Coumadin Guidelines

[kevtt]

I am still getting bouts of atrial fib even after being on toprol for a year now. At my last visit with my cardiologist, he said at some point we should be talking about putting me on coumadin. But he didn't say what that point should be and of course I just said Ok when I should have been asking that question. I am 54 with no other medical problems and the heart tests turned out fine.

In terms of frequency and duration of afib attacks, when is coumadin indicated?

Also, what would be the next level of medications since toprol doesn't seem to be working?

And is accurate that it takes three days for the heart to flush out old (and potentially clotting) blood?

Thank you for being on this board.

[teakimax]

A related discussion, coumadin vs, aspirin for atrial fibrillation was started.

[dquenzer]

I am not on coumadin anymore because I don't have a problem with AFIB.  Ablation worked very well.  Still have a few PVC's and PAC's but not much.

I was on coumadin for awhile after ablation.

I am only on one adult aspirin once a day.  And since I am 49 this is just good preventative practice.

Also I chose not to take coumadin even when I had paroxymal atrial fib.  Due to some other physical issues I felt the risk was greater on coumadin from bleeding than on aspirin from getting a stroke.

[Cleveland Clinic]

kevtt,

thanks for the post. The incidence of people with atrial fibrillation continues to increase. While there will be some alternatives to coumadin in the near future, the debate will always boil down to aspirn versus coumadin.

Coumadin is probably underutilized in the population for those with atrial fibrillation. Especially given the seriousness of the risk of embolization which include stroke.

The absolute risk of embolization varies among patients.

Beacuse of this it is important to risk stratify patients to make decisions about treatment. Coumadin reduces stroke risk by about two to three times with respect to aspirin, but increases the major bleeding rate by about 1.5 times.

So if your overall risk of embolization versus bleeding is on the higher side then you should be on coumadin.  There are multiple factors that we know increase the risk, so for your particular case I can't say definitely you should be on on or another.  Factors such as age, diabetes, hypertension, heart failure, echocardiographic findings can all play a role.

With respect to your questions:

In terms of frequency and duration of afib attacks, when is coumadin indicated?

People with intermittant atrial fibrillation have almost as high of a risk for embolization as those that are in fibrillation all the time. So you should have a talk with your physician about the choice of anticoagulation to assess other factors that would play a role such as those above.

Also, what would be the next level of medications since toprol doesn't seem to be working?

There are several other antiarrythmics that may be beneficial and also electrophysiology procedures such as ablation.  If you wish to pursue these, it may be beneficial to discuss your case with an electrophysiologist.

And is accurate that it takes three days for the heart to flush out old (and potentially clotting) blood?

No.  Coumadin takes several days to wear off on its own if this is what you're referring to.

good luck

[Pagequeen1]

Are you still on coumaden?

Thanks.

[dquenzer]

I also suffered from intermittent AFIB.  My cardiologist was fairly agressive in treating it.  His philosophy was to keep me out of AFIB as much as possible if not completely.  Also he said that if we don't treat the irritable muscle in the heart the AFIB will get worse over time.

I think toprol basically deals with rate control.  There are other classes of anti-arrythmics that keep you in sinus rythmn.  I had a couple of opinions on coumadin and aspirin.  One recommended coumadin, and the other said that due to my age, 46, and living a fairly active lifestyle I would be better off on aspirin.  So there is some debate out there as the doctor said.

Long story short, I failed two anti-arrythmics, and had an ablation which worked very well.

I would definitely go to an EP specialist at a major university or teaching hospital and have an EP study done, and look at a possible ablation if anti-arrythmics do not work for you.  Mayo basically has the principle that if you fail two drugs you look at an ablation procedure.  

Ablations don't always work for everyone, but they work for most.  It's expensive, so make sure your insurance will cover it.
But it has been great being in sinus rythmn plus getting rid of two other arrythmias that I had that I didn't even know about!

I would not settle for intermittent AFIB.  I would seek a cure.

[DottyCece]

I have lots of experience with atrial fib and coumadin.  For me, I was in persistent atr fib for about 5 days when it was discovered so went on coumadin.  They gave me Fragmin as well at the beginning and treated the atrial fib with cardizen and digoxin.  They would not consider cardioverting until I was therapeutic on coumadin for four weeks. Eventually, I was therapetic for a month so they loaded me with sotolol and then cardioverted.  It was successful till surgery. I think it takes a month long to break up any clots and prevent others from forming in the atria so that is why they wait.  If Toprol works for you that is great.  Certainly other beta blockers, calcium channel blocking agents such as cardizem can be effective. Amiodarone is a excellent drug but many side effects so they reserve that for last if other treatments don't work.  Yes, atrial fib is difficult and a challenge to cope with.  There are also ablations and cardioversion that can be very effective,