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


Drug Therapies

Book Review: Bad Pharma—How Drug Companies Mislead Doctors & Harm Patients

Bad Pharma by Ben GoldacreThe author of Bad Pharma does an excellent job of shining a light on the truths that the drug industry wants to stay hidden.

Those truths include how they mislead doctors and the medical industry through sales techniques, and manipulate consumers into becoming life-long drug customers. (For doctors that industry influence begins in medical school and continues throughout their practice.)

We also learn truths about the internal workings of the medical academia, the U.S. FDA, and medical journals publishing. Here are a few highlights from Bad Pharma.

Manipulating Clinical Drug Trials

As consumers, how do we really know which drugs are best? The U.S. FDA protects us, right? Well sort of. Read how trials for drugs and their perceived usefulness can be manipulated, poor trials go unpublished or outright suppressed, and underperforming trials are stopped early or the trial period extended.

One way to manipulate clinical trials starts at the beginning―the design of the trial. Often, few comparison studies are done. Far more common are new drug studies going against placebo pills (that everyone knows don’t work). This helps inflate findings, makes new drugs look more effective than older drugs―because they were never compared against each other.

Bad Pharma & the Cost of Doing Business

Learn how pharmaceutical companies legitimately funnel $10 million to $20 million a year to major medical journals including the New England Journal of Medicine and the Journal of the American Medical Association. So, are we surprised then that studies funded by the pharmaceutical industry are much more likely to get published by these influential journals?

Direct to Consumer Drug Sales

Did you know drug companies spend twice as much on marketing and advertising as on researching and developing new drugs? (I was shocked.)

To learn how medication advertisements on TV can be misleading to consumers, see my review of “Know Your Chances: Understanding Health Statistics” by Steven Woloshin.

Of special interest to me is the ‘Direct to Consumer’ drug sales which has significantly increased drug sales in the U.S. ‘Direct to Consumer’ drug sales is so misleading that it is banned in all countries except two: the U.S. and New Zealand. (No wonder that 70% of drug companies’ profit comes from the U.S.)

To be specific, I hate those misleading TV commercials that target A-Fib patients. What these ads for anticoagulants don’t tell you is:

• You are on their meds for life! (they want lifelong customers!)
• These meds do nothing to treat your A-Fib (only your risk of stroke)
• A-Fib can be cured (you don’t have to be on meds for the rest of your life)

These ads for anticoagulant medications imply if you just take their pill once day, you’ve taken care of your A-Fib. Wrong!

Well Written, Easy to Understand

Bad Pharma, is written in an easy-to-understand manner (you don’t need a medical or science degree). If you wish, you can skim through the book to get an overview, then stop and read a topic of interest. Or you can dig in for a full read, including the authors’s research and other references (documented in footnotes with citations.)

Check on Your Doctor

After reading how big Pharma may be influencing your doctor, you can now find out. In the U.S., with the passing of the Sunshine Act (part of the 2010 Patient Protection and Affordable Care Act), we can now research if a doctor has received pharma money to prescribe their products. Just go to the Open Payments or Dollars for Doctors website.

One of our tenets at A-Fib.com, is ‘Educate Yourself’! If you want to be a more savy consumer of health care services, I highly recommend Bad Pharma. I also recommend Ben Goldacre’s other book, Bad Science.

Bonus Idea: If you pair this book with “Know Your Chances: Understanding Health Statistics” by Steven Woloshin, you’ll have a complete course on how the drug industry skillfully markets their products.

 

My Top 5 Articles About Warfarin Therapy, Associated Risks and Alternatives

my-top-5-picks-stamp-warfarin-400-pix-sq-at-96-res

Any treatment plan for Atrial Fibrillation must address the increased risk of clots and stroke. By far the most commonly used medicine for stroke prevention is the anticoagulant warfarin (brand name Coumadin).

But warfarin is a tough drug to take long term with monthly blood tests and possible side effects. These are my top 5 articles to help you understand warfarin therapy, the associated risks and some of the alternatives.

Review these articles to learn more about Warfarin therapy:

1. Clinical Trials Results: Watchman Better Than a Lifetime on Warfarin;

2. Arterial Calcification From Warfarin: Vitamin K May Reverse it;

3. “Is there a way to get off blood thinners all together? I hate taking Coumadin. I know I’m at risk of an A-Fib stroke.”;

4. How to Avoid the Bleeding Risk of Anticoagulants;

5. If Sixty and Older: 99% Have Microbleeds—So Are Anticoagulants Risky?

Bonus: Video about Warfarin

A-Fib.com video libraryLiving with Warfarin: Patient Education
Excellent introduction to anticoagulant therapy with warfarin (Coumadin). Patients and medical professionals (clinical nurse, doctors, a pharmacist  and clinical dietician) discuss the practical issues associated with taking warfarin. (16:22) Uploaded on Mar 7, 2011. Produced by Johns Hopkins Medicine.

An Alternative to Blood Thinners

WATCHMAN device at A-Fib.com

The WATCHMAN device

Do you hate having to take Coumadin? Hate the monthly testing? Bothered by side effects? An alternative to taking blood thinners is closing off your Left Atrial Appendage (LAA) with the Watchman, an occlusion device. Learn more: The Watchman™ Device: The Alternative to Blood Thinners.

Don’t Just Manage Your A-Fib with Meds. Seek your Cure!

Daniel Doane, A-Fib free after Mini-Maze surgery, from Sonora, California. - A-Fib.com

Daniel Doane, Sonora, CA, A-Fib free after Mini-Maze surgery,

Don’t Expect Miracles from Current Medications

Antiarrhythmic drugs are only effective for about 40% of patients. Many patients can’t tolerate the bad side effects. When drugs do work, over time, the they become less effective or stop working. According to Drs. Savelieva and Camm:

“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”

Drugs don’t cure A-Fib but merely keep it at bay.

Learn All Your Treatment Options

To start, educate yourself about Atrial Fibrillation and review all your treatment options on our page: Treatments for Atrial Fibrillation.

Next, move on to the guidelines we’ve posted: Which of the A-Fib Treatment Options is Best for Me? Then, discuss these treatment options with your doctor. This should be a ‘team effort’, a decision you and your doctor will make together.

Don’t just manage your A-Fib. Seek your Cure.

Reference for this article

Don’t Take Any Medication Without Asking These 10 Questions

Before taking any prescription drug to treat your Atrial Fibrillation, you should educate yourself about the drug. We’ve prepared the top 10 questions you should ask your doctor. As a service to our readers, we offer the questions as a free PDF worksheet you can Download. It has convenient spaces to write down your doctor’s replies for later review.

Print as many as you need and take a copy to every doctor appointment (you never know when you’ll need one). Download our worksheet (and don’t forget to save to your hard drive).

Before Starting a Prescription Drug, Ask These Questions

Use our worksheet as a guide as you ask these questions of your doctor or healthcare professional, and note their responses:

Download our Free Worksheet

1. Why am I being prescribed this medication?
2. What are the side effects of this drug?
3. Are there any precautions or special dietary instructions I should follow?
4. Can it interfere with my other medications?
5. What should I do if I forget a dose?
6. How long before I know if this drug is working?
7. How will I be monitored on this drug? How often?
8. What happens if this drug doesn’t work?
9. What if my A-Fib symptoms become worse?
10. If I don’t respond to medications, will you consider non-pharmaceutical treatments (such as a Pulmonary Vein Isolation procedure)?

Keep your medical records in a binder or folder. at A-Fib.com

Keep your medical records in a binder or folder.

Your A-Fib Binder or Folder

When completed, file the worksheet in your A-Fib binder or file folder to use for future reference and follow-up.

Your A-Fib binder is where you should file and organize all your A-Fib-related treatment information: printouts of information from the internet and your local public library or medical center library, notes from phone calls with doctors’ offices, and answers to “interview” questions during doctor consultations.

Research Any Prescription Drug 

To determine if the prescription is the right one for you, do your research. An excellent prescription database is the U.S. National Library of Medicine Drug Information Portal. (For an example, see the page on Warfarin [Coumadin].)

Also see the free worksheet: Keep an Inventory List of Your Medications


Worksheet from Chapter 6 of Beat Your A-Fib: The Essential Guide to Finding Your Cure, by Steve S. Ryan, PhD

Stubborn A-Fib Returns Again and From Unusual Areas

We first posted Marilyn Shook’s personal A-Fib story, “Pill-In-the-Pocket” for Five Years, then Catheter Ablation for a Cure (#25) in 2008. She then sent us updates in 2014, 2015 and now her latest update after a third ablation in late April 2016. Marilyn’s A-Fib appears to find new and unusual places to originate from.

Marilyn Shook - A-Fib story at A-Fib.com

Marilyn S.

In her lasted installment, Marilyn writes:

“It’s been a few weeks since my third PVA [Pulmonary Vein Ablation] and I am doing  well.

Just to jolt your memory―I had my first PVA in 2007 and did well for 7 years. But my A-Fib returned in 2014 and was documented by a tiny Medtronic Reveal LINQ cardiac monitor implant. A second PVA followed in October of 2014.

I was A-Fib free until February 2016 when A-Fib/Flutter returned. I opted for my third PVA, which was performed in April 2016 by Dr. David Haines at Beaumont Hospital.

Marilyn Shook is also an A-Fib Support Volunteer who lives near Detroit, MI.

My Third Ablation and Post-Ablation Complication

Under general anesthesia, my PVA was extensive work but completed in about 4 hours. I was in sinus rhythm before and after the procedure. After my ablation, I was awake, alert and responsive and then suddenly became unresponsive, with thready pulse, blood pressure plummeted.

I was having a post PVA complication―a cardiac tamponade―an emergency situation!…”

Continue reading about Marilyn’s third ablation and her medical emergency->.

Editorial: Leaving the Patient in A-Fib—No! No! No!

Recently I corresponded with a fellow who just found out he was in “silent” Atrial Fibrillation with no symptoms.

I commend his family doctor for discovering he was in A-Fib during a routine physical. Otherwise, he might easily have had an A-Fib stroke. (Of those with untreated A-Fib, 35% will suffer a stroke.) We don’t know how long he might have been in A-Fib before being diagnosed.

I wish I could commend his cardiologist too, but I can’t. His cardiologist just put him on the rate control drug, diltiazem, and left him in A-Fib.

That is so wrong for so many reasons!

Rate control drugs aren’t really a “treatment” for A-Fib. They slow the rate of the ventricles, but they leave you in A-Fib.

Rate Control Drugs Don’t Really “Treat” A-Fib

Rate control drugs aren’t really a “treatment” for A-Fib. Though they slow the rate of the ventricles, they leave you in A-Fib. They may alleviate some A-Fib symptoms, but do not address the primary risks of stroke and death associated with A-Fib.

Effects of Leaving Someone in A-Fib

A-Fib is a progressive disease.

Leaving a patient in A-Fib can have long-term damaging effects with disastrous consequences. Atrial Fibrillation can:

• Enlarge and weaken your heart often leading to other heart problems and heart failure.

• Remodel your heart, producing more and more fibrous tissue which is irreversible.

• Stretch and dilate your left atrium to the point where its function is compromised.

• Lead to progressively longer and more frequent A-Fib episodes and within a year can progress to chronic (continuous) A-Fib.

• Increase your risk of dementia and decrease your mental abilities because 15%-30% of your blood isn’t being pumped properly to your brain and other organs.

I’m So Angry at Doctors Who Just Leave Patients in A-Fib!

I can’t tell you how angry I am at cardiologists who want to leave people in A-Fib.

Even if a patient has no apparent symptoms, just putting them on rate control meds and leaving them in A-Fib can have disastrous consequences (and verges on malpractice).Don't Settle for a lifetime on medication April 2016 600 x 935 pix at 300 res

What Patients Need to Know

The goal of today’s A-Fib treatment guidelines is to get A-Fib patients back into normal sinus rhythm (NSR).

Treatment options includes antiarrhythmic drugs, chemical and electrocardioversion, catheter ablation and mini-maze surgery.

Unless too feeble, there’s no good reason to just leave someone in A-Fib.1

Don’t let your doctor leave you in A-Fib. Educate yourself. Learn your treatment options. And always aim for a Cure!

References    (↵ returns to text)
  1. A cardiologist may cite the 2002 AFFIRM study to justify keeping patients on rate control drugs (and anticoagulants), while leaving them in A-Fib. But this study has been contradicted by numerous other studies sinse 2002.

New FAQ: Risks of Xarelto and 3 Alternatives to Anticoagulants

We’ve posted a new FAQ and answer about the risks of anticoagulants and three alternatives to taking them.

“I have A-Fib, and my heart doctor wants me to take Xarelto 15 mg. I am concerned about the side effects which can involve death. What else can I do?”

You are right to be concerned about the side effects of Xarelto, one of the new Novel Oral Anticoagulants (NOACs). Uncontrolled bleeding is the primary risk (patients have bled to death in the ER.)

Be advised: No anticoagulant will absolutely guarantee you will never have a stroke.

All anticoagulants are inherently dangerous. You bruise easily, cuts take a long time to stop bleeding, you can’t participate in any contact sports; there is an increased risk of developing a hemorrhagic stroke and gastrointestinal bleeding. (Most EPs are well aware of the risks of life-long anticoagulation.)

Anticoagulants cause or increase bleeding. That’s how they work. To decrease your risk of blood clots and stroke, they hinder the clotting ability of your blood. But, they also increase your risk of bleeding. But in spite of the possible negative effects of anticoagulants, if you have A-Fib and a real risk of stroke, anticoagulants do work.

What Else Can You Do? Remove the Reason for an Anticoagulant—Three Options

The best way to deal with the increased risk of stroke and side effects of anticoagulants is to no longer need them. Here are three options…<…continue… to read my full answer…>

Patients’ Best Advice #7: Persevere—More Than One Treatment May be Needed

THE TOP 10 LIST #7

Persevere-Try More Than One Treatment if Necessary

A-FIB PATIENTS’ BEST ADVICE

From Beat Your A-Fib: The Essential Guide to Finding Your Cure, Chapter 12: Your Journey to a Cure. These patients needed more than one type of treatment to become free from the burden of Atrial Fibrillation:

Joan S.

Joan Schneider, Ann Arbor, MI, USA, tells about starting with drug therapy:

“The Pill-in-the-Pocket (PIP) [drug therapy] served me well prior to my [catheter ablation] procedure.” (pp. 119-124)

Jay Teresi, Atlanta, GA, describes his second ablation after being A-Fib free for three-years:

Jay T.

Jay T.

“[My EP] explained that my first procedure was a success. However, during the healing process a tiny spot did not scar and this allowed the A-Fib to trip again. He ablated that portion and touched up all the other areas. I have now been free of A-Fib for over four years (as of September, 2011).” (pp. 98-100)

Harry Emmett Finch, Malibu, CA. With 40-years of A-Fib, Emmett’s treatment evolved beyond drug therapy to his PV catheter ablation, then AV Node ablation with Pacemaker and, most recently, installation of the Watchman device:

Emmett F.

Emmett F.

“There is more help available today than when I first developed my A-Fib [in 1972], and I’m sure more treatment options (like the Watchman device) will be available in the future.” (pp 181-189)

A-Fib is Not a One-size-fits-all Disease

Your Atrial Fibrillation is unique to you. Along with various treatments, you may need to address concurrent medical conditions (i.e, hypertension, diabetes, obesity, sleep apnea). Likewise, you may need to make lifestyle changes (e.g., diet, exercise, caffeine, alcohol, smoking).

In addition, your heart is a resilient muscle that tends to heal itself, so you may need repeated procedures.

Try More Than One Treatment if Necessary.

Learn more at: Treatments for A-Fib


‘The Top 10 List of A-Fib Patients’ Best Advice’ is a a consensus of valuable advice from fellow patients who are now free from the burden of Atrial Fibrillation. From Chapter 12, Beat Your A-Fib: The Essential Guide to Finding Your Cure by Steve S. Ryan, PhD (beatyoura-fib.com)

Next, look for #8 on the
Top 10 List of A-Fib Patients’ Best Advice
Please, share the advice ♥ 

FAQs A-Fib Drug Therapy: Safety of Multaq [dronedarone] vs amiodarone

 FAQs A-Fib Drug Therapy: Safety dronedarone vs amiodarone

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

Safety of dronedarone

25. “Is the antiarrhythmic drug Multaq [dronedarone] safer than taking amiodarone? How does it compare to other antiarrhythmic drugs?”

Multaq is probably safer than amiodarone, but it isn’t just “amiodarone-lite.”

Higher Death Rates with Dronedarone

Some studies indicate Multaq by Sanofi-Aventis (generic name: dronedarone) has its own set of problems.

In a study of dronedarone in high-risk patients with permanent A-Fib (PALLAS-3,236 patients), patients taking dronedarone were dying at more than twice the rate of those on a placebo. The ratio of stroke and hospitalization for heart failure was also more than twice as high.

The EMA recommends dronedarone not be used in patients still in A-Fib.

Dronedarone Shouldn’t Be Used in Patients in A-Fib

The European Medicines Agency (EMA) has recommended that the antiarrhythmic drug dronedarone not be used in patients still in A-Fib, that it should be discontinued if A-Fib reoccurs, that it shouldn’t be used in patients who have previous liver or lung injury following treatment with amiodarone, and that patients using it should have their liver and lung functions regularly monitored.

Who Should be Taking Dronedarone (If Anyone)?

The Committee for Medicinal Products for Human Use (CHMP) of the EMA said that dronedarone may be a useful option in patients who are in sinus rhythm after a successful cardioversion. But even in this case, dronedarone should only be prescribed after alternate treatment options have been considered.

…Dronedarone should only be prescribed after alternate treatment options have been considered.

About dronedarone, noted A-Fib blogger, Dr. John Mandrola wrote, “I’m surprised that the drug has persisted. I don’t know any of my colleagues who would start a patient out on Multaq [dronedarone]. It just doesn’t work.”

Editor’s Comments
According to these studies and news reports, no one with any type of A-Fib should be taking dronedarone (Multaq).
This is a major change in treatment options for patients with A-Fib.
Dronedarone may be associated with increased strokes, hospitalizations, heart failure, liver damage, lung damage and death. And it may not be very effective anyway.
No antiarrhythmic drug is 100% safe and effective for all A-Fib patients. But until we get more favorable research on dronedarone, all patients with A-Fib should consider not taking it and try alternative options.

References:

Connolly SJ. Dronedarone in High-Risk Permanent Atrial Fibrillation. PALLAS Clinical trial (Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy). New England Journal of Medicine, 2011; 365: 2268-76. http://www.nejm.org/doi/full/10.1056/NEJMoa1109867 DOI: 10.1056/NEJMoa1109867

O’Riordan, Michael. “EMA recommends restricting use of dronedarone” HeartWire, Sept. 22, 2011. http://www.medscape.com/viewarticle/750196

Burton, Thomas M., FDA Reviews Heart-Rhythm Drug. The Wall Street Journal, September 22, 2011. http://www.wsj.com/articles/SB10001424053111904563904576585091471862916

The European Medicines Agency (EMA): a decentralised agency of the European Union (EU) is responsible for the scientific evaluation, supervision and safety monitoring of medicines developed by pharmaceutical companies for use in the EU. http://www.ema.europa.eu/ema/; See: Multaq/dronedarone

Last updated: Wednesday, May 25, 2016 Return to FAQ Drug Therapies

New Report: Is Your Stroke A-Fib-Related or Something Else?

Third in my series from the Ninth Annual Western Atrial Fibrillation Symposium held February 26-27, 2016 in Park City, UT. Read my other reports here.

If you have A-Fib, it’s important to realize that not all strokes are ‘A-Fib related’. You may be perfectly anticoagulated or have a Watchman Device installed and still experience a stroke.

Realize: an A-Fib patient can have a stroke that isn’t caused by A-Fib.

Dr. Jennifer Majersik of the Stroke Center of the Un. of Utah described the case of a man with A-Fib who had an ischemic stroke even though his INR on warfarin was in the correct range.

An A-Fib patient can have a stroke that isn’t caused by A-Fib. There are multiple mechanisms which can cause a stroke. Of the 690,000 strokes in the US/year nearly 1/3 are cryptogenic (of unknown cause) and of those 30% is caused by asymptomatic or Silent A-Fib.

Read my full report in which Dr. Majersik described five subtypes of artery occlusion strokes (as opposed to hemorrhagic [bleeding or vessel rupture] strokes.) <…continue reading…>

 

A-Fib Drug Therapies: Joann’s Success with Multaq

Recently I got good news from Joann Sickinger. She wrote me about controlling her A-Fib with drug therapy. She has been almost A-Fib free for 2 years and has not experienced any side effects.

She has been taking Multaq (dronedarone) 400 mg twice a day, along with metoprolol 12 1/2 mg once a day and Xarelto 15 mg once a day.

Joann says “I am not sure how long this will last and will opt for ablation if I start having attacks again.”

Thanks, Joann for sharing. I’m glad you are aware that drugs often stop working over time and that you are prepared to have a catheter ablation if that happens. (With a successful ablation, you may be able to stop all medications.) We wish you continued good heart health!

What's working for you? Share your tips at A-Fib.com

Email us what’s working for you.

Joann invites your email about Multaq. You can reach her at: joannbday(at)aol.com

Do you have a drug therapy story to share?

Are drugs working for you? Are your A-Fib symptoms under control? Or, have A-Fib drugs been ineffective or with side effects? Email us and share your experiences with our A-Fib.com readers.

FAQs A-Fib Drug Therapy: Anticoagulant Side Effects and Alternatives to Xarelto (NOACs)

 FAQs A-Fib Drug Therapy: Alternatives to Xarelto

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

24. “I have A-Fib, and my heart doctor wants me to take Xarelto 15 mg. I am concerned about the side effects which can involve death. What else can I do?”

You are right to be concerned about the side effects of Xarelto, one of the new Novel Oral Anticoagulants (NOACs).

All anticoagulants are inherently dangerous. You bruise easily, cuts take a long time to stop bleeding, you can’t participate in any contact sports; there is an increased risk of developing a hemorrhagic stroke and gastrointestinal bleeding. (Most EPs are well aware of the risks of life-long anticoagulation.)

Primary risk: Uncontrolled bleeding is the primary risk (patients have bled to death in the ER.) Anticoagulants cause or increase bleeding. That’s how they work. To decrease your risk of blood clots and stroke, they hinder the clotting ability of your blood. But, they also increase your risk of bleeding.

Normally, clotting is a good thing like when you have a scrape or cut.

Other risks: Do the NOACs have the same long-term problems as warfarin (Coumadin), i.e., microbleeds in the brain, hemorrhagic stroke, early dementia, etc.?

We don’t know yet. The NOACs haven’t been around long enough to determine their side effects. But intuitively one would expect so. (The recent spate of ads from lawyers seeking clients who have been harmed by NOACs would seem to lead to this conclusion.)

Anticoagulants Protect You and Give Peace of Mind

But in spite of the possible negative effects of anticoagulants, if you have A-Fib and a real risk of stroke, anticoagulants do work. You’re no longer 4–5 times more likely to have an A-Fib (ischemic) stroke. Taking an anticoagulant to prevent an A-Fib stroke also may give you peace of mind.

What Else Can You Do? Remove the Reason for an Anticoagulant—Three Options

Be advised: No anticoagulant will absolutely guarantee you will never have a stroke.

Be advised that no anticoagulant or blood thinner will absolutely guarantee you will never have a stroke. Even warfarin [Coumadin] only reduces the risk of stroke by 55% to 65% in A-Fib patients. See Risks of Life-Long Anticoagulation.

The best way to deal with the increased risk of stroke and side effects of anticoagulants is to no longer need them. Here are three options:

#1 Alternative: Get rid of your A-Fib.

As EP and prolific blogger Dr. John Mandrola wrote: “…if there is no A-Fib, there is no benefit from anticoagulation.”

Action: Request a catheter ablation procedure. Today, you can have an ablation immediately (called ‘first-line therapy’). You don’t have to waste a year on failed drug therapies. See Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients

#2 Alternative: Close off your Left Atrial Appendage (LAA).

The Left Atrial Appendage is where 90%-95% of A-Fib clots originate.

Action: Request a Watchman device. The Watchman device is inserted to close off your LAA and keep clots from entering your blood stream. See Watchman Better Than Lifetime on Warfarin

#3 Alternative: Consider non-prescription blood thinners

Ask your doctor about your CHA2DS2-VASc score (a stroke risk assessor). If your score is a 1 or 2 (out of 10), ask if you could take a non-prescription approach to a blood thinner.

Perhaps you can benefit from an increase in natural blood thinners such as turmeric, ginger and vitamin E or, especially, the supplement Nattokinase. See FAQ: “Are natural blood thinners as good as prescription blood thinners?” 

Bottom Line

Whether or not to take anticoagulants (and which one) is one of the most difficult decisions you and your doctor must make. Talk to your doctor about alternatives to anticoagulants: 

Taking an anticoagulant isn’t like taking a daily vitamin. Only take one if you are at a real risk of stroke.

• Catheter ablation
• LAA closure (Watchman device)
• Non-prescription blood thinners

If you decide to stay on a NOAC, ask your doctor about taking Eliquis instead of Xarelto. Eliquis tested better than the other NOACs and is considered safer. See Warfarin vs. Pradaxa and the Other New Anticoagulants and the FAQ: Is Eliquis Safer.

Thanks to Jim Lewis for this question.

Remember:
You must be your own best patient advocate.
Don’t settle for a lifetime on anticoagulants or blood thinners.

Don't Settle for a lifetime on medication 10-2015 400 x 500 pix at 300 res

Last updated: Thursday, May 19, 2016 Return to FAQ Drug Therapies

Are Anticoagulants and blood thinners the same thing? How do they thin the blood?

We’ve posted a new FAQ and answer under Drug Therapies and Medicines in our section:

Are Anticoagulants and blood thinners the same thing? How do they thin the blood?

Blood clots are usually good, such as when you get a scrape or cut.

Since A-Fib increases your risk of clots and stroke, blood thinners are prescribed to prevent or break up blood clots in your heart and blood vessels and thereby reduce your chance of an A-Fib-related stroke.

Although referred to as “blood thinners”, they don’t actually affect the “thickness” of your blood.

Anticoagulant Warfarin chemical diagram

Anticoagulant Warfarin

There are two main types: anticoagulants and antiplatelet agents.  They work differently to accomplish the same end effect.

Anticoagulants work chemically to lengthen the time it takes to form a blood clot.

Common anticoagulants include warfarin (Coumadin), Heparin and the NOACs such as apixaban (Eliquis).

Antiplatelet Aspirin

Antiplatelets prevent blood cells (platelets) from clumping together to form a clot.

Common antiplatelet medications include aspirin, ticlopidine (Ticlid) and clopidogrel (Plavix) .

Final answer: Yes, an anticoagulant is a blood thinner, but not all blood thinners are anticoagulants.

Note: To read about ‘clot buster’ drugs or treatments that could save you from a debilitating stroke, see my article: Your Nearest ‘Certified Stroke Center’ Could Save Your Life.

NOACs: Why Isn’t There a Way to Measure Their Effectiveness?

Warfarin has one, but the NOACs don’t. What am I talking about?

Warfarin (Coumadin) has a way to monitor and measure its effectiveness for a specific patient. But there’s no similar way to measure the effectiveness of the new Novel Anticoagulant drugs (NOACs).

Warfarin and Your INR

With warfarin, blood testing for your INR (International Normalized Ratio) will tell your doctor what dosage of warfarin is needed to maintain your ideal INR range between 2.0 and 3.0. (Below 2.0, there’s more of a risk of an ischemic [clotting] stroke; above 4.0, there’s more of a risk of a hemorrhagic [bleeding] stroke.)

An A-Fib-related stoke is an ischemic [clotting] stroke.

NOACs: No Blood Testing but at What Price?

From the clinical trials we know NOACs work as well as warfarin. In addition, the NOACs don’t require periodic blood testing. But the FDA, under pressure for new anticoagulants, approved the NOACs without there being any established or universally recognized method of determining their clot preventing effectiveness.

Without any method of determining their clot preventing effectiveness, how can you determine if your NOAC is working for you? … Continue reading this report…->

How to Avoid the Bleeding Risk of Anticoagulants

Taking almost any prescription medication has trade-offs.

In the case of anticoagulants, on the one hand you get protection from having an A-Fib stroke (which often leads to death or severe disability), but on the other hand you have an increased risk of bleeding. That’s how they work. Therefore blood thinners are inherently dangerous.

As an A-Fib patient, whether or not to be on anticoagulant or not, and which one, is one of the most difficult decisions you and your doctor must make.

Your Risk of Life-Long Anticoagulation Therapy

With the 2014 Guidelines for Management of Patients with Atrial Fibrillation, came significant changes to the rating scale doctors use to assess your risk of stroke. The guidelines call for many more people to be on a lifetime of anticoagulant therapy.

An anticoagulant should not be prescribed as a precaution, but only when a significant risk of stroke exists.

But taking an anticoagulant isn’t like taking a daily vitamin. An anticoagulant should not be prescribed as a precaution, but only when a significant risk of stroke exists.

Long term, we know the blood thinner warfarin (Coumadin) is associated with microbleeds, hemorrhagic stroke, and developing early dementia. What about the newer NOACs? There’s little long-term risk data, but we expect similar long-term risks.

Was 10 years of Anticoagulant Use the Cause of this Patient’s Dementia?

Dr. John Day, in an editorial in The Journal of Innovations in Cardiac Rhythm Management, described his patient, Bob, who had been on anticoagulation therapy for 10 years (even though he had had a successful catheter ablation and was A-Fib free).

“Could the drug therapy be the cause of this case of dementia? – Dr. John Day”

Bob was suffering from early dementia. A cranial MRI revealed … Continue reading this report…->

The Controversy Continues: Women, Anticoagulants, CHA2DS2-VASc and Risk of Bleeding

The controversy began with the publication of the 2014 Guidelines for Management of Patients with Atrial Fibrillation (A-Fib). The joint HRS/ACC/AHA committee report included significant changes to the rating scale used by doctors to assess an A-Fib patient’s risk of stroke (The rating scale now used is the CHA2DS2-VASc).

Magically, simply because of her gender, a woman is automatically given one point on the stroke risk scale no matter how healthy she is otherwise.

Yes, you read that correctly.

Just because of gender, ALL women automatically have one strike against them when assessing their risk of A-Fib-related stroke.

All it takes is one additional point, say for having hypertension, and the Guidelines call for life-long anticoagulant drug therapy. (It doesn’t seems to matter if your hypertension is under control with meds.) A score of 2 or higher (out of 10) = lifelong anticoagulation therapy!

Really? … Continue reading this report…->

Patients’ Best Advice #4: Don’t Just Manage Your A-Fib with Meds. Seek your Cure.

Top 10 List #4 Meds don't cure A-Fib 600 x 530 pix at 300 res

THE TOP 10 LIST #4

Drugs have a role, but other treatment options target a cure.

A-FIB PATIENTS’ BEST ADVICE

From Beat Your A-Fib: The Essential Guide to Finding Your Cure, Chapter 12: Your Journey to a Cure. Advice from patients now free from the burden of Atrial Fibrillation:

Dan Doane at A-Fib.com

Dan Doane

Daniel Doane, Sonora, California, USA, shares his mistake:

“Don’t think that the medication is a long term solution. Don’t put up with nasty side effects. That was the mistake I made. I thought I could tough out the medication as long as I stayed out of A-Fib.” (pp. 152-162)

Terry DeWitt, Massachusetts, USA, advises act sooner than later:

Terry Dewitt at A-Fib.com

Terry D.

“I knew I could continue on medication for several years, but I was concerned about the remodeling of my heart. …I would need an ablation…and sooner seemed better when my heart was still strong.”  (pp. 138-143)

Max Jussila, Shanghai, China, says meds are for the short term:

“Do not listen to your doctors if they suggests medication as a long-term solution!
Max Jussila, A-Fib Support Volunteer at A-Fib.com

Max J.

The doctors who see medication as a solution commit serious negligence and are ignorant of the terrible nature and consequences of Atrial Fibrillation.” (pp. 92-97)

Don’t Just Manage Your A-Fib with Meds. Seek your Cure.

According to Drs. Savelieva and Camm:

“The plethora of antiarrhythmic drugs currently available for the treatment of A-Fib is a reflection that none is wholly satisfactory, each having limited efficacy combined with poor safety and tolerability.”

In general, don’t expect miracles from current medications. Antiarrhythmic drugs are only effective for about 40% of patients; many can’t tolerate the bad side effects. When they do work, the drugs become less effective or stop working over time. To date, the magic pill that will cure your A-Fib probably doesn’t exist.

Drugs don’t cure A-Fib but merely keep it at bay.

Learn more at: Drug Therapies.


‘The Top 10 List of A-Fib Patients’ Best Advice’ is a a consensus of valuable advice from fellow patients who are now free from the burden of Atrial Fibrillation. From Chapter 12, Beat Your A-Fib: The Essential Guide to Finding Your Cure by Steve S. Ryan, PhD (beatyoura-fib.com)

Next, look for #5 on the
Top 10 List of A-Fib Patients’ Best Advice
Please, share the advice ♥ 

FREE Download: Keep an Inventory List of Your Medications

 Medication Inventory form complements of Alere at A-Fib.com

Medication Inventory form complements of Alere

It’s important to keep your doctor and other healthcare providers up-to-date on all the medications you are taking, the dosages, and for what purpose. And because over-the-counter drugs, vitamins and mineral supplements can interfere with your medications, you’ll want to include them, as well.

Download this FREE Medication List (PDF) and save to your hard drive.

Just type your information into the PDF document and print a copy for each of your doctors or other medical healthcare providers.

Because your medications will change over time, you may want to print a few blank worksheets. Use to collect changes for entering later into your PDF document. (Store the blanks with your A-Fib records binder or folder.)

 

The Risk of Dementia Caused by A-Fib―20 year Study Results

Atrial Fibrillation (A-Fib) has been suggested as a risk factor for dementia since A-Fib can lead to a decrease of blood supply to the brain independent of stroke.

Other long-term studies evaluating the link between A-Fib and dementia have shown inconsistent results.

Study Patients and Method

In a 20-year observational study of participants in the long-term Rotterdam Study, researchers tracked 6,514 dementia-free people. Researchers were monitoring participants for dementia and Atrial Fibrillation (A-Fib). 

“The Rotterdam Study” is a long-term study started in 1990 in Rotterdam, The Netherlands. Cardiovascular disease is just one of several targeted diseases. Since 2008 it has 14,926 participants.

At the start of the study (baseline), 318 participants (4.9%) already had A-Fib.

Results

During the course of the 20-year study, among 6,196 people without established A-Fib:

• 723 participants (11.7%) developed A-Fib, and
• 932 participants (15.0%) developed incident dementia.
• Development of A-Fib was associated with an increased risk of dementia in younger people (<67 years old).
• Dementia risk was strongly associated with younger people (<67 years old) who developed A-Fib but not strongly associated in the elder participants who developed A-Fib.

The authors concluded… Continue reading

New A-Fib Patient Story: Pill-In-The-Pocket Works, Until It Doesn’t

Lise Soares Personal experience story on A-Fib.com

Lise Soares

Our newest patient A-Fib story is told by a retired nurse from Arizona. (Coincidently, her husband had A-Fib, too.) Both are now A-Fib free. Her story begins in an all too familiar way.

I Woke at 2 AM with an Urgent Need to Urinate

My first episode started in September 2006 when I woke up at 2 AM with an urgent need to urinate. My heart was beating so hard that I thought it would come out of my chest. My pulse was irregular, I had chest pain and was dizzy. I was anxious and scared. At the emergency room, just before I was scheduled for a cardioversion, to my great relief, I went back into sinus rhythm.

I was discharged with a ‘pill-in-a-pocket’, Flecainide 100 mg, if I got another episode. I thought I would be free from other episodes. But 10 months later I woke up at 1 AM again with an urgent need to urinate. My heart was beating out of my chest and my pulse was over 130 per minute.

But this time I took Flecainide 100 mg and was back in sinus rhythm at 2:15 AM with a pulse of 68.

My cardiologist instructed me to eat salty foods such as chips and nuts while in A-Fib 

Why Did I Urinate 10-15 During an A-Fib Episode?

As my A-Fib became more frequent, I wanted to know why I urinated so many times (10-15) during an A-Fib episode. Apparently, when in A-Fib, the “atrial natriuretic peptide hormone” in the atria kicks in and acts as a diuretic to lower the blood pressure and regulate the calcium and salt in the body.

My cardiologist instructed me to eat salty foods such as chips and nuts while in A-Fib and drink plenty of water so as not to get dehydrated. I was also told that my A-Fib episodes were vagal… .

To read more of Lise’ A-Fib story and how she beat her A-Fib for more than three years, go to: Retired Nurse: Over 3 Years A-Fib Free (Husband Had A-Fib, Too).

Follow Us
facebook block 65 pix REVtwitter block 65 pixlinkedin block 65 pixpinterest.block 65 pix


A-Fib.com is a
501(c)(3) Nonprofit



Your support is needed. Every donation helps, even just $1.00.


We Need You
A-Fib.com Mission Statement
BYA - Alerts ad Green

A-Fib.com top rated by Healthline.com for the third year.
A-Fib.com top rated by Healthline.com for the third year. 2014  2015  2016

Mug - Seek your cure - Beat Your A-Fib 200 pix wide at 300 resEncourage others
with A-Fib
click to order

Home | The A-Fib Coach | Help Support A-Fib.com | A-Fib News Archive | Tell Us What You think | Media Room | GuideStar Seal | HON certification | Disclosures | Terms of Use | Privacy Policy