New to AF, worried about anticoagulants

[Vanna-C]

Hi all, I was diagnosed with AF last week, after having what I thought was a really bad panic attack. Two days later my OH took me to the walk-in centre. It turned out that my heart rate was between 176 and 218, and they sent me off to A&E.

Because I didn't get help early enough, it wasn't possible to shock me back into rhythm, but eventually they managed to do it chemically.

I was sent home with Bisoprolol 2.5mg, and Flecainide 50mg as pill in pocket. Yesterday I had to see my GP, and was prescribed Rivaroxaban.

One of the things that worries me, is could this have been just an odd event, perhaps I might never have another episode, do I really need to take all these tablets?

My biggest worry is that when my Father was just 4 years older than me (I'm 61 and female) he had a stroke, was prescribed warfarin, and died a few months later from a bleed on his brain.

Am I really walking a line, that has a possibility of a stroke without medication, or a brain haemorrhage with medication? I am taking the Bisoprolol, and no problems so far, but I haven't dared to take the anticoagulant yet.

If I did take it, would I have to take it every day?

[BobD Volunteer]

Anticoagulation is very important if you have AF as this makes you five times more likely to have a stroke. Thousands. no millions of people across the world take anticoagulants and yes some may die but then many more would die if they did not. Worse may be a stroke which leaves you in a near vegetative state since AF related strokes account for 80% of the least recoverable ones.

Rivaroxaban has less chance of causing inter-cranial bleeding than warfarin. especially poorly controlled warfarin.

Spontaneous bleeds are very rare and usually need a secondary factor such as high blood pressure or an injury such as a bang on the head.

OK so those are the bald facts but what you really need is to talk to your doctor about your options. Unless you have other medical factors such as BP problems, or other heart related issues, diabetes etc your risk factor according to CHADSVASC is 1 for being female at which point you are optional on anticoagulants although that changes when you reach 65. For more explanation on Chadsvasc go to AF Association website read up on it and do your own risk assessment.

I feel that your GP has your best interest at heart (pardon the pun) but you do need to engage with him on any decision you make after due discussion. Anxiety almost always accompanies AF and a sympathetic GP is vital unless that anxiety is to overshadow everything so don't be afraid to be assertive with him/her.

Will you have other events? Who knows but AF is usually progressive. Many people have AF events which they are not aware of in fact a great number of people only discover their AF after they have the stroke since many are asymptomatic ( they are not aware of their hearts doing odd things). You may be having events while asleep and there are members here who were shocked to discover when wearing an event monitor that they were going into AF so much. They just never knew. You see it is not an easy yes or no answer to you main question.

Go to AF Association. read all you can and then go back and talk and I mean talk to your GP. If they can't or won't help then ask to see a specialist as is your right.

Ask us anything and we will try to help

Bob

[Vanna-C in reply to BobD]

Thanks Bob, that does put things into perspective. My Grandmother did have a stroke which left her totally incapacitated for the last 3 years of her life, and there is no way I would want to end up like that either for myself or the family. I did have a good talk with my GP, but he said that it had to be my decision, -he didn't talk about the devastating stroke risk though.

Just one further question, I take the Bisoprolol at 8 in the morning, but I'm not much of a breakfast person, and I see that Rivaroxaban has to be taken with food, so would be better for me at lunch time. Is it ok to take the tablets at different times, or indeed is it better to take them at different times of the day?

Many thanks again for your informative answer

Vanna

[BobD Volunteer in reply to Vanna-C]

I have no experience of rivaroxaban as I have been a warfarin person for many years with no problems . What I do know is that regardless of what time you take any particular drug it is vital that you take anticoagulants at the same time each day. I doubt it makes much different what that time is so long as it is convenient to you.

One thought re the bisoprolol. I know people are told to take it in the morning but many find the side effects unpleasant but less intrusive if they take it in the evening. Again I have never been on that drug so only reporting others' comments.

[Nickibmibile in reply to BobD]

I take my Bisoprolol tablet with water just before I go to bed at night. In fact I take all my medication at night and so far, fingers crossed, haven't had any problems. Maybe because I sleep through any unpleasant side effects

[PeterWh in reply to Vanna-C]

A few things that I have been told / read about since my formal AF journey started in Sep 14.

With most it is important to take at the same time(s) each day. However there differences and important considerations. For instance quite a number of drugs are designed to be taken in a specific period. Also with most drugs you should not break in half because the potency and effects could be significantly altered since they are coated and the coating is designed to dissolve over a period of time whereas an open end where broken will dissolve more quickly.

Certainly with apixaban I was told same time but within a half hour window either side (eg if 8.00 is selected then between 07:30 to 08:30 and 19:30 to 20:30 but to try and avoid the opposite extreme ends. However I have heard tighter windows mentioned.

With warfarin I was told one or sometimes a two hour window CAN be OK for most due to the reservoir effect.

With Bisoprolol it is specifically designed to be taken in a morning so that it has more effect in reducing heart rate during the day and less effect at night because at night the heart is beating lower and it shouldn't drop too low!!!! Before switching to evening make sure you ask your EP or cardiologist first. I know of someone who had problems with it but they were swapped to a split dose which made it more bearable whilst still getting some of the daytime benefit. I take Bisoprolol and I have found that if I take it in the morning and then go straight out for my daily walk straight away I end up with the heart beating much more rapidly and getting more sweaty than if I take the Bisoprolol and then wait about 1.5 hours.

My GP is very anti taking two of the same tablets if there is a single tablet of the same total dose. For instance when my dose became 5mg of Bisoprolol she said no to taking 2 X 2.5mg so that I used up the 2.5mg ones and again when I was on 7.5mg no to a 5mg and a 2.5mg. This again was because of possibility of different discharge / dissolving rates. When I was on 6.25mg (stepping up and stepping down) she said to take 5mg + 1.25mg because there is no 6.25mg tablet. If it does make a difference my feeling now with hindsight is 3.75mg + 5mg since sizes more similar.

[Hidden]

Suggest you look up Dr Sanjay Gupta's of YorkCardiology.com videos, just watched another good one on strokes - very clear and very informative; if you search here it will probably come up.

[Vanna-C in reply to Hidden]

Thank you, I have watched the video on NOAC's so far, I see there are many more to go.

[Rellim296]

Hello Vanna-C. Much of what you say is all too familiar when I think back three years to when I was leaned upon by everyone except my other half and 'persuaded' very much against my own wishes to take Warfarin. It seemed to me that I was damned if I did and damned if I didn't and if I say it wasn't a happy time, it doesn't really paint the full horrid picture. But nothing terrible happened. I didn't cut myself and bleed uncontrollably, I didn't have a stroke or a bleed. I didn't get on with Warfarin but I do like being on Rivaroxaban and don't have any worries about taking it. I feel it's the right thing for me to do. Yes, it's taken every day and I feel it's giving me protection from stroke. I'd prefer to bleed to death in a serious accident than be seriously debilitated by something that could have been avoided.

When Warfarin was prescribed I didn't fully appreciate the fact that if you get AF you have AF, even if it's an occasional visitor. It is a nasty little trick that the heart learns and, apparently, doesn't forget - even though it can be persuaded, by various methods, to have a poor memory.

The brain bleed thing is a tricky one for you and it does concern me too - but not so much now - I took Warfarin for almost two years and have been on Rivaroxaban for just over a year. I believe Rivaroxaban has a much better record in this direction than Warfarin.

[Vanna-C in reply to Rellim296]

Thank you for that, it is encouraging to hear that others have or had the same concerns, I really was hoping that it was a 'one off' event!

[Rellim296 in reply to Vanna-C]

AF tends not to be a one off thing. I had been having a few isolated events over many years and had had an echocardiogram which revealed enlargement of the left atrium, which is something AFers get. I'd also had an ECG monitor for 7 days which revealed absolutely nothing but normal rhythm and to me it did seem overkill to make me take Warfarin for something that only happened for a short time once in a while. I am grateful to the forum for all the knowledge I've since gained.

[denny-62]

Imperative that you should take the rivaroxaban. Stroke is the biggest risk for you and I have found it to be a very good drug. Don't stop taking it at all unless advised to for a medical procedure.

[Rellim296 in reply to denny-62]

The thing is that it can be really difficult to take something that you feel might be harmful to you and doing so can take away all your sense of wellbeing. It might be the right thing to do but it may not feel that way.

[Judydiane in reply to Rellim296]

I share your feeling about taking a drug that can be so harmful. And i'm always trying to justify going off it (xarelto) but I guess my fear of debilitating stroke scares me even more. Afib can be a tough thing to handle

[Lainie2875]

I was taken off warfarin once for 6 months and suffered an emboli heart attack so I wouldn't dare not take it now

[PeterWh]

Re Denny's comment. If your dentist says to come off Anticoagulation DON'T. NICE rule changes mean you can stay on and if on warfarin INR only has to be below 4.0 !!!! Also many procedures can now be done without stopping Anticoagulation. Last year my ablation was done without even a single dose missed. Also if you do have to stop you should be bridged until the day of the procedure (that's what my heart hospital does and they were unhappy that another stopped warfarin for 4 days to do a lumbar puncture. As I was told that meant no protection for a minister of a week (including the time to get back up to INR) and that period is a higher risk one.

[Vanna-C]

Thanks all for your advice. I took the Rivaroxaban last night with my evening meal, and although I didn't sleep too well, (anxiety rears its head again) I am going to keep on with it.