Here are a few internet news stories related to atrial fibrillation. In the future I’ll try to update more frequently so I don’t end up with four topics in one blog entry.
Overall, the increase in risk of heart attack was about 70% in AF patients, even after accounting for other cardiovascular disease risk factors, such as hypertension, high cholesterol, body mass index, and history of stroke and vascular disease. However, when the researchers looked at subgroups, they found that increased risk of heart attack was more than doubled in women and African Americans with AF—but less than 50% for men and whites with AF.
I’m not sure what to say about this – hopefully runners with atrial fibrillation (who hopefully also have other heart healthy lifestyle choices – like a healthy diet, not smoking, reasonable body weight) will do better than the general population. One bit of good news – the blood thinners a fib patients take to prevent stroke also seem to help prevent heart attacks.
“Novel” anticoagulants refers to the newer prescription anticoagulants that are used as an alternative to Coumadin (warfarin). Specifically: Pradaxa (which is the one I currently take), Xarelto, and Eliquis.
I can tell you that as a clinician there are not many things more frustrating than prescribing medications for people who are on Coumadin – it seems like it interacts with everything! One of the great things about the newer anticoagulants is that they have less drug interactions – but they still do have potential drug interactions.
Please click on the link to see tables for drug interactions involving Pradaxa (Dabigatran), Xarelto (Rivaroxaban), and Eliquis (Apixaban).
Obviously all of the novel anticoagulants can interact with any other drug that is *ALSO* an anticoagulant – like Plavix or aspirin. Keep in mind that this includes NSAIDs like Alleve (naproxen), Motrin (ibuprofen), etc.
Personally, I completely avoid taking ibuprofen and naproxen – but every once in a while (like after a brutal long run) I will take a Celebrex. Tylenol (Acetaminophen) is fine – no interactions with the anticoagulants (although it has its own issues).
By the way – if you read the article and see a possible drug interaction please don’t stop taking any of your meds – but contact your own doctor immediately for advice.
A recent study has shown that Coumadin (warfarin) actually increases the risk of stroke for people in atrial fibrillation during the FIRST THIRTY DAYS of warfarin therapy. That’s just the first thirty days – the idea is to prevent having a stroke, and that’s what taking Coumadin does.
This finding does not suggest that anything will change – doctors are still going to put people on warfarin to prevent stroke. They just have to get through the first thirty days!
If you are on warfarin and you read this article – please do not stop taking your medication.
Finally – the FDA has not yet approved the Watchman left atrial appendage closure device by Boston Scientific – but it has given a “vote of confidence.” It appears that this gadget, which is implanted in the left atrium to prevent the formation of the clots that cause strokes, may be approved by the FDA for the US market late this year. The majority of the panel agreed that the Watchman was equivalent to standard treatment with warfarin, but it hasn’t been compared to the new novel anticoagulants (see above).
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Could you address the issue of bleeding when using Pradaxa. What do you do for minor bleeding like cutting yourself while shaving or getting a small nick from a pair of scissors or a knife.
The major drawback of taking an anticoagulant whether it is aspirin, coumadin, Pradaxa, Xarelto, etc. is increased bleeding – especially hitting your head and bleeding into the brain, or bleeding from the GI tract (a bleeding ulcer for example) – both of these can be fatal. (The advantage is decreasing the chance of stroke – also possibly fatal and debilitating.)
Personally, I have not noticed much difference in bleeding from minor cuts and scratches after being on Pradaxa for over a year. I’ve crashed on my mountain bike and have fallen trail running a few times and the bleeding from “road rash” (trail rash?) seems normal. I have noticed increased bruising, however.
Years ago – for most of my younger life – I was plagued by nosebleeds – often quite bloody. Since I’ve been on Pradaxa I’ve learned to avoid blowing my nose too forcefully and keep my fingers out of there – haven’t had a single nosebleed.
To answer your question – I apply direct pressure for sixty seconds. That seems like a long time when you’re doing it but it usually works. If not try another sixty second. The bleeding from a minor cut will stop but it will just take a little longer.
For nosebleeds – pinch the nose firmly just above the nostrils, lean forward, hold for sixty seconds. Repeat if necessary.
That’s what I do.