Doctors & patients are saying about ''...

" is a great web site for patients, that is unequaled by anything else out there."

Dr. Douglas L. Packer, MD, FHRS, Mayo Clinic, Rochester, MN

"Jill and I put you and your work in our prayers every night. What you do to help people through this [A-Fib] process is really incredible."

Jill and Steve Douglas, East Troy, WI 

“I really appreciate all the information on your website as it allows me to be a better informed patient and to know what questions to ask my EP. 

Faye Spencer, Boise, ID, April 2017

“I think your site has helped a lot of patients.”

Dr. Hugh G. Calkins, MD  Johns Hopkins,
Baltimore, MD

Doctors & patients are saying about 'Beat Your A-Fib'...

"If I had [your book] 10 years ago, it would have saved me 8 years of hell.”

Roy Salmon, Patient, A-Fib Free,
Adelaide, Australia

"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

"...masterful. You managed to combine an encyclopedic compilation of information with the simplicity of presentation that enhances the delivery of the information to the reader. This is not an easy thing to do, but you have been very, very successful at it."

Ira David Levin, heart patient, 
Rome, Italy

"Within the pages of Beat Your A-Fib, Dr. Steve Ryan, PhD, provides a comprehensive guide for persons seeking to find a cure for their Atrial Fibrillation."

Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA

bleeding risk

FAQs A-Fib Drug Therapy: Vitamin K Foods and Bleeding Risks

 FAQs A-Fib Drug Therapy: Vitamin K Foods

Drug Therapies for Atrial Fibrillation, A-Fib, Afib“Do I need to avoid foods with Vitamin K?  I am on Coumadin (warfarin) to thin my blood and prevent A-Fib blood clots. Do I now need to avoid foods with Vitamin K which would interfere with the blood thinning effects of Coumadin?”

No, don’t avoid Vitamin K foods. Vitamin K is an important nutrient, especially for bone health and brain function. Vitamin K aids the metabolism and regulation of “sphingolipid” metabolism. (Sphingolipids are fats that are a major component of brain cell membranes. They have a significant role in the structure and function of the nervous system.).

You should instead try to maintain a consistent intake of vitamin K through food and/or supplements. You should maintain at least the U.S. recommended amounts of Vitamin K (120 mcg/day for men, 90 mcg/day for women).

Your liver uses vitamin K to make blood clotting proteins. Warfarin lowers your risk of forming a blood clot by reducing the liver’s ability to use vitamin K to produce these blood clotting proteins. But you still need vitamin K for your overall good health. A lack of vitamin K, for example, can lead to osteoporosis.

Prolific A-Fib blogger, Dr John Mandrola (Dr. John M.), recently posted about misinformation surrounding warfarin patients and vitamin-K. He wrote:

“I am so utterly tired of correcting this mistake….Patients on warfarin can indeed eat green vegetables; they should just eat them consistently. I have vegetarians who do beautifully on warfarin.

The problem comes when people vary the weekly dose of vegetables.

Warfarin works by inhibiting vitamin K-dependent clotting factors. If one eats the same amount(dose) of vitamin K, the caregiver can easily adjust warfarin dose….This is not a nitpicky criticism; patients on warfarin have disease, and they should not be avoiding healthy plant-based foods.”

Let’s say you have low levels of vitamin K. If you then eat a spinach salad or liver which are high in vitamin K, this will cause a huge increase in vitamin K intake and consequently a significant drop in your INR (the amount of thinning of your blood). But if you consistently have normal (or preferably higher) levels of vitamin K, a spinach salad or liver will not cause a huge increase in vitamin K.

When starting Coumadin, you should talk over with your doctor how to maintain a consistent diet and/or supplement level of vitamin K. This is especially important if you change your diet. Ideally you should consult your doctor before making any major changes in your diet and vitamin K intake.

Thanks to Ruth McKee for the suggestion of this question.

NOACs Update: With the new anticoagulants (NOACs) now available, some patients may want to change from warfarin. To learn more, go to Warfarin vs. Pradaxa and the Other New Anticoagulants.

Return to FAQ Drug Therapies
Last updated: Monday, June 18, 2018

FAQs A-Fib Drug Therapy: Bleeding Risk on Warfarin

 FAQs A-Fib Drug Therapy: Bleeding Risk  

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

“I’m worried about the risk of bleeding. I have to take the blood thinner warfarin (Coumadin). If I cut myself, do I risk bleeding to death?”

In general, no.

On a normal dosage of warfarin (Coumadin) you will bleed longer if you cut yourself (minor wound). But your blood will still clot.

You will also bruise more easily. You should stay away from contact sports like hockey, football, rugby, etc. or activities where you could easily injure yourself like mountain climbing, competitive biking, etc. (Professional athletes should not be on warfarin). But you can do normal daily activities on warfarin.

However, you may want to get a Medical ID Alert wallet card, bracelet or dog tag. Then, in case of an emergency, paramedics and doctors will know you’re taking a blood thinner.

If you do have a more serious injury, you are definitely more at risk to bleed to death than if you weren’t on warfarin.

If you’re taken to an Emergency Room for treatment, most ER personnel are experienced in using proven antidotes to reverse the blood thinning effects of warfarin. But depending on the seriousness of your injury, there’s no guarantee the reversal agents for warfarin will work in time.

(The newer anticoagulants like Pradaxa, Xarelto, Elquis unfortunately have no proven antidote. Pradaxa in particular seems to be associated with many deaths in the ER where doctors currently have no way to stop people from bleeding to death. See my article, Stop Prescribing or Taking Pradaxa)

Return to FAQ Drug Therapies
Last updated: Monday, June 18, 2018

Dabigatran (Pradaxa) Danger During Ablation—Switch to Warfarin

Warning - cautionDabigatran (Pradaxa) Danger During Ablation—Switch to Warfarin

Dabigatran Danger During Ablation

by Steve S. Ryan, PhD

In an important multi-center study, A-Fib ablation patients on dabigatran (Pradaxa) were compared to ablation patients on warfarin. The dabigatran group had a significantly higher major bleeding and total bleeding rate, and a higher “thromboembolic complications” (clots, strokes) in those who had persistent A-Fib than the warfarin group.

The researchers went even further and said that dabigatran “was confirmed as an independent predictor of bleeding or thromboembolic complications.”

They concluded that “in patients undergoing A-Fib ablation, periprocedural dabigatran use significantly increases the risk of bleeding or thromboembolic complications compared with uninterrupted warfarin therapy.”

Editor’s Comments: The researchers are basically saying that taking dabigatran before and during an ablation significantly raises your risk of developing bleeding problems and clots/stroke compared to warfarin. “Independent predictor” means there is a higher degree of certainty that taking dabigatran will lead to bleeding/stroke.
This is a very important finding for A-Fib patients. And this was no small, limited study. It enrolled 290 A-Fib patients at eight different high-volume centers in the US. The results were dramatically significant. Any A-Fib patient going in for an ablation needs to be aware of this research and act accordingly.
Consequences: Doctors are now weaning A-Fib patients off of dabigatran and on to warfarin before an ablation. If your doctor doesn’t do this, you should get a second opinion—even if your ablation is already scheduled.
In addition, this study raises much more serious red flags about dabigatran for all A-Fib patients, not just for those having an A-Fib ablation. Did the clinical trials of dabigatran miss something? If dabigatran has such bad effects during an ablation, does it have such bad effects in “normal” usage? Why does dabigatran have such bad effects during an ablation and not in “normal” usage? If you are taking dabigatran, you should pose these questions to your doctor. (Thanks of Carol Devenir for alerting us to this research and its importance.)
References for this Article
Lakkireddy, D. et al. “Feasibility and Safety of Dabigatran Versus Warfarin for Periprocedural Anticoagulation in Patients Undergoing Radiofrequency Ablation for Atrial Fibrillation.” Journal of the American College of Cardiology, Vol. 59, Issue 13, March 2012, pp. 1168-1174. doi:10.1016/j.jacc.2011.12.014

Posted July 2012

Back to top

Return to Index of Articles: Research and Innovations

Last updated: Wednesday, August 3, 2016

Follow Us
facebook - A-Fib.comtwitter - A-Fib.comlinkedin  - A-Fib.compinterest  - A-Fib.comYouTube: A-Fib Can be Cured!  - Mission Statement

We Need You

Encourage others
with A-Fib
click to order. is a
501(c)(3) Nonprofit

Your support is needed. Every donation helps, even just $1.00. top rated by since 2014 

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