"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"


"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

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, Afib11. “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). 7

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. 8

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.

Update 6/20/15: With the new anticoagulants (NOACs) now available, no one probably should be taking warfarin anymore. Warfarin produces arterial calcification, and also puts patients at increased risk of osteoporosis and bone fractures. (See Stop Taking Warfarin [Coumadin]!!! Switch to Eliquis [Apixaban].)

Return to FAQ Drug Therapies

FAQs A-Fib Drug Therapy: Bleeding Risk on Warfarin

 FAQs A-Fib Drug Therapy: Bleeding Risk  

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

10. “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

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

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Last updated: Wednesday, August 3, 2016

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