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


Eliquis

Can I Take the Supplement Krill Oil While on Eliquis?

We’ve added a new FAQ and answer to our section, Mineral Deficiencies & Supplements:

“I’m taking Eliquis for my risk of A-Fib stroke. I’m interested in the supplement, Krill Oil, that has natural blood thinning properties. Is It OK to take Krill Oil along with Eliquis?

Krill Oil and Eliquis Work Differently

The supplement, Krill Oil, is similar to fish oil. Both contain omega-3 fatty acids. Fatty acids are thought to make blood platelets less sticky, and thus are less likely to form clots. Krill Oil is considered superior to fish oil for not accumulating toxins the same way fish do.

Eliquis is an anticoagulant, a ‘Direct Factor Xa Inhibitor’, and affects only one stage in the anticoagulation process (the stage after platelets do their part). It works to slow or stop clotting proteins (like fibrin) from binding together and forming a clot.

Continue reading my answer

How Blood Clotting Works: First, platelets clump together to temporarily ‘plug’ the wound; Next, a cascade of coagulation stages reinforces the plug with fibrin threads that act as a ‘molecular glue’ during healing.

FAQs Minerals & Supplements: Can I Take Krill Oil with Eliquis?

 FAQs Minerals & Supplements: Krill Oil

Minerals & Supplements

Minerals & Supplements

13. “I’m taking Eliquis for my risk of A-Fib stroke. I’m interested in the supplement, Krill Oil, that has natural blood thinning properties. Is It OK to take Krill Oil along with Eliquis?

I wish I had a more definitive answer for you. Here’s what we know.

Krill Oil and Eliquis Work Differently

The supplement, Krill Oil, is similar to fish oil. Both contain omega-3 fatty acids. Fatty acids are thought to make blood platelets less sticky, and thus are less likely to form clots. Krill Oil is considered superior to fish oil for not accumulating toxins the same way fish do.

How Blood Clotting Works: First, platelets clump together to temporarily ‘plug’ the wound; Next, a cascade of coagulation stages reinforces the plug with fibrin threads that act as a ‘molecular glue’ during healing.
Eliquis is an anticoagulant, a ‘Direct Factor Xa Inhibitor’, and affects only one stage in the anticoagulation process (the stage after platelets do their part). It works to slow or stop clotting proteins (like fibrin) from binding together and forming a clot.

Eliquis: No Method to Measure Anticoagulant Effect

The anticoagulant, warfarin, has ‘one’ but Eliquis doesn’t. The effectiveness of warfarin can be determined by blood tests measuring INR levels. By comparison, there’s no method to measure Eliquis’ anticoagulant effect (or any of the new NOACs).

Unlike warfarin, there’s no method to measure Eliquis’ anticoagulant effect.

Antiplatelets vs Anticoagulants

We know that Krill Oil and Eliquis work differently. Krill Oil affects the clumping of blood platelets. Eliquis (and all NOACs) affect the anticoagulant process.

Intuitively one would think that since Eliquis and Krill Oil affect different stages in the anticoagulant process, it might be OK to use them together. But Eliquis is so new we have little research to definitively say this.

Bottom line: We can’t measure how Krill Oil affects the anticoagulation process when taking Eliquis.

Discuss with your Doctors

Ask your doctors about taking Krill Oil along with Eliquis (but they probably won’t know the answer). Most doctors consider nutritional supplements, like Krill Oil, of dubious value and little more than ‘snake oil’. (But this is changing in today’s medical schools.)

Most doctors consider nutritional supplements of dubious value and little more than ‘snake oil’.

If you and your doctor agree to start Krill Oil, begin with a low dosage, then increase it gradually.

IMPORTANT: Keep accurate, scrupulous records of how you react to taking Krill Oil with Eliquis. Be prepared to stop the Krill Oil, if necessary.

(Thanks, Ralph, for this question. Please share your experience with us.)

References for this article

Last updated: Tuesday, June 14, 2016

Return to FAQ Mineral Deficiencies and Supplements

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

Stop Taking Warfarin―Produces Arterial Calcification

Stop Taking Warfarin―Produces Arterial Calcification

Warfarin - Coumadin tablets various dosages

Warfarin (brand name Coumadin) various dosages

The blood thinner, warfarin (Coumadin) is a “vitamin K-antagonist” which works by blocking vitamin K (i.e., K-2, menaquinone), thereby affecting several steps in the anticoagulation pathway and decreasing clotting proteins in the blood.

But vitamin K is also essential for heart and bone health. Vitamin K determines whether we maintain strong bone density and soft pliable tissues. Without enough K-2, osteocalcin, a protein that binds calcium to bone, doesn’t function. This vascular calcification produces plaque and reduces aortic and artery elasticity.

“When calcium doesn’t stay in bones, it can end up clogging your arteries, causing a heart attack or stroke.”

Vitamin K chemical structure

Vitamin K chemical structure

Warfarin Blocks Vitamin K: Deposits Calcium in Arteries

By blocking vitamin K (K-2), warfarin deposits calcium in our arteries and progressively turns them into stone. In the absence of vitamin K, bony structures form in soft tissues. When you hear the term “hardening of the arteries,” this means that previously flexible blood vessels are turning into rigid (calcified) bony structures.

In a study of 451 women using mammograms to measure arterial calcification, after just one month of warfarin use, arterial calcification increased by 50% compared to untreated women. After five years, arterial calcification increased almost 3-fold.

Why You Should You Stop Taking Warfarin

If you are taking warfarin (Coumadin), you should talk to your doctor about switching to Eliquis (apixaban) which tested the best of the NOACs and is the safest. (See my article, Warfarin and New Anticoagulants.)

NOACs anticoagulants on notepad 150 pix at 96 res

Eliquis (Apixaban) is one of the new NOACs

The new oral anticoagulants (NOACs) do not block vitamin K. But the NOACs do have drawbacks. In the case of severe bleeding, there is currently no antidote or reversal agent like there is for warfarin (a reversal agent for the direct factor Xa inhibitors Xarelto and Eliquis is close to FDA approval).

Added 2015: The FDA approved a reversal agent Praxbind for the NOAC Pradaxa Oct. 16, 2015. In clinical trials, 5gs of Praxbind (idarucizumab) administered by IV reversed the anticoagulant effect of Pradaxa within minutes (which is significantly faster than the current antidotes for warfarin).

Whether or not to be on an anticoagulant and which one to take is the most difficult decision you and your doctor have to make (and your initial decision may change over time as your body changes.)

If you aren’t happy with your doctor’s response, get a second opinion. You need to feel confident and at peace with this decision.

References for this article

The Year in Review: Highlights and Achievements

By Steve S. Ryan, PhD

When I think about the field of atrial fibrillation in 2013, several thoughts come to mind. There were technical advancements, some new drug therapies, and additions to our understanding of Atrial Fibrillation (and a few accomplishments for our A-Fib.com website).

Heart Imaging And Mapping Systems

Perhaps the most important technical innovations in 2013 for A-Fib patients were the introduction of two new heart imaging and mapping systems. A third system, the Bioelectronic Catheter, represents a whole new technology with tremendous potential for A-Fib patients.

Patients wearing 'vest' lies down for the ECGI.

The ECGI System

The ECGI system, combined with a CT scan, produces a complete 3-D image of your heart along with identifying all the A-Fib-producing spots. Think of it as an ECG with 256 special high resolution electrodes rather than 12. It greatly reduces your ablation time and your radiation exposure.

A day before your ablation, you simply don a special vest with 256 electrodes covering your upper torso, and lay down. The 3-D image created is a road map of your heart with all the focal and rotor areas (A-Fib-producing spots) identified. During your ablation your EP simply ablates the “guilty” areas. Read more of my article…

Topera-FIRMap catheter - three sizes

The FIRM System

The FIRM system uses a different approach to mapping the heart and the A-Fib producing spots. It uses a basket catheter inside the heart to map large areas in a single pass and reveal the location of foci and rotors. Read more of my article…

Why are these two technologies important? ECGI allows your imaging & mapping to be performed the day prior to your ablation, rather than during your ablation. This shortens the length of your ablation procedure.  In addition it reduces your radiation exposure and produces remarkably accurate 3D images of your heart and identifies where A-Fib signals are coming from. The FIRM system, though performed during an ablation rather than before it, may be a significant improvement over the Lasso catheter mapping system now in current use. Both systems may mark a new level of imaging/mapping for A-Fib.

Flexible Biomechanical Balloon Catheter - photo credit: Dae-Hyeong Kim-University of Illinois

Stretchable Electronics Meets the Balloon Catheter

The merging of living systems with electronic systems is called “bioelectronics”. Key is a flexible, pliable circuit made from organic materials—the carbon-based building blocks of life. Bioelectronics have entered the EP lab with a prototype of a ‘bioelectronic catheter’, the marriage of a pliable integrated circuit with a catheter balloon.

In a mapping application, the deflated bioelectronic balloon catheter is slipped into the heart, then pumped up. The inflated integrated circuit conforms to the heart’s grooves and makes contact with hard-to-reach tissue. It can map a hundred electrical signals simultaneously, across a wider area and in far greater detail than had been previously possible. And it’s being developed to function in reverse. For ablation applications, instead of detecting current, it can apply precise electrical burns. This is a potentially breakthrough technology that may well change the way catheter mapping and ablation are performed. (Thanks to David Holzman for calling our attention to this ground-breaking research article.)

This is a remarkable time in the history of A-Fib treatment. Three very different technologies are poised to radically improve the way A-Fib is detected, mapped and ablated. We’ll look back at 2013 as a watershed year for A-Fib patients.

Three New Anticoagulants

In 2013 we saw three new anticoagulants, a welcome development for A-Fib patients. Note: the new anticoagulants are very expensive compared to the proven anticoagulant warfarin.

pradaxa_logo 150 pix 96 res Eliquis apixiban logo 150 pix 96 res Xarelto logo 150 pix 96 res

How do they compare to warfarin?

Warfarin seems to have a slightly higher chance of producing intracranial bleeding.
In general stay away from Pradaxa. There are horrible ER reports of patients bleeding to death from even minor cuts, because there is no antidote or reversal agent. Read more about my Pradaxa warning

Eliquis, in general, tested better than Xarelto in the clinical trials, but it’s so new we don’t have a lot of real-world data on it yet. And, as with Pradaxa, neither have antidotes or reversal agents.
In addition, there was what some consider a major problem with the clinical trials comparing the new anticoagulants to warfarin. ‘Compliance’ rates by warfarin users were poor (many either weren’t taking their warfarin or weren’t in the proper INR range). Did this skew the results?

And finally, unlike warfarin where effectiveness can be measured with INR levels, we don’t have any way to measure how effectively the new blood thinners actually anticoagulate blood. Read more of my article Warfarin vs. Pradaxa and the Other New Anticoagulants“.

Keep in mind: ‘New’ doesn’t necessarily mean ‘better’ or ‘more effective’ for You.

A-Fib with high blood pressure?

High Blood Pressure with Your A-Fib? Is Renal Denervation a solution?

As many as 30% of people with A-Fib also have high blood pressure which can’t be lowered by meds, exercise, diet, etc. There was hope that Renal Denervation would help.

With Renal Denervation, an ablation catheter is threaded into the left and right arteries leading to the kidneys, then RF energy is applied to the nerves in the vascular walls of the arteries, hopefully reducing ‘Sympathetic Tone’, lowering high blood pressure and reducing A-Fib. For many people Renal Denervation seemed the only realistic hope of lowering their high blood pressure. However, the Medtronic Simplicity-3 trial indicated that renal denervation doesn’t work. Read more of this article…  For 2014 news on this topic, read more…

A Study of Obesity and A-Fib: A-Fib Potentially Reversible

Apple and tape measure - weight loss 200 pix by 96 resObesity is a well known cause or trigger of A-Fib, probably because it puts extra pressure and stress on the Pulmonary Vein openings where most A-Fib starts.

In 2013 A research study report focused on obese patients with A-Fib. Those who lost a significant amount of weight also had 2.5 times less A-Fib episodes and reduced their left atrial area and intra-ventricular septal thickness.

Good news! Losing weight can potentially reverse some of the remodeling effects of A-Fib. Related article: Obesity in Young Women Doubles Chances of Developing A-Fib.

Data collected in a typical sleep study

Obstructive Sleep Apnea and A-Fib

Obstructive Sleep Apnea (OSA) is another well recognized cause or trigger of A-Fib. Anyone with A-Fib should be tested for sleep apnea.

Earlier studies have shown approximately two-thirds (62%) of patients with paroxysmal or persistent A-Fib suffer from sleep apnea. In 2013, research reports showed that the worse one’s sleep apnea is, the worse A-Fib can become. In addition, sleep apnea often predicts A-Fib recurrence after catheter ablation.

Before an ablation, Dr. Sidney Peykar of the Cardiac Arrhythmia Institute in Florida, requires all his A-Fib patients be tested for sleep apnea. If they have sleep apnea, they must use CPAP therapy after their ablation procedure.

A-Fib.com: Our New Website’s First Year

A-Fib_com logo The original A-Fib.com web site was created using the phased out software MS FrontPage. Thanks to a  “no strings attached” grant from Medtronic, A-Fib.com was reinvented with a more up-to-date but familiar look, and features more functionality (built on an infra-structure using Joomla and WordPress). We can now grow the site and add features and functions as needed.

It involved a tremendous amount of work. A special thanks to Sharion Cox for building the new site and for technical support. My wife, Patti Ryan, designed the look and all graphics. (I can’t thank Patti enough; I’m so lucky!)

A-Fib.com Project:
Update the Directory of Doctors & Facilities

Steve and A-Fib.com bulk mailing to update the A-Fib.com Directory of Doctors and Facilities

Back when I started A-Fib.com in 2002, there were less than a dozen sites performing ablations for A-Fib. Today our Directory of Doctors and Facilities lists well over 1,000 centers in the US, plus many sites worldwide.

Increasingly, doctors were writing me asking why they weren’t included, or why their info was incorrect since they had moved, etc. To update our records and our service to A-Fib patients, starting in July 2013, we prepared and mailed letters to over 1,000 doctors/facilities. We asked each to update/verify their listing (and include a contact person for our use).

Note to Doctors! If you haven’t updated your listing in our A-Fib.com Directory of Doctors and Facilities, just use our Contact Us form to email me and I’ll send you the form to fill in and return.

The response to our bulk mailing was great. The data input started in October and continued for several months (as time allowed). Recently, we cut over to the ‘new’ Directory menu and pages.

 


2014 PREVIEW A-Fib.com

What’s Ahead for A-Fib.com in 2014

2014 Boston AFib Symposium Reports: Check out my new reports from the 2014 Boston A-Fib Symposium (BAFS) held January 9-11, 2014 in Orlando FL.

The first two reports are posted. Look for more reports soon. I usually end up with 12-15 reports in total.

Steve and bulk mailing to update the A-Fib.com Directory of Doctors and Facilities

Our a-Fib.com Directory of Doctors & Facilities: Work on updating our listings is still underway. We need to contact those who did not respond to our request for verification or updating of their listing. (Shall we write again or maybe make phone calls?)Beat Your A-Fib by Steve S Ryan, PhD

Amazon Best Sellers list:  Our book sales continue to grow. Did you know that our book ‘Beat Your A-Fib’ has been on Amazon’s Best Sellers list continually in two categories (Disorders & Diseases Reference and Heart Disease) since its debut in March 2012? Visit Amazon.com and read over 40 customer reviews.

Help A-Fib.com Become Self-sustaining: We plan to step up our efforts to make A-Fib.com a self-sustaining site. (Since 2002, Steve and Patti Ryan have personally funded A-Fib.com with an occassional reader’s donation.)


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Spreadshirt shop= Beat your a-fib - 4 piece 240 x 150 at 96

Visit our shop at Spreadshirt.com.

In our efforts toward sustainabiliy, several years ago we added a PayPal ‘Donate’ button (you don’t need a PayPal account to donate) and invited donations toward our onlline maintenance costs.

Then, a year or so ago, we added a portal link to Amazon.com. When you use our Amazon.com link, A-Fib.com receives a small commission on each sale (at no extra cost to you).

Our newest effort is our ‘A-Fib can be Cured! shop with T-shirts and more at Spreadshirt.com. With each shirt purchase $2 goes to support A-Fib.com. (We will roll out new designs every quarter or so).

Posted February 2014

Help A-Fib.com become self-sustaining! Help keep A-Fib.com independent and ad-free.
Will 2014 be the year you help support A-Fib.com?

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Return to Dealing with A-Fib

Last updated: Wednesday, February 11, 2015

New A-Fib Patient Story: Serious Pradaxa Side Effects

Jeff Patten, Ashby, MA

Jeff Patten, Ashby, MA

Jeff Patten’s A-Fib started briefly in 2000, then returned in 2010 when his father-in-law died. The emotional upset, high summer heat, stress and accumulated age, followed closely by a bout with appendicitis, put him back into A-Fib .

In 2012, came a successful CryoBalloon ablation. But Jeff’s post-ablation recovery on Pradaxa turned into “alimentary torture” and burning diarrhea. Later came a Right Atrium Catheter Ablation for PACs/PVCs. Learn how Jeff emerged in 2015 healthy and A-Fib free.

 

FAQs A-Fib Treatments: Medicines and Drug Therapies

FAQs A-Fib Treatments: Medicines and Drug Therapies

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

Drug Therapies for Atrial Fibrillation

Atrial Fibrillation patients often search for unbiased information and guidance about medicines and drug therapy treatments. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)

1. Which medications are best to control my Atrial Fibrillation?” “I have a heart condition. What medications work best for me?

2. “Is the “Pill-In-The-Pocket” treatment a cure for A-Fib? When should it be used?”

3. “I take atenolol, a beta-blocker. Will it stop my A-Fib.”

4. I’ve been on amiodarone for over a year. It works for me and keeps me out of A-Fib. But I’m worried about the toxic side effects. What should I do?”

5. Should everyone who has A-Fib be on a blood thinner like warfarin (Coumadin)?”

6. Which is the better anticoagulant to prevent stroke—warfarin (Coumadin) or aspirin?

7. What’s the difference between warfarin and Coumadin?

8. I’m on warfarin. Can I also take aspirin, since it works differently than warfarin? Wouldn’t that give me more protection from an A-Fib (ischemic) stroke?

9. “What are my chances of getting an A-Fib stroke?

10. “I’m worried about having to take the blood thinner warfarin (brand name Coumadin). If I cut myself, do I risk bleeding to death?

11. “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?” UPDATED

12. “The A-Fib.com web site claims that an A-Fib stroke is often worse than other causes of stroke. Why is that? If a clot causes a stroke, what difference does it make if it comes from A-Fib or other causes? Isn’t the damage the same?

13. “I just had an Electrical Cardioversion. My doctor wants me to stay on Coumadin for at least one month. Why is that required? They mentioned something about a “stunned atrium.” What is that?

14. Are natural blood thinners for blood clot treatment as good as prescription blood thinners like warfarin?”

15. “How long do I have to be in A-Fib before I develop a clot and have a stroke?

16. I have to be on aspirin for stroke prevention. Which is better—the low-dose baby aspirin (81 mg) or a high dose (325 mg)? Should I take the immediate-release (uncoated) or the enteric-coated aspirin?

17. I don’t want to be on blood thinners for the rest of my life. I’ve had a successful catheter ablation and am no longer in A-Fib. But my doctor says I need to be on a blood thinner. I’ve been told that, even after a successful catheter ablation, I could still have “silent” A-Fib—A-Fib episodes that I’m not aware of.  Is there anything I can do to get off of blood thinners?

18. “My last cardiologist had me on Pradaxa. My new cardiologist wants me to switch to Eliquis. Is Eliquis easier to deal with if bleeding occurs?

19. “My doctor told me about the Tikosyn drug option that I want to consider in getting rid of my 5-month-old persistent A-Fib. That seems like something that should be discussed on your web site.

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

21. “I”ve read about a new anticoagulant, edoxaban, as an alternative to warfarin (Coumadin) for reducing risk of stroke. For A-Fib patients, how does it compare to warfarin? Should I consider edoxaban instead of the other NOACs?

22. “Do you have information about Hormone Replacement Therapy (HRT) and if it might help or hinder my atrial fibrillation?

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

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?

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

Last updated: Wednesday, May 25, 2016

Back to FAQs by Patients with Atrial Fibrillation

FAQs A-Fib Drug Therapy: Is Eliquis Better if Bleeding Starts?

 FAQs A-Fib Drug Therapy: Eliquis

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

18. My last cardiologist had me on the anticoagulant Pradaxa. My new cardiologist wants me to switch to Eliquis. Is Eliquis easier to deal with if bleeding occurs?”

There have been horrendous stories of people on Pradaxa (dabigatran) bleeding to death in the ER even from minor cuts while the ER doctors and staff can only watch as they die. Unlike for warfarin, there is no reversal agent or antidote for Pradaxa. The other NOACs, Eliquis and Xarelto, also don’t have reversal agents. But anecdotally they don’t seem to have as many bleeding deaths associated with them.

Added October 26, 2015: The FDA granted “accelerated approval” to Praxbind®, a reversal agent (antidote) to Pradaxa®. Praxbind is given intravenously to patients who have uncontrolled bleeding or require emergency surgery. In clinical trials, 5gs of Praxbind (idarucizumab) reversed the anticoagulant effect of Pradaxa within minutes (which is significantly faster than the current antidotes for warfarin).

Eliquis Safer

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 (1=lowest risk, 100=highest risk). In comparison, Coumadin (warfarin) had a score of 67.57. Pradaxa (dabigatran) had a score of 67.15, Xarelto (rivaroxaban) 67.08.

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 Coumadin (warfarin) 50%.

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

For more about the new anticoagulants, see Warfarin vs. Pradaxa and the Other New Anticoagulants.

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.

References

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.

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.

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