I can come off Warfarin!

[Phaedra]

Hi folks, well i've just seen Consultant for my post ablation check up, and he says i can stop Warfarin, no tailing off required. Am on 8mg daily, last INR 1.8. Although delighted, is it really safe just to stop it abruptly? My stroke risk is quite low as i am 62 not diabetic and have low BP. The ablation (4 months ago) seems to have been successful! Any thoughts would be welcome.

[BobD Volunteer]

It is a personal choice really. Many EPs think that the stroke risk continues even after successful ablation and I chose to continue even though I have not had AF for seven years. The thinking is that the changes that AF makes/made in the atrium can still allow clots to form. I stress that this is not a universal opinion and my own EP told me to stop. It was only discussion with others that made me want to continue. That said My risk stratification is higher than yours as even though my BP is quite low it is controlled by meds so therefore still counts as parts of CHADSVASC. At 70 I therefore have a score of 2. One might argue that because I don't have AF now then CHADSVASC doesn't apply but I would rather not risk that myself. As I say you pays your money an you takes your pick.

Bob

[Phaedra in reply to BobD]

Thanks Bob for your reply, i only started Warfarin in march to prepare for ablation. Before that i spent 5 years with AF and flutter just on aspirin. I didnt need bp meds and refused to take Amioderone!... Flecanide gave me bradycardia.. Just hope i can put it all behind me now, get fit and lose some weight...

[rosyG in reply to Phaedra]

I agree with Bob and you have to choose!1 There was a patient at the Kings Fund today who had had an ablation and come off warfarin but several of the doctors there said they questioned the wisdom of this- it's tricky and I am no expert!!

[DavDug]

Phaedra,

I'm chugging along in sinus rhythm after my second ablation last week with everything crossed. The Diltiazem (Calcium Channel Blocker) has been stopped but I shall continue with the anticoagulant Dabigatran, and that seems to be a common approach from many sources. Something that you might look at instead of the warfarin?

Well done you in sinus rhythm. Keep it up. Dave.

[RetaMay]

Your question has compelled me to leave my first reply. I was 12 months AF free (only 2 episodes per year) and doctor said it was OK to go off my 5mg Warfarin. 4 days later big AF, ambulance, etc. Friend on 10mg went off cold turkey and ended up with clot within a week.

Could be a coincidence but I have read a fair bit about Warfarin rebound. I suggest you do some reading on it first.

[Phaedra in reply to RetaMay]

Thank you for replying everyone... Some scary stories! I'm planning to go back to natural ways like taking garlic capsules, cranberry juice etc... All the things that supposedly enhance effects of warfarin. Consultant is top man at well know heart institute so i'm hoping i can trust him!

[teach2learn in reply to Phaedra]

My understanding is that fish oil has anticoagulant properties as well. I was allowed to stop Eliquis after successful ablation. So far so good a year later.

[PeterWh in reply to teach2learn]

This is not specifically addressed to you but comments for everyone's benefit so that an informed choice is made.

There are two steps in this decision.

The first is that the consultant says [in their view] that it is OK to stop taking anticoagulation.

The second step is that you CHOOSE whether or not you want to continue taking anticoagulants or to stop them.

There are many others on here (including BobD) who choose to continue taking anticoagulants for peace of mind and to reduce further the chance of a stroke. Also don't forget that some, even after ablations, end up reverting into AF and this may be unsymptomatic. I am in persistent AF so anticoags is a no brainer.

I have no medical qualifications.

[Wilol in reply to Phaedra]

Might try fish oil and one aspirin per day; that is what I am going to put myself on post ablation in 3 months.

[Hidden in reply to Phaedra]

Phaedra: I've also read a lot about the anticoag effects of ginger. There are loads of other benefits from it as well. I read of how one chap keeps his vagally-mediated PAF under complete control with ginger. I'm sure it wouldn't do that for everyone but it sounds good, doesn't it? Very good luck and best wishes with your healthy lifestyle choice.

[Hidden]

I stopped 8 weeks after starting and 4 weeks post ablation. No worries at all. I do have to take pla ix for the rest of my life tho.

[Phaedra in reply to Hidden]

Hi and thank you, what is it you take? Havent heard of that one

[Hidden in reply to Phaedra]

Plavix, sorry I am from Australia and we have similar but different ways of being treated post ablation, because of the time I was in AF, I was deemed as high risk for stroke, plavix is one of the new drugs they use in place of warfarin. The down side to the drug is that they cannot reverse any beeding whereas warfarin can be reversed with vitamin k injections. After weighing up my options I take the plavix because I could never get the warfarin high enough

[Therealsue]

Hi Phaedra. I'm so pleased to hear that you've had a successful ablation. Like you, I only started on warfarin to prepare for the ablation, and my EP wanted me on it for 4-6 months post-ablation. I'm 59 with no other health risks and my ablation (14 months down the line) is still working. I had a conversation about the anticoags and the on-going risk factors with my EP and although I don't really need them, he was happy for me to keep taking them as I feel happier doing so. I decided though to stop warfarin and to try one of the NOACs - rivaroxaban in my case - and my EP wrote to my GP requesting that I go on to this (it's quite expensive and doesn't technically have an antidote although all of the NOACS have much shorter half-lives than warfarin). That was 6 months ago. I find it suits me perfectly. I don't have to worry about diet and only have to have an annual liver and kidney function test. Like Bob says though, in a case where you have a low risk factors, it comes down to individual choice. Some of us can't wait to be rid of the drugs and some are happier sticking with them.

I'm sure you'll make the right decision for you and I wish you all the very best. Sue.

[Phaedra]

Thank you Sue, glad you have found things that work for you and are doing well. Guess i've always had a fear of bleeding to death! I have worked with stroke survivors and it's obviously an awful thing to have, but there's no family history of it so that reassures me somewhat. Take care.

[pip_pip]

Hi.

There is no trailing off from Warfarin. You either take it or you don't.

Phil

[CDreamer]

When considering to take or not to take I think it useful to consider the issue wholistic ally. Would you feel better psychologically taking it or not taking it?

All drugs will have an effect on our bodies and many of the NOACS are effective AND quite hard on the liver and kidneys, hence requiring the liver/kidney function tests. I am coming up to 65 - AF free since Mar2014 after 2 ablations. I came off Dabigatran a few weeks after, my EP was happy for me to do so, particularly as I was starting on immune suppressants for another condition, also very hard on liver/kidney function long term so I have blood tests every 4-5 weeks.

There has to be a balance of risk:benefit for your individual circumstances. Whatever you decide - make it as an informed decision as possible.

Best wishes.

[rosyG in reply to CDreamer]

CDreamer- I'm no expert but I don't think the NOACS are hard on the kidney and liver- I think the tests are to make sure both liver and kidneys are working effectively as if they were not they would not eliminate the NOAC so dangerous levels would build up and we would be over coagulated ??

[CDreamer in reply to rosyG]

Exactly - it is the liver and kidneys that help eliminate the substances - therefore they have to work harder - depending upon lifestyle, diet & other drugs taken will also influence how effective waste and toxins are eliminated. Over time that will inevitably take a toll, especially if you are taking other drugs.

[Julie10051]

Hi as one on the other side ,preparing for ablation and just started on Warfarin your discussion is very enlightening, not for the first time I am very glad that I have found you like hearted souls, it means such a lot to know there are others with the same or similar thoughts and fears.

[Mike11]

I'd be very very careful on this. Indeed I think it might be better if everyone over 55 was on some form of anti-coagulant or blood thinner as most are on statins now. You could just reduce the dosage and aim for a lower INR.

A friend had a successful stenting, then came off warfarin and within a week suffered a full heart attack. Of course we don't know if the warfarin would have stopped this or not, but .....

[Hidden in reply to Mike11]

How strange that you think everyone over 55 should be anticoagulated! So create a bleeding risk when there's no increased risk to start with?

[Mike11 in reply to Hidden]

Obviously it would need monitoring for early signs of bleeding, and I did say aim for a lower INR, but the fact remains that deaths from heart disease and strokes are now the most preventable cause of death.

[Hidden in reply to Mike11]

Is it not rather more likely that your poor friend had a heart attack because of his heart disease, rather than lack of warfarin? Of course, no-one can be sure but the stenting obviously was not successful.

[Mike11 in reply to Hidden]

No - the angiogram showed quite clearly what had happened. As soon as the warfarin had stopped a clot started forming around the stent even though it had been installed two years earlier.

"Anti-coagulants are for life, not just for Christmas"

[Hidden in reply to Mike11]

In that case, sounds like absolute negligence and lack of knowledge on behalf of the cardiologist who surely should know if this happens with stents.

[Mike11 in reply to Hidden]

Now there I might tend to agree with you, but we have to accept all medical professionals can only do their best.

This thread began with someone being told to come off their anti-coagulant and I'm sure this consultant also thinks it for the best but what if the person did suffer a subsequent stroke ?

[Mike11]

I don't think that's a correct assessment of current medical opinion. Most consultants believe all males over 55 should be on a daily aspirin if they have no problems with it. But of course many do and anti-coagulants are an alternative way of achieving similar though not identical results, and can be monitored far more accurately with the INR test.

[Hidden in reply to Mike11]

But aspirin is very different from warfarin. Yes, it has anti-clotting properties but doesn't NEED monitoring. With aspirin, there's just a tiny risk of bleeding in the odd unfortunate person, Warfarin has a substantial risk. After all, we take 2-3 aspirins for a headache. 3 aspirins = 900 mg; 1 baby aspirin = 75 mg. So a normal headache dose is 12 times the generally recommended anti-clotting dose. Haven't heard of too many people bleeding to death with the aspirin though. Even today, I believe there are some conditions where people are given several aspirins every day. Doesn't suit Big Pharma to put this about. They want people to think that an aspirin will kill them. They want people to use the sledgehammer drugs 'cos that's what's profitable.

[Mike11 in reply to Hidden]

Warfarin is slightly cheaper that aspirin so cost is a non-argument. Indeed I doubt pharma companies make much of a profit on either.

And many people do have problems with aspirin causing stomach bleeding, hence the development of clopidogeral but even that often needs a quite expensive prazole drug prescribed with it.

[Hidden in reply to Mike11]

Yes, warfarin is probably cheap now. But I didn't say that Pharma want you to take warfarin. I said they want you to take the sledgehammer drugs -warfarin is one such, but so are the new ones.

[Mike11 in reply to Hidden]

Please keep to the medical debate of the thread and not make hypothetical political statements about the companies supplying drugs. The thread is about staying on warfarin or not, and made no mention of NOACs.

[Hidden in reply to Mike11]

Mike: Then please do not make hypothetical statements and invent data that you can't back up. "Many people" having bleeding is not a scientific statement and who put you in charge of the thread anyway?

[Hidden in reply to Mike11]

I have known countless people who have taken aspirin. I have not come across a bleeder. How many have you known? Yet aspirin used to be used in great quantities. I myself take a lot for arthritis, since prescription arthritis drugs have an appalling record for safety. Aspirin is also said to prevent various types of cancer, bowel cancer for one. And yet you really believe that "many people" have a problem with a quarter tablet of aspirin?

[Mike11 in reply to Hidden]

I do - hence I am on clopidogeral and lanzoprazole.

[Hidden in reply to Mike11]

Mike: One swallow does not make a summer. You are one person, not "many". You are being very unscientific.

[Mike11 in reply to Hidden]

And it took an expensive camera down the throat procedure to see the damage aspirin was doing to my stomach.

[Hidden in reply to Mike11]

Mike: You accept my view then - that clopidogrel causes bleeding if you don't take the lanzoprazole with it to protect your stomach. We are in agreement. Did you take lanzoprazole with the aspirin? If you did, then it didn't work, did it? You cannot say aspirin is worse than clopidogrel unless you took the lanzoprazole with it and still got the stomach damage. Did you take the lanzoprazole with your aspirin?

[Mike11 in reply to Hidden]

Lanzoprazole is contra-indicated with aspirin without monitoring for triggering of breathing problems so of course not.

[Hidden in reply to Mike11]

xpil.medicines.org.uk/ViewP...

Hi Mike

Do you have a reference re the breathing problems and contraindication to taking aspirin with lanzoprazole? The link I have posted above specifically lists lanzoprazole as a adjuvant therapy to protect the stomach from NSAIs, specifically including aspirin.

[PeterWh]

I can't resist stating the obvious old adage.

One man's meat is another man's poison (or woman!!).