ABOUT 'BEAT YOUR A-FIB'...


"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"



ABOUT A-FIB.COM...


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013


Product Reviews

Are You Using the AliveCor Kardia or BodiMetrics Heart Monitors?

Are you using the latest AliveCor ‘Kardia™ Mobile’ heart monitor? The current model (Model 1141) has been out since February. I want to update our February 2015 review.AliveCor ECG smartphone at A-Fib.com

The AliveCor Kardia attaches to an android or Apple device. And by pressing the sensors with your fingers (or thumbs), it capture single-lead, medical-grade EKGs in just 30-seconds. Instantly it shows if your heart rhythm is normal or if atrial fibrillation is detected.

How is the AliveCor Kardia Working for You?

If you are using the AliveCor Kardia, how do you typically use it? Regularly? Or only when you think you’re in A-Fib?

Do you take readings just for your own peace of mind or do you transfer the data to your doctor? Are you satisfied with its performance? Do you recommend the Alivecor Kardia or other brand monitor to others with A-Fib?

Share Your Insights

Do you have first-hand experience? I’m asking any A-Fib.com readers using the latest AliveCor Kardia model to share your product experiences with me. Just send me an Email with your impressions.

BodiMetrics

BodiMetrics

Other Heart Monitors:  I’m also interested if you are using another brand of handheld heart monitor, such as the BodiMetrics Performance Monitor.

While the BodiMetrics unit is much more than just a heart monitor, I’d love to hear if you are using it to help monitor your A-Fib. Send me an email, won’t you?

My Search for the Best 7-Day Medicine/Vitamin Organizer

By Patti J. Ryan

Do you struggle with the daily mix of supplements and prescriptions you take? Some are small, but some are horse-pill size! Some you take in the AM, others you take in the PM.

Trying to find the right pill organizer has been a trial for me. Most often the compartments are too small and hard to open.

EZ Dose 7-Day AM/PM organizer at A-Fib.com

EZ Dose 7-Day AM/PM organizer with push-button lids

I Found the Best Organizer

After years of trial and effort, I’ve FINALLY found a great pill organizer―the EZY Dose AM/PM 7-Day Push Button organizer.

This 7-day organizer has two rows for AM/PM dosages with large letters for the days of the week.

Compartments are extra large―about 1 1/8″ wide by 1 3/8″ deep. That’s large enough for those ‘horse pill’ size tablets. The compartments have rounded bottoms― making it effortless to get the pills out. And the cherry on top? Push button lids―easy open and easy close.

EZY Dose - 4-times a day organizer

EZY Dose – 4-times a day organizer

Do you carry your meds with you? The EZY Dose is also compact and portable for carrying in your purse or jacket pocket.

Note: If you take pills four times a day, there’s an EZY Dose for you too: 7-Day XL Medtime Planner

Use our Link to Amazon.com and Support A-Fib.com

For my needs, I bought two 7-Day EZY Dose organizers from Amazon.com, so I’m set for two weeks at fill up time.

amazon_logo white square

Use our Amazon.com portal link: Here’s a link to get two EZY Dose AM/PM 7-Day Push Button organizers and Free Amazon Prime shipping. (Purchases through our portal link helps support A-Fib.com―at no extra cost to you!)

The EZY Dose AM/PM 7-Day organizer is also available from other retail and online sources.

My A-Fib Story: The Healing Power of Prayer

Jon Murray - My A-Fib Story at A-Fib.com

Jon Murray

By Jon, August 2016

I have been cured of A-Fib since 2011 and simply wanted to share my testimony with you and your readers at A-Fib.com.

A-Fib Medications Didn’t Work

I struggled with A-Fib for almost eight months in the year of 2011. It began in January, and I had episodes of it throughout the year. My episodes weren’t too bad—as in I never had any side effects of the A-Fib like fainting or clotting. The only real thing I had during the episodes was an irregular heartbeat and a fast heart rate.

Being as young as I am and having a family of my own, it was a lot to have on my shoulders.

I wanted the A-Fib gone, and the medication I was taking did not make it go away.

My Pastors Prayed for My Healing

I knew of another way that the A-Fib could go away—by God supernaturally healing me.  Well, in August of 2011 I asked the pastors of my church to pray for me that God would heal me.  After the Sunday service they prayed for me. And a week after that my A-Fib was gone. I was healed by prayer.

I haven’t had an episode or problem since 2011!  It’s a miracle!

Helped by Great Physicians Too

I am not writing this to refute your book, Steve, nor am I saying that the medical field should not be called upon for help in the time of need.

If it wasn’t for the great physicians here where I live on the East Coast, I would be in bad shape—who knows what would have happened if they didn’t break those episodes I had. And, I’ve read testimonies of others where medicine helped them with, if not cured, their A-Fib episodes.

I simply wanted to share with you my experience – since it included A-Fib.  Who knows—maybe God can bless you through my e-mail.

Jon
ayatingl@gmail.com

Editor’s Comments
A-Fib.com's Positive Thought/Prayer group

A-Fib.com’s Positive Thought/Prayer group

At A-Fib.com one of our volunteer groups is a Positive Thought/Prayer group comprised of wonderful people worldwide. If you would like their support, especially at the time of your ablation or surgery, please email us your request. It’s comforting to know that others who’ve had A-Fib care about you and wish you well.

How to Send Your Request: Send your request to our coordinator, Barbara. Write to barbara: babareeba(at)aol.com (substitute an “@” for the “(at)”).

Join our Group: We invite you to join our ‘A-Fib Positive Thought/Prayer’ group. Learn more on our page: The Healing Power of Hope, Belief and Expectations. All are welcome.

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Return to Patient A-Fib Stories

Related Reading:
Anatomy of Hope book cover 350 pix wide at 96 resThe Anatomy of Hope: How People Prevail in the Face of Illness

by Jerome E. Groopman

There’s more to hope than we thought. Hope triggers biochemical changes.

Written by an oncologist and citing actual patient cases (mostly cancer), Dr. Groopman explores the role of hope in fighting disease and healing. Top scientists are interviewed who study the biological link between emotion and biological responses; the most relevant studies are reviewed.

The author shows how hope, belief and expectations can alter the course of our lives, and even of our physical body. HOPE works! (Read Patti’s review on Amazon.com.)

If you find any errors on this page, email us. Last updated: Thursday, August 18, 2016

A-Fib.com 2016 Top-Rated by Healthline.com For Third Year

A-Fib.com top rated by Healthline.com for the third year.

A-Fib.com top rated by Healthline.com for the third year.

We are proud to announce, for the third year, A-Fib.com has been named to the Healthline.com list of the ‘Best Atrial Fibrillation Blogs’Atrial Fibrillation: Resources for Patients (A-Fib.com) is one of a ten websites selected for special recognition by the Healthline.com Marketing Team.

Of the ten heart health websites, A-Fib.com is one of only four websites dedicated exclusively to Atrial Fibrillation patient education. The other three are ‘Atrial Fibrillation by Dr. John M’ (Dr. John Mandrola),  ‘Living with Atrial Fibrillation’ (by our friend, Travis Van Slooten) and ‘Stop A-Fib Atrial Fibrillation Blog’.

About Healthline: Healthline.com is  the fastest growing consumer health information site — with 65 million monthly visitors. Their goal: “Healthline’s mission is to be your most trusted ally in your pursuit of health and well-being.”

From the Healthline.com article:

“We’ve carefully selected these blogs because they are actively working to educate, inspire, and empower their readers with frequent updates and high quality information…new medical research, personal stories, and helpful advice.”

Visit Healthline’s The 10 Best A-Fib Blogs of 2016 to review all ten winners.

OUR MISSION: A-Fib.com offers hope and guidance to empower patients to find their A-Fib cure or best outcome. We are your unbiased source of well-researched information on current and emerging Atrial Fibrillation treatments.

A-Fib Patient Review of the AliveCor Heart Monitor for SmartPhones

Visit the Alivecor website: http://www.alivecor.com/getstartedOf late, there have been several new consumer heart rate monitors on the market of interest to A-Fib patients.

One such product is the FDA-approved AliveCor now in its third-generation (no longer requires a doctor’s prescription). Attached to your cell phone and with the proper app, it can display your an EKG (ECG) signal.

In this report, Frances Koepnick shares her experience with the AliveCore, some of the problems and some of the benefits. Read Frances’ report->(corrected link)

Patient Review: AliveCor Heart Monitor for SmartPhones

AliveCor with logoBy Frances Koepnick, February 2015

Of late, there have been several new consumer heart rate monitors on the market of interest to A-Fib patients. One such product is the FDA-approved AliveCor. Attached to your cell phone and with the proper app, it can display your an EKG (ECG) signal. In this report, Frances Koepnick shares her experience with the AliveCore, and the pros and cons. Note: models shown may vary.

What is the Alivecor?

FDA-cleared for detection of atrial fibrillation (A-fib), the AliveCor Heart Monitor when combined with its AliveECG App provides a 30-second, one lead electrocardiogram (ECG) that is In addition to an ECG, this monitor also determines heart rate in beats per minute (BPM). This easy-to-use device attaches to iPhones (models 4 thru 6) by means of a phone case.  It is also available for some compatible smartphones and mobile devices other than Iphones.

Frances Koepnick photo 1: Phone 4S Case with First Generation AliveCor Heart Monitor

Frances Koepnick photo 1: Phone 4S Case with First Generation AliveCor Heart Monitor

Frances Koepnick photo 2:  iPhone 4S - AliveCor ECG Recording with Heart Rate in BPM

Frances Koepnick photo 2: iPhone 4S – AliveCor ECG Recording with Heart Rate in BPM

This technology is now in its third generation and is available for purchase without a prescription on AliveCor’s website at www.alivecor.com.  

The items required include an AliveCor Heart Monitor and the specific phone case which attaches the heart monitor to your smartphone. Prices vary according to the make and model of smartphone or mobile device.  A Third Generation AliveCor Heart Monitor with case for the iPhone 6 will be available for $84.99.

“In clinical studies, the AliveCor Heart Monitor has been shown to be accurate and efficacious.  The Heart Monitor is FDA-cleared and as such has shown equivalency to other ECG machines”.1 Two studies done in 2013 and published in peer reviewed journals document the accuracy of the AliveCor Heart Monitor.2,3  Furthermore, this technology has successfully detected undiagnosed A-fib when placed in pharmacies.4

How to Use the Alivecor

Setting up your Alivecor is not covered here. See your Alivecor instructions and/or visit the AliveCor website.

This device records ECGs and heart rate simply by placing the fingers of each hand on the electrodes located on the back of the smartphone case.  You can also rest the phone case electrodes on your chest.  Once the ECG/pulse rate is recorded and saved, you can add personal notes as well as select your symptoms and activities from a check list.

What You Can Do With Your Recording

You can print, obtain a PDF or email an ECG to your physician at no charge directly from your smartphone.  There is also an AliveCor function available whereby a physician can set up a “provider dashboard” to review their patients’ ECG recordings by means of a free web-based application.  All of the above functions “travel with you” via your smartphone.  Consequently, ECG data can be shared on an international basis.

Expert Review of a Specific Recording

If you want to obtain an expert review of a specific ECG recording, you can do so for a fee by simply tapping on the “ANALYSIS” icon.   There are two choices available from AliveCor depending on the credentials of the reviewer:

A clinical analysis and report by a U.S. Board Certified Cardiologist costs $12 and is “best suited for patients with limited technical ECG knowledge”.5 This analysis has a 24-hour turnaround time and contains a doctor recommended course of action.

A preliminary finding by a U.S.-based cardiac technician costs either $2 for a 24-hour turnaround or $5 for a 30-minute turnaround. This analysis contains preliminary technical findings by non-physicians with no recommendations for a course of action.

My Experience with AliveCor on my iPhone 4S

This technology is certainly easy to use and as convenient as the proximity of your cell phone.

I was diagnosed 11 months ago with asymptomatic, persistent A-fib by my cardiologist. I purchased an AliveCor Heart Monitor for my iphone 4S last November and have been using the AliveECG app to record my heart rate and ECGs for the past three months.  In fact, the photos taken for this article show the front of my smartphone with one of my ECG recordings as well as the back of my phone showing the electrodes for finger placement.  This technology is certainly easy to use and as convenient as the proximity of your cell phone.

However, the ECGs which I have recorded on my AliveCor Heart Monitor are usually not flagged as “possible A-fib”.  I sent one of my “unflagged” ECGs for review by an AliveCor cardiac technician and the result was reported as “Atrial Fibrillation Sustained”.  When I reported this discrepancy to AliveCor’s Customer Service, they agreed that the ECG which I had submitted should have been “flagged” as A-fib.  Their reply also indicated that “every (ECG) recording we get helps us improve our algorithms to better serve our customers”.

In spite of the discrepancy which I have experienced with the AliveECG algorithm, I do recommend the AliveCor Heart Monitor.

 In spite of the discrepancy which I have experienced with the AliveECG algorithm, I do recommend the AliveCor Heart Monitor for those individuals who want to monitor and document their paroxysmal A-fib attacks.  Also, the AliveCor Heart Monitor is an excellent resource for routinely determining heart rate in beats per minute.

About the AliveCor, App and Compatiable Cell Phones

Although the AliveCor Heart Monitor was originally developed for the iPhone, it is also available for other compatible devices.  Currently, this monitor is available for the iPhone 6/6 Plus, iPhone 5/5S/5c, iPhone 4/4S, iPod Touch 5G, iPad Air and iPad mini.  Other compatible devices include the Samsung Note 3, Galaxy S3/S4/S5, HTC One, and Jitterbug Touch 2/Touch 3.

The AliveECG App is free and this software can be downloaded from the Apple App Store or the Android App on Google Play. Before downloading the AliveECG App, be sure that your smartphone’s operating system has been updated to the minimum version required for use with this app. See the instructions with your AliveCor or visit AliveCor.com.

How to get started with the Alivecor monitor; go to http://www.alivecor.com/getstarted

Getting started with your AliveCor Monitor, Go to http://www.alivecor.com/getstarted

About the author: Frances Koepnick, M.A. is a retired medical microbiologist and current A-fib patient.  She previously taught microbiology, anatomy and physiology at the community college level.

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Return to Research and Innovations in Atrial Fibrillation

Last updated: Friday, March 6, 2015

 

References    (↵ returns to text)
  1. Is the AliveCor Heart Monitor accurate? http://www.alivecor.com/getstarted:
  2. J.K. Lau et al., iPhone ECG application for community screening to detect silent atrial fibrillation:  A novel Technology to prevent stroke, International Journal of Cardiology, Vol. 165:193-194, 2013.
  3. L.A. Saxon et al., Ubiquitous wireless ECG recording:  A powerful tool physicians should embrace, Journal of Cardiovascular Electrophysiology, Vol. 24:  480-483, 2013.
  4. Nicole Lowres et al.  Thrombosis and Haemostasis, Vol. 111, Issue 6:   1167-1176, 2014.
  5. http://www.alivecor.com/why-use-it: ECG analysis.

Win a FREE AliveCor Heart Monitor

AliveCor is giving away a device a day during the month of February in honor of American Heart Month.

Winners picked at random DAILY.

ALIVECOR GIVEAWAY – ENTER TODAY

U.S. only. One entry per person.

Warfarin vs. Pradaxa and the Other New Anticoagulants

by Steve S. Ryan, PhD, Update July 2014, June 2015, October 2015
red-heart-negative 150 pix by 96 res

“I’ve read about people bleeding to death in the ER because they are on the new anticoagulant Pradaxa. Doctors can’t stop the bleeding, even from minor cuts. Is that true? Doesn’t Coumadin carry the same risk? What about the other new anticoagulants Xarelto and Eliquis?”

You’re correct about Pradaxa and the reported bleeding deaths (See “Stop Prescribing or Taking Pradaxa: Suspect in 542 deaths.”) None of the new anticoagulants (including Xarelto and Eliquis) has a proven, reliable antidote or reversal mechanism. But, Pradaxa, in particular, has been associated with tragic deaths in the ER where doctors are helpless and can only watch as someone bleeds to death.

 Stroke Prevention

Most would agree that the worst thing that can happen to a patient with A-Fib is a life-altering stroke. A stroke often causes death or permanent disability. Thus the importance of anticoagulation therapy for A-Fib patients.

For many years, there was only one proven therapy for stroke prevention in A-Fib patients at high or intermediate risk for stroke: the anticoagulant Coumadin (warfarin). It’s readily available and inexpensive.

But maintaining correct Coumadin levels is difficult especially over the long haul (studies indicate around 30% of people will stop taking Coumadin).

But maintaining correct Coumadin levels is difficult especially over the long haul (studies indicate around 30% of people will stop taking it).

Frequent blood tests are required to regulate the dose. Coumadin also has many interactions with other drugs, herbs, and food sources. If taken incorrectly, Coumadin can increase your risk of dangerous bleeding (yes, just like with Pradaxa).

In addition, Coumadin taken over several years may lead in microbleeds in the brain and dementia. (Read about the post-ablation patient on anticoagulation therapy for 10 years who develops cerebral microbleeds and early dementia: The New CHA2DS2-VASc Guidelines and the Risks of Life-Long Anticoagulation Therapy )

For patients at low or intermediate risk of stroke (including younger patients without any additional stroke risk factors) aspirin may be prescribed, or no anticoagulation therapy at all.

Read about the post-ablation patient on anticoagulation therapy for 10 years who develops cerebral microbleeds and early dementia: The New CHA2DS2-VASc Guidelines and the Risks of Life-Long Anticoagulation Therapy

 The NOACs Trials

For over 20 years there have been extensive efforts to replace warfarin with other drugs. In the US, we have four new anticoagulants to consider: Pradaxa (dabigatran), Xarelto (rivaroxaban), Eliquis (apixaban), (added January, 2015) and the recently approved (January, 2015) Savaysa (edoxaban)).

The data on the new anticoagulant come from three randomized controlled trials involving more than 50,000 A-Fib patients:

RE-LY (dabigatran)1
• ROCKET-AF (rivaroxaban)2
• ARISTOTLE (apixaban)3

Each study compared one drug against warfarin (not against each other). Taken together, these studies consistently revealed that A-Fib patients who took the non-warfarin blood thinners suffered fewer strokes, intracranial bleeds, and serious bleeds than those who took warfarin.

All of these drugs are at least as good as warfarin for preventing stroke and all are better than warfarin in reducing your risk of serious bleeding in the brain. But none have antidotes or reversal agents (at this time).

Note: Each of these NOAC trials had a questionable bias toward the new drug when compared against warfarin. Warfarin users are notoriously non-compliant, up to 50% are inconsistent in managing their diet, monitoring their INR levels and taking the correct dosage.4 Each of the three trials compared a group of compliant patients against a group of inconsistent warfarin patients. So results should be viewed with a critical eye.

For a more in-depth look at the clinical trials of the new NOACs, see 2013 BAFS: The New Anticoagulants (NOACs).

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 Three Notable Concerns

The new anticoagulants offer several advantages over warfarin. They are fast acting. And when stopped (i.e., for surgery), they just as quickly clear your body (a short “half-life). There’s a broad therapeutic window (wide range of safe use), and they have minimal drug or dietary interactions. They can be administered in fixed doses without monitoring, making them potentially more convenient to use than warfarin.

Remember: The goal of anticoagulation therapy is to reduce your risk of life-altering stroke.

Enthusiasm for the new anticoagulants, (NOACs), however, must be tempered by three notable concerns in patients taking these drugs:

1. No readily available means for assessing the degree of anticoagulation
2. No readily available reversal strategy
3. Life-threatening bleeding complications can occur after an injury
(Added May, 2015) Dr. Stephen Kimmel of the Un. of Pennsylvania discusses a fourth concern—stomach problems and gastrointestinal bleeding. “If you have a history of stomach problems or gastrointestinal bleeding, you may want to avoid Pradaxa and Xarelto—both medications have the highest risk for those complications.”5

 No Way to Measure Effectiveness

One of the problems with the newer anticoagulants (NOACs) is we don’t have a good way to measure how effective they are or how much of an anti-clotting effect there is at a given point in time. (For example, in treating trauma patients, ER doctors can only use the elapsed time from the last dose to estimate the clotting effect.)

With Coumadin (warfarin), on the other hand, we can measure how effective it is by its level in the blood stream measured in INR (International Normalized Ratio). A person not on anticoagulants will have an INR slightly above 1 (the author’s INR is 1.1). Someone with A-Fib on Coumadin should have an INR between 2.0 and 3.0. At this INR level a person will bleed more than someone with an INR of 1.0, but the blood will still clot.

With an INR below 2.0 you are more in danger of having an ischemic (clotting) stroke, the kind that most often occurs in A-Fib. With an INR of 4.0 and above, there is much more risk of blood not clotting and of developing a hemorrhagic stroke.

But the INR blood test doesn’t work with the new anticoagulants which affects only one particular stage in the anticoagulation process. Pradaxa, for example, is a direct thrombin inhibitor, whereas Coumadin affects nearly every stage in the anticoagulation process. (Thrombin is an enzyme that converts soluble fibrinogen into insoluble fibrin. Fibrin is a fibrous protein involved in the clotting of blood. It forms a mesh or clot over a wound.)

The lack of a readily available method to determine the degree or current level of anticoagulation is a major challenge for ER physicians and staff treating trauma patients.

Medical ID: If you’re on any blood thinner, it’s a good idea to carry some kind of medical ID. (See our Resources and Links for MedIDs free medical ID wallet card generator.) If you have an accident involving bleeding, EMTs don’t normally carry anticlotting meds. But they can call ahead to the ER and get the staff ready to help you.

 Are the NOACs Too Effective?

Pradaxa, in particular seems to work almost too well.

Pradaxa, in particular seems to work almost too well.

In some patients there is excessive bleeding that is catastrophic (usually in older or weaker patients). Pradaxa has been associated with some deaths in the ER where doctors currently have no antidote to stop people from bleeding to death.

Coumadin on the other hand has several proven, time-tested reversal or antidote strategies.6

Pradaxa (dabigatran) won the FDA sweepstakes by being the first new anticoagulant to get FDA approval and consequently captured a significant share of the anticoagulant market. Pradaxa comes in two doses in the United States, 150 mg twice daily or 75 mg twice daily. It’s large and harder to swallow, comes in a bottle with a 30-day shelf life once opened (or in blister packs which eliminates the shelf-life problem.) And it’s expensive.7 In the RELY trial, Pradaxa was not only equal to warfarin, but it proved to be superior to it in preventing stroke. Bleeding rates in the head were lower with Coumadin. However, bleeding from the stomach or bowels was higher. The most common side effect was stomach pain.

In addition to the bleeding deaths in the ER mentioned above, Pradaxa’s own fact sheet states common side effects of Pradaxa include:8

• Indigestion, Upset Stomach, or Burning
• Stomach Pain

[These statements don’t capture the actual human toll—burning throat, roiling intestines, diarrhea, burning anus, lasting intestinal damage, etc. that Pradaxa can produce in some people.]

 Xarelto and Eliquis Test Better

Xarelto (rivaroxaban) was the second drug available in the United States. Xarelto comes in two doses, 20 mg daily or 15 mg daily. In contrast to Pradaxa, it is a small pill taken once-a-day that doesn’t seem to cause a lot of intestinal problems. In the Rocket AF trial, Xarelto also significantly lowered the risk of bleeding in the brain and head compared to Coumadin. Like the other new anticoagulants, Xarelto also doesn’t have a reversal agent; but anecdotally we don’t seem to see a lot of deaths in the ER from Xarelto.

Eliquis (apixaban) was third to be approved, comes in two doses, 5 mg twice daily or 2.5 mg twice daily (the lower for A-Fib patients with kidney dysfunction). Similar to Xarelto, the risk of bleeding in the brain and head was lower versus Coumadin. However, this drug was unique in that bleeding from other sites including the stomach, bowels, and bladder was less. In the Aristotle trial, Eliquis was at least as good and tended to be better than warfarin at preventing stroke.  Eliquis is the only drug that can claim that survival improved with its use compared to warfarin.

Xarelto and Eliquis, just like Pradaxa, are also very expensive.

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 Bleeding Complications

The reported bleeding events tend to occur mainly in elderly patients (median age of 80) which raises a question regarding safe dosing and monitoring in older patients. Elderly patients often have mild to moderate renal impairment, which can cause plasma levels of the NOAC to increase to up to three times those in normal renal function.

“One-size-fits-all” dosage of these new anticoagulants may need to be re-examined for elderly patients. (The FDA rejected the lower 110-mg twice-daily dose of Pradaxa (dabigatran) tested in the RE-LY trial, instead approving a 75-mg twice-daily dose just for patients with severe renal impairment.)

Lack of a proven, reliable antidote or reversal mechanism creates a major challenge for trauma staff.

 Lack of a proven, reliable antidote or reversal mechanism creates a major challenge for trauma staff and emergency physicians treating injured and often unstable patients (as does the lack of a readily available method to determine the degree or current level of anticoagulation). Currently, the only reversal option is emergency dialysis. The ability to perform rapid dialysis in patients with bleeding whose condition is unstable or in those with large intracranial hemorrhages is an incredible challenge, even at the best trauma centers.

With a relatively short elimination half-life, for now, time may be the most important antidote for NOACs.

 Adverse-Events Analysis

Eliquis Earns Best Safety Score

Through an analysis of data from the FDA Adverse Event Reporting System by AdverseEvents, Inc., Eliquis has received an “RxScore” safety score of 39.45 on a 100 point scale, with 100 representing the highest risk. In comparison, warfarin had a score of 67.57. Pradaxa (dabigatran) had a score of 67.15, Xarelto (rivaroxaban) 67.08.9,10

The FDA’s database comprises all the reports made by doctors, patients and other healthcare providers, which means it’s not a “scientific” finding with the authority of a clinical trial. AdverseEvents applies logic, math and software to the database to sift out the important data.

For Eliquis, “the rate of suspect cases was lower in every type of adverse-event report, from hospitalization to death.” For example, among Eliquis patients reporting side effects, only 21% cited hospitalization, while Pradaxa had 39%, Xarelto 43% and warfarin 50%.

The results all point to the same general conclusion: Eliquis may be a safer choice among the new NOACs.

 Update May 2014: Pradaxa

Since it was approved for use in 2010, Pradaxa has been linked to more than 500 patient deaths. More than 1,600 individuals have filed lawsuits in state and federal courts in the United States alleging they suffered bleeding events caused by the drug.

In May 2014, Boehringer-Ingelheim, the privately held German company that makes Pradaxa, settled 4,000 Pradaxa lawsuits and will pay $650 million. The lawsuit states that Pradaxa can cause bleeding events that cannot be controlled and are sometimes fatal.11

Pradaxa has generated $1 Billion in revenue for Boehringer-Ingelheim. So, will this $650 million settlement hurt BI’s bottom line and affect its marketing of Pradaxa? (BI’s revenues in 2012 were $1.5 billion). Probably not.

 Author’s Recommendations

If you’re conscientious and are pretty good at staying in the proper INR range, stick with Coumadin if you can. It may not be as convenient and easy to use as the newer anticoagulants, but we know Coumadin works if you stay within the proper INR range. And there are proven reversal agents for Coumadin, unlike for the newer anticoagulants. The cost of Coumadin is significantly lower when compared to the new anticoagulants.12

Update June 2015: Instead of the above statement, I suggest you talk with your doctor about switching from warfarin (Coumadin) to the NOAC Eliquis (apixaban). Studies show that warfarin produces arterial calcification and plaque which damage your heart over time. (See Stop Taking Warfarin! Switch to Eliquis.) Eliquis doesn’t block Vitamin K like warfarin, it tested better than the other NOACs and is safer.

If you struggle with staying in the proper INR range13, can’t juggle the diet restrictions or monthly monitoring, you should talk with your doctor about switching to Eliquis. It has no interactions with food (not even spinach) and requires NO monitoring (no more finger stick checks). Though be aware of Eliquis’  much higher monthly price.14 You will need to judge if the benefits outweigh the costs.

When choosing an anticoagulant, you need to consider which is worse: the risk of uncontrolled bleeding or the risk of a debilitating stroke.

Update October 26, 2015: FDA Approves Reversal Agent for Pradaxa (dabigatran) 
In a new study of 90 patients who had uncontrolled bleeding with Pradaxa, Praxbind (idarucizumad) stopped this bleeding within minutes. No serious side effects were reported.
We have previously reported on the reversal agent Andexanet Alfa which is on FDA fast track approval as an antidote to the Factor Xa inhibitors Xarelto and Eliquis. FDA approval is pending.15,16

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Return to Index of Articles: Drug Therapies (Medicines)

Last updated: Saturday, March 26, 2016

 

References    (↵ returns to text)
  1. Connolly SJ, et al. RE-LY Steering Committee and Investigators.  Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361(12):1139-51. Last accessed July 10, 2014 URL: http://www.ncbi.nlm.nih.gov/pubmed/19717844
  2. Patel MR, et al. ROCKET AF Investigators.  Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.  N Engl J Med. 2011;365(10):883-91. Last accessed July 10, 2014, http://www.ncbi.nlm.nih.gov/pubmed/2183095
  3. Granger CB, et al. ARISTOTLE Committees and Investigators.  Apixaban versus warfarin in patients with atrial fibrillation.  N Engl J Med. 2011; 365(11):981-92 Last accessed July 10, 2014
  4. Ansell J, et al. Descriptive analysis of the process and quality of oral anticoagulation management in real-life practice in patients with chronic non-valvular atrial fibrillation: the interactional study of anticoagulation management (ISAM) J Thromb Thrombolysis 2007; 23: 83—91. Last accessed July 10, 2014
  5. Kimmel, Stephen. The Truth About Blood Thinners, Bottom Line/Health, May 2015, p. 11
  6. Coumadin reversal or antidote strategies: Vitamin K antagonist, Fresh Frozen Plasma, Prothrombin Complex Concentrate (PCC), and the newly FDA-approved Kcentra.
  7. Pradaxa costs about $250 a month; By comparison, warfarin (Coumadin) costs about $60-$80/month when you add in INR monitoring once a month. Last accessed July 10, 2014
  8. Pradaxa: Highlights of Prescribing Information. Boehringer-Ingelheim website. Last accessed March 13, 2014 URL: http://tinyurl.com/PraxadaInfo
  9. Examining the Comparative Safety of Blood Thinners: An Analysis Utilizing AdverseEvents Explorer, February 2014, Special Report Download. http://info.adverseevents.com/special-report-blood-thinner Last accessed July 10, 2014
  10. Staton, Tracy. Eliquis earns best safety score in its class in analysis of FDA adverse event reports. FiercePharma, February 26, 2014. Last accessed July 10, 2014, http://www.fiercepharma.com/story/eliquis-earns-best-safety-score-its-class-analysis-fda-adverse-event-report/2014-02-26
  11. Feeley, Jef. Boehringer Pays $650 Million to End Blood-Thinner Cases. May 28, 2014. Bloomberg.com. Last accessed July 10, 2014, URL: http://www.bloomberg.com/news/2014-05-28/boehringer-pays-650-million-to-end-blood-thinner-cases.html
  12. Your insurance provider will have a direct say into which drug you take.
  13. Consider a warfarin sensitivity test. About a third of the people who take warfarin are at a higher risk of bleeding because their genes make them more sensitive to warfarin. If a family member experienced side effects, talk to your doctor about taking a genetic warfarin sensitivity test.
  14. For those in the US and on Medicare with Part D coverage, the monthly cost may range from $30 to $50.
  15. Marzo, Kevin. Blood thinner Antidote. Bottom Line Health, Volume 29, Number 9, September 2015, p. 1.
  16. Mundell, E.J.. Drug May Be Antidote to Bleeding Tied to Blood Thinner Pradaxa. Medline Plus. Monday, June 22, 2015. http://www.nlm.nih.gov/medlineplus/news/fullstory_153206.html

Sleep Apnea: Home Testing with WatchPAT Device and the Philips Rspironics

Itamar Medical: Managing Sleep Apnea GFX

Photo: Itamar Medical patient brochure

by Steve S. Ryan, PhD

At least 43% of patients with A-Fib suffer from Sleep Apnea as well.1  (In Sleep Apnea your breathing stops while you’re sleeping). It is now established that Sleep Apnea and A-Fib are correlated.

If you have untreated Sleep Apnea, your chances of having a more severe form of A-Fib or of not benefiting from an A-Fib treatment are greater. After a successful catheter ablation, people with sleep apnea have a greater chance of A-Fib recurring.

In a normal test for sleep apnea, you to go to a hospital-like room, put on cumbersome sensors, then try to go to sleep in this unfamiliar environment. And this test isn’t cheap. It requires extensive monitoring to measure airflow, chest/abdominal movements, electromyography, electrocardiography, and oxygen saturation levels. The formal name for this test is polysomnography (PSG).

The WatchPAT™ Device

WhyWPMed_desc2_6_2

Photo: Itamar Medical patient brochure

The WatchPAT™ is an FDA-approved wrist-worn sleep study device you can use in the comfort of your own bedroom to determine if you have sleep apnea. (PAT is short for Peripheral Arterial Tonometry [pressure measurement].)

It assesses respiratory disturbances and indirectly detects sleep apnea by measuring volume changes in the peripheral arteries along with pulse oximetry (oxygen desaturation) and respiratory arousals. (When you have sleep apnea, your breathing often stops till you have to gasp for breath. This is called “respiratory arousal.”)

Multiple studies have shown there is a high correlation of the WatchPAT with sleep indexes such as the respiratory disturbance index (RDI) and the apnea-hypopnea index (AHI), compared with the same indexes measured by the normal sleep test PSG.

 

Philips Respironics Alice NightOne Sleep Apnea Test

Added 7/21/16: Singular Sleep.com features a different home use system for determining if you have sleep apnea. Developed by Dr. Joseph Krainin, MD, Singular Sleep offers home sleep testing in 24 states (new states are being added regularly), as well as online sleep doctor telemedicine consultations. They use the Philips Respironics “Alice NightOne Sleep Apnea Test” which features a belt that goes around your chest with a nasal cannula which you place in your nostrils and a Pulse Oximeter which you wear on your finger. This system can test both for obstructive sleep apnea and central sleep apnea. See https://singular sleep.com. Many people diagnosed with sleep apnea have trouble using or tolerating a typical CPAP breathing device. Dr. Krainin specializes in helping people adopt to or find the right machine or device to stop their sleep apnea. He is available for consultation in 24 states in the US.

 

 

 

Editor’s Comments:
Everyone with A-Fib should be tested for sleep apnea. Talk to your EP. With the WatchPAT device there is no excuse for not doing a sleep study. It’s easy. You just strap the WatchPAT on your wrist and put the sensors on your fingers, then go to sleep.
If your EP doesn’t have the WatchPAT device for you to use, contact Itamar Medical which produces the WatchPAT. They can usually connect you with an EP in your area who uses the WatchPAT. Website: www.itamar-medical.com; email: infousa@itamar-medical.com. Itamar’s North American number is 888-748-2627; their worldwide number is +972 4 6177000.

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Return to Diagnostic Testing

Last updated: Thursday, July 21, 2016

References for this Article
References    (↵ returns to text)
  1. Bitter, T. et al. Sleep-disordered Breathing in Patients With Atrial Fibrillation and Normal Systolic Left Ventricular Function. Dtsch Arztebl Int 2009; 106(10): 164-70  http://www.aerzteblatt.de/pdf/di/106/10/m164.pdf. DOI: 10.3238/arztebl.2009.0164

Recommended Books and Reports


• • •

Recommended Online Links and Resources

Recommended Online Links and Resources

We have personally picked these sites for you. We value the information they present. These online sites may be helpful when seeking additional information and research on A-Fib.

A Word of Caution: Some web sites for A-Fib patients may be biased toward a particular technique or approach, often for financial gain. When searching online always ask yourself, “Who is paying for this website, and what is their agenda?”

(In alphabetical order)

A-FibFacts.InfoA-FibFacts.Info: Resource of unbiased Atrial Fibrillation facts and statistics backed up with full research citations and sources. Useful for journalists, reporters, bloggers and educators. Sponsored by Steve S. Ryan and A-Fib.com; http://www.A-FibFacts.Info.

Pinterest logo with A-fib Facts A-Fib Facts on Pinterest: There’s lots of misinformation on the internet along with biased websites and out-of-date information. Links to the best sources for the truth about A-Fib and A-Fib treatments (#afib) http://www.pinterest.com/ssryan90265/a-fib-facts/

AF-Ideas: Analysis of the surgical options to cure A-Fib, and what doctors and/or centers perform them. By Dick Inglis.  http://www.af-ideas.com/Choosing treatment for atrial fibrillation.htmAmerican Heart Association

American Heart Association: heart disease/arrhythmia information; http://www.americanheart.org

AFA - UK; Atrial Fibrillation AssociationAtrial Fibrillation Association (AFA-UK): is a non-profit organization which provides information, support and access to established, new or innovative treatments for atrial fibrillation; patient advocacy and information sharing; UK branch and United States branch.

http://centerwatch.com Center Watch: an information source for patients interested in participating in current clinical trial; http://centerwatch.com 

Cleveland Clinic Foundation: the basics of A-Fib; http://www.clevelandclinic.org/heartcenter/pub/atrial_fibrillation/afib.htm 

Cleveland ClinicCleveland Clinic’s MyConsult Online Medical Second Opinion program: online fee-based consulting second opinion service (about $600.00); http://eclevelandclinic.org/myconsult (Not available in every US state and overseas.)

Clinical Trials.govClinical Trials: service provided by the National Institutes of Health (NIH); lists current federally funded and privately supported clinical trials; http://clinicaltrials.gov 

Dr Lam Dr. Lam 11 Strategies to Prevent Lone Atrial Fibrillation; Incorporating the best of the East and West may offer a sensible solution to a complicated issue.  http://www.drlam.com/articles/lone_atrial_fib.asp?page=4

DrugWatch.com: Informing patients about dangerous drugs and medical devices. Sponsored by the Paterson Law Firm. http://drugwatch.com/

Healthfinder: U.S. Department of Health and Human Services; U.S. government’s principal agency for protecting the health of all HealthFinder.govAmericans and providing essential human services, especially for those who are least able to help themselves. Atrial Fibrillation search results-> http://www.healthfinder.gov/search/?q=atrial+fibrillation

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MedHelpThe Heart Forum/MedHelp: questions and support regarding heart issues, including A-Fib; Questions are answered by doctors from the Cleveland Clinic; http://www.medhelp.org/forums/Cardio/WWWboard.html

Heart Rhythm Center: good technical description of PVA(I) procedures; Robert S. Fishel, MD, FACC; http://www.heartrhythmcenter.com

Heart Rhythm Society Heart Rhythm Society: professional organization for cardiologists; A-Fib information and help in finding A-Fib doctors; http://tinyurl.com/HRS-Patient-Resources

Heart Rhythm Specialist - UK - logoHeart Rhythm Specialists (UK): well-written, readable, up-to-date A-Fib info and case studies from the largest EP center in England (the UK); http://www.heartrhythmspecialist.co.uk

Johns Hopkins Medicine Johns Hopkins Arrhythmia Service: “A Guide for Patients and their Families” (PDF). A 52-page guide focused on Arrhythmias (including A-Fib) descriptions of all diagnostic tests, drug therapy and catheter procedure; Includes out-of-area patient services and information. http://tinyurl.com/JohnsHopkinsArrhythmiaService

London AF CentreLondon Atrial Fibrillation Centre (UK): good explanations and graphics of A-Fib (where Prime Minister Tony Blair was treated); http://www.londonafcentre.co.uk 

MedIDs_com MedIDs medical ID wallet form: Print a blank medical ID wallet card provided FREE by MedIDs.com. Just click to open and print the form. Add your medical emergency information, then trim, fold and add to your wallet; http://medids.com/Pocket_Med_ID_Card.pdf

Medifocus logoMedifocus Guide and Digest Alert on Atrial Fibrillation: subscribe to free Medifocus Digest Alert on Atrial Fibrillation. http://www.medifocus.com/2009/digest.php?gid=OC016&a=a

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MedlinePlusMedlinePlus logo: designed by U.S. NLM/NIH for consumers, containing hundreds of topic pages including videos, health check tools, drug, herb and supplement info, links to Fact Sheets from other NIH Institutes, the CDC, etc., and more; http://www.nlm.nih.gov/medlineplus/

Medscape: Cardiology, Arrhythmia/EP; excellent articles, current research, and expert medical opinions on A-Fib; http://www.medscape.com/resource/atrialfibrillation 

MySleepApnea.org logoMySleepApnea: About 43% of patients with A-Fib have sleep apnea; Most don’t know it. Good information and videos (see the Shaq O’Neal  video). https://www.myapnea.org/learn

National Center for Complementary and Alternative Medicine:The NCCAM is the US http://nccam.nih.gov/about/ataglancegovernment’s lead agency for scientific research on complementary and alternative medicine; see pages: “Using Dietary Supplements Wisely” and  “How To Find A Complementary Health Practitioner“.

Nation Heart, Lung, and Blood InstituteNational Library of Medicine (NLM)/National Institutes of Health (NIH): PubMed, MEDLINE & MedlinePlus databases of U.S. government agencies and health-related organizations; http://www.nlm.nih.gov and http://www.nlm.nih.gov/medlineplus/arrhythmia.html

NY Presbyterian Hospital Columbia U Medical Center

New York-Presbyterian Hospital/Columbia University: describes Maze and minimally invasive surgeries for A-Fib; Using catheter ablation, we can completely cure atrial fibrillation. Watch video to find out more. http://www.afibsurgery.org

Polar logoPolar Heart Rate Monitors: helps you monitor your heart rate while exercising and/or while in A-Fib; http://www.polar.fi/polar/channels/eng/index.html 

PubMed & MEDLINE Database: over 24 million citations for biomedical literature, life science journals, and online books. Free resource of the U.S. National Library of Medicine (NLM)/National Institutes of Health (NIH); http://www.ncbi.nlm.nih.gov/pubmed/

St Jude Medical

St. Jude Medical: information about A-Fib including diagnosis and treatment: http://www.AFAnswers.com. For videos see: http://tinyurl.com/Videos-St-Jude

 

CHU Hopitaux de Bordeaux logoUniversity Hospital of Bordeaux, France, Cardiology and Electrophysiology Services: (Cardiologic Hospital of Haut-Lévêque): (referred to as “the Bordeaux Group”) Headed by Prof. Michel Häissaguerre, Electrophysiology and Ablation Unit head: Prof. Pierre Jais; URL: http://tinyurl.com/The-Bordeaux-Group

U of VAUniversity of Virginia Atrial Fibrillation Center: general info on A-Fib; diagnosis and treatment of Atrial Fibrillation; “There’s no “one-size-fits-all” approach.” http://uvahealth.com/services/heart/atrial-fibrillation/patient-resources

UptoDate logoUp-to-Date: review of over 350 journals for new research findings on A-Fib; very comprehensive and current; Beyond the basics, for patients, requires a subscription either weekly or monthly. http://patients.uptodate.com/topic.asp?file=hrt_dis/4882 

WebMD: health information; Atrial Fibrillation Health Center, Living With Afib Directory; help in WebMD finding A-Fib doctors; Slideshow: A Visual Guide to Atrial Fibrillation; http://www.webmd.com/heart-disease/atrial-fibrillation/default.htm


 

A Word of Caution: Some web sites for A-Fib patients may be biased toward a particular technique or approach, often for financial gain. When searching online always ask yourself, “Who is paying for this website, and what is their agenda?”

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