Long Term Coumadin Therapy with Pacemaker

[Angela1277]

I am 58 yrs old woman. Five years ago I had a sudden onset of acute ischemic colitis. No cardiac issues were present at that time. Approx. 6 mos. later I suffered an episode of syncope followed by a second bout of ischemia; at that time a heart arrythmia was diagnosed as well as a PFO.  The PFO has not been closed. Neither my gastroenterologist nor my cardiologist can say with any certainty that the bouts of ischemia are directly related to the cardiac issue. I've been treated for each issue concurrently; I've had a cardiac ablation and pacemaker for the heart related issues and vigilant monitoring of the gastrointestinal issue for the colitis. Even with the pacemaker, I've had a total of 5 episodes of syncope and subsequent hospitalizations for ischemic colitis that started after the fainting. I have also had 'near syncope' without colitis. The pacemaker has been checked and is working great - the fainting episodes may be vasovagal.

Each specialist has a different opinion as to whether or not I should continue with Coumadin - the gastroenterologist is concerned anbout the long term effects and GI bleeds and the cardiologist is concerned about the ongoing possibility of emboli...I'm caught in the middle. I'd appreciate your thoughts. Other than these two issues I'm in excellent health.

[Angela1277]

That's a great approach - thanks for your advice.

[Jerry_NJ]

If it is your "call" I'd suggest getting some quantification from each doctor on the risk and penalty.  For example, I'd guess the probability of forming a clot that hits the lung or brain is under 1%, but he penalty if very severe.  What are the complications and penalties of intestinal bleeding?

The numbers I give are my understanding/recollections, please discuss with your doctors.

I think you need to know the prognosis of each decision: coumadin or none.    

[Angela1277]

Jerry,
Thank you for your response. I've not discussed any type of 'clot' therapy other than warfarin (Coumadin); the colitis matter definitely results in bleeding and when it happens I'm usually taken off Coumadin until everything heals up but then put back on. I was told that the issue of having a PFO is still of some concern and there is a small chance a clot could travel through the PFO to either a lung or my brain instead of my intestines. Hearing that made me a bit nervous! So I've been on 3.5mg Coumadin with little trouble maintaining my INR between 2-3. This has been the system for about 4-5 years...and all of a sudden the Coumadin has been stopped. It just doesn't make sense to me.

[Jerry_NJ]

Has your cardiologist discussed a lower "impact" clot therapy, just aspirin?  Sorry, I don't know if your condition makes aspirin not possible.  I take both a half aspirin and 5 mg warfarin for clot control, my case being AFib.  Does the colitis make you more susceptible to GI bleeding?  My understanding is if I can keep my INR between 2 and 3, my bleeding risk is limited to impact trauma or abrasion/cut, I believe.