Warfarin Withdrawal in Patient’s Awaiting Surgery Increases the Risk for Stroke

picasso

Last April Dr. Adnan I. Qureshi reported on research, at the 67th Annual Meeting of the American Academy of Neurology, that has shown that atrial fibrillation patient’s who are taken off of warfarin for surgical procedures have an increased likelihood of having a stroke.

Subjects included in the analysis had atrial fibrillation plus at least one additional risk factor for stroke or death: age >65 years, systemic hypertension, diabetes, congestive heart failure, transient ischemic attack, prior stroke, left atrium diameter 50+ mm, left ventricular fractional shortening <25%, or left ventricular ejection fraction <40%.

Specifically atrial fibrillation patients who discontinued warfarin for surgical procedures had a 1.1% rate of stroke while atrial fibrillation patients who remained on warfarin had a 0.2% rate of stroke.

Read more here:

Warfarin withdrawal in atrial fibrillation patients awaiting surgery dramatically ups stroke risk

Well, this seems like one of those articles where you read the headline and think, “Duh!” Like the article about how obese children have a higher chance of hypertension – No kidding?

Obviously if you are on a medication, in this case warfarin, to prevent having a stroke, and you stop taking the medication, well, you have an increase likelihood of having a stroke. I think everybody suspected this – but what we see here is that the rate of stroke increases five-fold. Wow – that seems incredible!

This article reinforces my strong belief that strict compliance with taking my medications, especially warfarin, is a good idea!

As far as surgery is concerned, clearly, if you need to have the surgery and you need to go off the warfarin, then so be it. The article didn’t mention anything about bridging with Lovenox. You might want to ask your surgeon about that. And also – consider how important the surgery is to your general health. Is the surgery truly necessary? Is it worth risking a stroke?

La Muerte Tocando Guitarra

Advertisements

Persistent and Intermittent Atrial Fibrillation

There are different types of atrial fibrillation. They’re all the same arrhythmia, the main difference is duration. Some people have intermittent (or paroxysmal) atrial fibrillation. This means that the individual goes into atrial fibrillation for a short period of time – maybe a couple minutes, maybe twenty-four hours, but less than one week. Most of the descriptions of atrial fibrillation I have found on the web describe paroxysmal atrial fibrillation.

Atrial fibrillation that lasts for longer than seven days is called persistent atrial fibrillation, and atrial fibrillation that lasts for over one year is referred to as long-standing persistent atrial fibrillation or permanent atrial fibrillation.

Regrettably that is the type of atrial fibrillation that I have. I have just “celebrated” my one year anniversary of persistent atrial fibrillation. I miss sinus rhythm.

twentysix

The Best Mile Marker

People who are in sinus rhythm most of the time and go into atrial fibrillation only occasionally are fortunate because they get to be in sinus rhythm most of the time, which is basically the hot set up for any type of endurance sports. The disadvantage is that when these individuals to go into atrial fibrillation the effects are pretty devastating, and more often than not they find themselves on their hands and knees wondering what happened. The other bad news for people with intermittent atrial fibrillation is that it may very well progress into a persistent type atrial fibrillation, and of course there is a risk of having a stroke. So it is important to discuss this and formulate an appropriate treatment plan with your healthcare provider.

The disadvantage of being in persistent, but relatively asymptomatic, atrial fibrillation is that you have a performance penalty all the time; but the advantage is that you stabilize, at least I have, and are able to participate in your sport, albeit at a slower pace. It never gets much worse or much better.

Maybe there are some athletes out there who are in persistent atrial fibrillation who are unable to continue to participate in running, mountain biking, etc. if so I would encourage you to share your stories in the comments section.

All unable to discuss at this point in time is my own personal experience.

finish line

Bizz Johnson Marathon – I think I’ve done this one five times

Atrial Fibrillation and Performance

I was under the impression that atrial fibrillation had not actually affected my pace that much, and that my slowing down was primarily a consequence of normal aging. I am fifty-three years old now and certainly can’t run at the same pace that I was able to when I was forty. One of my friends, who is approximately the same age as me, and also an endurance athlete, says that “every year is like a dog year now as far as performance is concerned.” In other words, for every year you get older you get seven years slower.

ringo racer

Every Year is Definitely a Dog Year for Ringo

I have always been a Clydesdale runner and at over 6’3″ in height I have spent the last ten years around 235 pounds. I decided when I went into persistent atrial fibrillation that it was finally time to lose the extra weight and have successfully kept my weight around 195 pounds for the past year primarily by means of a vegetarian/pretty much vegan diet. Conventional wisdom states that if you lose 10 pounds you get approximately 30 seconds per mile faster as far as your running pace is concerned. So I figured a 40 pound weight loss combined with persistent atrial fibrillation would mean more or less breaking even as far as pace is concerned.

I discovered that this is certainly not the case.

Last Fall I had a procedure called cardioversion, wherein the heart is zapped back into normal sinus rhythm, and I remained in sinus rhythm for thirty-three days before going back into persistent atrial fibrillation. My electrophysiologist thought it would be worthwhile to try cardioversion with a “one strike and you’re out” philosophy – in other words nobody really expected that I would stay in sinus rhythm, but it would be worth a try.

Video of a Man (not me) Being Cardioverted

It was during those thirty-three days that I realized that atrial fibrillation really does slow me down more than I had thought. Mountain bike rides that were taking me one hour and fifteen minutes in atrial fibrillation, where taking the fifty-five minutes in sinus rhythm – even though I did the exact same trails. I also found I was doing my training runs at a pace approximately 1 to 1 1/2 minutes per mile faster in sinus rhythm. This is a significant difference. When I finally went back into atrial fibrillation I had slowed down again.

OLYMPUS DIGITAL CAMERA

Running With A Fib Feels Like Running in a Foot of Snow

Being in sinus rhythm, by the way, was sort of uncomfortable for me. I am more or less asymptomatic when I am in atrial fibrillation as far as how I actually feel, but my sinus rhythm sucks. If I feel my pulse, while in atrial fibrillation, obviously, I can feel that it is irregular, but I don’t feel all that bad except that certain times – such as getting up to run across room to answer the phone, or right after I get done with a run. (More on that later.) But when I went into sinus rhythm I realized that my sinus rhythm really isn’t that great to begin with – I was having PVCs or PACs about every fifth or sixth beat, and these are noticeably uncomfortable.