Living with Afib and Coumadin

[Gunter]

Unless chemical or electro conversion to sinus rhythm is successful, afib patients(and others) may have to take Coumadin for the rest of their lives. The literature states that the probability of problems related to bleeding while on Coumadin increases with age. A recent publication stated that for 'low risk' patients (whatever that is)the probability of stroke is similar for patients on Coumadin and on Aspirin. This leads to the following questions:

1.) Are there any tests, such as susceptability to bruising, to measure blood vessel quality to determine when Coumadin becomes too risky as a person gets older?

2.) Is there an age where the use of Aspirin, and perhaps intermittent use of Coumadine to dissolve existing clots, may be more beneficial?

3.) Is there a 'kit' that a Coumadin user can carry to enhance clotting if an accident should occur where true medical help is several hours away (e.g cross-country skiing, hiking, etc)?

4.)Does long term afib cause atrophy in the atrial heart muscels that would make it difficult or impossible to restore sinus rhythm in the future when new techniques and medications may become available?

Thanks again.

[CCF CARDIO MD - DLB]

The remodeling I refered to likely occurs over weeks to months of being in afib. Adrenaline certainly can trigger atrial fibrillation. Beta blockers can blunt surges in adrenaline.

[Adrian Lewis (UK)]

re. your answer ". The longer a patient is in afib, the more difficult and less likely it is to restore sinus rhythm. This is due to remodelling of the atrial muscle": I experience AF once or twice per year, always starting with me waking up in the small hours often feeling as if I've had a bad dream. I have always suspected adrenalin as a causal factor. Could this be so, and are there drugs which can control adrenalin secretion during my sleeping hours? Also, how long does it take for remodelling of the atrial muscle? Thanks.

[Gunter]

1.)Are these K-9 injections available everywhere or do we need to carry a list where they are available?

2.)How long before they do kick in?

3.)What kind of injections are these e.g like insulin or are they given IV? Please describe the protocol.

Thanks.

[CCF CARDIO MD - DLB]

1. Any hospital would carry this.
2. Several hours.
3. Usually given subcutaneously, can be given orally or intravenously.

[CCF CARDIO MD - DLB]

1. No
2. No. Coumadin is much more likely to cause bleeding when a patient is elderly. However, it is much more effective at preventing stroke than aspirin in this population.
3. Not really. Vitamin K injections can reverse the effects of coumadin, but they do not kick in right away.
4. The longer a patient is in afib, the more difficult and less likely it is to restore sinus rhythm. THis is due to remodelling of the atrial muscle.