uboat]

There is a protocol for medical control of Afib. As my cardiologist explained to me, over 65 years of age with persistent Afib requires coumadin or a like medication for blood thinning. The fact that you've had a stroke already indicates a higher need of control via coumadin or a similar drug. I'm 51 with paroxysmal Afib and I'm on 81mg aspirin for it. If I were in your position, and likely I will someday, I'd stick with the more aggressive therapy. My 83 year old mom has Afib and handles coumadin well.

[LindaTX]

I've had a-fib for about 10-12 yrs. Diet pills and ephedrine brought it on. I've taken digoxin, flecanaide, and now I'm back on rhythmol 3 times a day and a small topral XL and quit my nightly ambien. Because my a-fib  had increased to weekly episodes of 1-3 days, Dr told me I could go on Coumadin or sit back and wait for a stroke. I opted for the Coumadin and I haven't had a-fib since. He also is very big on ablation. Anyway, I would really like to get off some of the meds. Any suggestions???

[va_tony]

Med researchers have devised a simple scoring system to help doctors and afib patients decide whether coumadin is warranted.  Called the CHADS model, it assigns a score from 0 to 6, based on the patient's age and other medical conditions. See the website

http://heartdisease.about.com/library/weekly/aa080601a.htm

for details. In my case, I had a score of 1 and my cardiologist gave me a choice of aspirin or coumadin. I opted for coumadin because one thing I don't want in my life is a stroke (see the percentage risk for each CHADS score).  It's inconvenient to be tested once a month for PT/INR but better safe than sorry IMO.

In your case, a prior stroke gives you two points and so it's highly recommended by the model that you continue taking coumadin. What does your cardiologist say?

Tony

[va_tony]

I should mention that it doesn't matter that you are now in normal sinus ryhthm with sotalol. You now have an increased risk of stroke.  Once you have had afib, even once, the risk becomes significant and can't be ignored.

From the journal of atrial fibrillation:

"The risk of stroke increases whether the lone atrial fibrillation was an isolated episode, recurrent, or chronic. "

I suggest that you discuss this with your cardiologist and follow his/her recommendations on whether to take aspirin or coumadin.