dabigatran versus warfarin in patients with atrial fibrillation

Why are you taking Warfarin? Do you suffer for atrial fibrillation? What is causing your doctor to be concerned about clot formation in your blood?

Another class of drugs called ‘spironolactone antagonists’ such as Aldactone or Eplerenone can be useful but are often reserved for more highly symptomatic patients. Both ACE inhibitors and spironolactone antagonists need to be used with caution in patients with kidney disease due to the risk of high potassium ‘hyperkalemia’.

I am a 70 year old male who was diagnosed with Lone Atrial Fibrillation in June of this year. My General Practitioner at the time immediately put me on 25 mg of Metoprolol to be taken twice a day in addition to Warfarin which I took once a day. However, when I visited the Cardiologist for the first time last Wednesday he informed me that neither he nor any of the other Cardiologists wanted me to continue taking Warfarin, and that they wanted me to switch over to one 81 mg baby aspirin a day.

He has never had any other symptoms of A-fib, has never been diagnosed with any other indicators of heart disease, and his BP is well controlled with drugs. Unfortunately, he has virtually no strength in his legs, constant leg-hip-back pain, urinary and bowel incontinence, and very limited energy.

In addition, an everyday heart rate of 150 is hard work for the heart, and (untreated) atrial flutter can, similar to atrial fibrillation, cause blood clots over time. I think most doctors prefers their patients have atrial fibrillation instead of atrial flutter, as this rhythm is easier to control. If you have atrial flutter, the heart rate will increase in steps with increasing exercise levels, as the blocking is less and less.

I was lucky not to have anyAFib (or at least symptoms) until in my mid 50s... and was able to stay in NSR most of the time using electrocardioversion (no ablation, but I did have a mini maze when they had my heart open for valve repair) and drugs. I have been in permanent AFib since the spring of 2007.

It is broadly approved for many uses, including treatment of DVT and of atrial fibrillation. The difficulties with warfarin are much as you stated (dietary restrictions limiting Vitamin K intake, frequent monitoring required, and possibly frequent dosage adjustments). The advantages are that it is incredibly cheap (dollars a month, rather than $5-10/day for newer drugs), and reversible relatively quickly if necessary (with fresh frozen plasma infusion or Vitamin K administration).

Five clinical trials evaluated the effects of warfarin in patients with non-valvular atrial fibrillation. Meta-analysis findings of these studies revealed that the effects of warfarin in reducing thromboembolic events including stroke were similar at either moderately high INR (2.0-4.5) or low INR (1.4-3.0). There was a significant reduction in minor bleeds at the low INR. There are no adequate and well-controlled studies in populations with atrial fibrillation and valvular heart disease.

Blood clots can be caused by heart irregularities, such as atrial fibrillation (I have that) and atrial flutter. There are other causes which I can not list. I'd suggest that she talk with her cardiologist about ongoing use of warfarin just to guard against future clots, clots are very dangerous and are to be avoided if at all possible. I take and tolerate well 5 mg of Warfarin daily.

Antiarrhythmic drugs (like Flecainide) is used to avoid atrial fibrillation from happening. Rate control means to accept to be in atrial fibrillation, but keeping the heart rate between 60 and 100 bpm, even with the arrhythmia. For that use, calcium blockers or beta blockers are the most effective. Sorry if this information was unnecessary - I just wanted to explain. Take care.

Most of them are related to structural changes in the left atrium (dilatation or hypertrophy) which tends to worsen BY having atrial fibrillation, which is why atrial fibrillation starts with brief episodes and ends up as a permanent condition. Hypertension seems to be a major risk factor. There are also a lot of non-cardiac causes, such as electrolyte imbalances (calcium especially), excess catecholamines, hyper/hypothyroidism, stimulants, drugs, alcohol.

Eliquis which belongs to a class of drugs called Factor Xa inhibitors is a new generation oral anticoagulant / blood thinning drug and is expected to replace warfarin the current gold standard treatment for stroke prevention in atrial fibrillation. The clinical data on Eliquis in atrial fibrillation is most impressive, when compared to Xarelto or Pradaxa.

Warfarin or Coumadin is prescribed to prevent strokes arising from atrial fibrillation and DVTs forming in the legs usually. Blood clots that form in veins (deep vein thrombosis, pulmonary embolism) are mainly made up of clotting proteins and platelets do not play a significant role in venous clots. Coumadin or warfarin is an effective blood thinner that prevens the production of clotting factors in the liver.

Rate control medication to control the heart rate Rhythm control medication, sometimes called drug cardioversion, to put the heart back into normal sinus rhythm Your doctor will decide which rhythm control drug is best for you based on the type of atrial fibrillation you have and your medical history, including the presence or absence of other existing heart disease.

The first step in managing atrial fibrillation is typically to treat it with medications, starting with a rate control drug to slow the heart rate in combination with anticoagulation by a blood thinner to reduce the risk of stroke.

I didn't see that you have had an EKG showing this is atrial fibrillation versus another heart rhythm. Atrial fibrillation that starts during sleep or as you start to fall asleep is usually vagal atrial fibrillation. It also occurs when you swallow cold things like ice cream. This can be treated with medications like flecainide or propafenone.

Hello... Abnormalities in the heart's structure are the most common causes of atrial fibrillation. Diseases affecting the heart's valves or pumping system also are likely causes, as is long-term high blood pressure. However, about a third of the people who have atrial fibrillation don't have underlying heart disease. In them, the cause is often unknown.

The most common anticoagulation drug prescribed after heart valve surgery is warfarin (Coumadin). The newer blood thinners are apixaban and dabigatran, also known as Pradaxa and are expensive. The main concern is that specific antidotes for bleeding are available for warfarin but not yet developed for the new drugs. Hope this helped and do keep us posted.

There are guidelines with American College of Chest Physicians that have proposed guidelines for antithrombotic prophylaxis in patients with different risk factors, and it recommends that if the risk for thromboembolism is low, warfarin therapy can be withheld for 4-5 days before the procedure without bridging. Your interest with the medication and a prosthetic heart valves pose a particular problem.

It is highly effective at antagonising the vitamin K dependent clotting pathway and is used for a wide range of diseases and conditions including atrial fibrillation and heart valve replacement. Warfarin has a narrow therapeutic window and wide inter-individual variability making dosing problematic. Under-anticoagulation can result in thrombosis but over-anticoagulation can result in dangerous bleeding episodes.

Hi gynine, I also have been diagnosed with atrial flutter and atrial fibrillation. I was on flecanaide since Sept--but that didn't seem to work--I had 3 'episodes' since that time with very rapid HR (240) for extended period of time, etc.. I had an ablation a few weeks ago and now am on Rhythmol. Were you just recently diagnosed? I think sometimes it takes a while to see what works since each case can be so different.

How does one evaluate the risk of clot formation without blood thinners versus the risk of bleeding in the brain when on blood thinners? A neurosurgeon told me that blood thinners were definitely out. Is an eventual stroke then my only option?

Hope this is of some use, if I missed your point/need post a follow up. Perhaps others will pitch in with more help/experience.

Very mild global right ventricular hypokinesis without focal wall motion abnormalities. EP study showed nonsustained atrial tachycardia versus atrial flutter, as well as atrial fibrillation. Positive for inducible nonsustained monomorphic ventricular tachycardia as well as inducible sustained ventricular tachycardia and ventricular fibrillation requiring defibrillation therpapy. 34-year old female. History of one syncopal episode and one pre-syncopal episode prior to diagnosis.

Dabigatran versus warfarin in patients with atrial fibrillation

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