Yesterday I went to my wonderful practice and saw one of the GPs I haven't seen for some time. She is warm and friendly, approachable and chatty. I had gone to see her about bruising under my toenails just to make sure there was nothing sinister going on there. She wasn't concerned and put the bruises down to my trainers, very long walks and warfarin. We discussed my AF (diagnosed last December, one confirmed episode then and probably the first a few months earlier - none since). To my utter amazement, when she heard I hadn't had any further episodes, she said she couldn't see why I was still on warfarin. I explained that Professor Schilling had advised that I may be having asymptomatic episodes and warfarin should be continued. When she heard the the 24hr ECG showed nothing, (my mistake, I haven't had one) she said that its all a bit belt and braces - let's review that (the warfarin) in six months.
If I didn't have access to this forum I would have been delighted to stop the warfarin immediately. I would appreciate knowing if this has this happened to anyone else.
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irene75359
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Nice to hear you are doing so well. Personally I would suggest that any decision regarding Warfarin be done between you and your cardiac consultant, preferably Electrophysiologist who specialises in heart rhythm. My experience of GPs over 20 years of this condition is that some take liberties with medication which they should not. Mainly because they don't know much about AF etc. Your consultant is right in suggesting there might be underlying episodes.
Keep with the anticoags regardless. And continue being well
I have found that my very excellent electrophysiologist knows a great deal more about atrial fibrillation than my family doctor, or a general cardiologist. There is so much to know. AF has many triggers, has causes involving magnesium and potassium deficiencies, has single nucleotide polymorphism genetic bio maRKERS. ( genetic tendency to get afib.)ETC. iT IS VERY IMPORTANT THAt someone with afib keeps an eye on the diet, rx.'s , supplements etc. It's a bit daunting because too much or too little of certain things can be dangerously harmful.
I am not doing down any GPs here but it is fair to say that many are risk averse where warfarin and anticoagulants is concerned. This is why Britain has one of the lowest rates of at risk patients on anticoags in Europe. 8000 serious stokes a year cold be avoided were that not the case so please don't risk it without discussing with your EP.
Hope this explains better. In Britain there are fewer people who are at risk of stroke from AF actually on anticoagulants than almost every other country in Europe. In other words we are very bad at identifying and anticoagulating people who need to be protected from stroke. In some part this is because GPs are reluctant to prescribe anticoagulants because they apparently fear gastro intestinal bleeding more than stroke in their patients.
It has been estimated that if we were able to change that we could save at least 8000 serious AF related strokes a year.
Bob..find your answer interesting in that my GP must think on these lines but I am now on Wafarin 3mg but also on lansoprazole which is supposed to help stomach ?
Proton pump inhibitors such as lanzoprazole can actually cause more problems than help in some cases. The sphincter which allows food down from the stomach to the gut needs an acid content to open so stopping acid can mean that food is retained in the stomach for too long and can result in the very reflux it is aimed to stop. I found this out having been prescribed that drug myself only to find that if anything my stomach irritation was worse.
By the way the actual amount of warfarin you take is of no importance. What matters is your INR. 3mg is quite a small dose . I take 4.5 but I know of people up on 15 or even 18 plus.
Thank you Bob. I have tried to come off Lansoprozole several times but get massive stomach pain and bowel problems so GP said stay with it. My INR reading is fairly consistent between 2.4 and 2.8 only varied when I was given by a locom Ibroprofen and co codimal for a knee problem...which I regret to say means a knee replacement...but just managing at present with the drug not the Ibuprofen gel. We get one thing under control then there's another...it's called getting old I suppose.
As an aside, when I was diagnosed with paroxysmal AF in Jan 2010 I was forbidden any sort of pain relief by my Cardiac Consultant except for Co-Codomol 30/500 (prescription grade here in UK). Last Nov I had a partial knee replacement and this was my sole pain relief. Hospital tried me on some sort of liquid morphine which didn't touch the pain, then tried Tramadol, - ditto - , then back to Co-Codomol. Job done. I am also on Warfarin but came off it prior to knee surgery and during surgery it was replaced with a bridging anticoagulant - Fragmin. Then after surgery back onto Warfarin. no problems !
Not what I said Eliza. Britain is very BAD at doing it. Yes I am in England and ashamed of these statistics. So many unnecessary strokes happening in UK because doctors are not identifying and anticoagulating those at risk. In other words fewer at risk patients on anticoagulation.
All I can say is that I have had AF for 13 years and for most of that time, no symptoms, either because of drugs or ablation for most of that 13 year period. My EP highly recommends that I was anti-coagulated throughout and now for life (probably). I never take notice of any advice from anyone else, except on here as appropriate. And I have no history of stroke risk, or high blood pressure, a CHADS score of zero till I reached 65 last year.
It sounds like things have been going well for you as far as the AF goes.
A negative 24 hour ECG (or for that matter a 7 day one) would not mean there's no AF, merely than in that day or week it didn't happen and little episodes that don't get noticed are not occurring.
Although it may be dormant, AF doesn't go away, so if you would welcome the opportunity to give up warfarin, why not consider a NOAC?
My thoughts exactly. However I manage fine on warfarin, it is just that seven months ago I took no drugs whatsoever and I would have welcomed the chance to return to that.
Personally I wouldn't stop even if professor schilling said it should be OK to stop. Note that medics rarely give definite things like this but qualify by using words like should or probably so as there is a let out.
In summary from what I have read there is no definitive study nor is there likely to be in the next few years.
There is not only a lack of knowledge by GPs re Anticoagulation but also by many other Drs and consultants. A deputy registrar at A&E said to me you shouldn't be on warfarin as you are only 61 but hadn't gone through the whys and wherefore nor my notes and not everything was in my notes as first time at that hospital. I enlightened him.
My EP consultant is directly under professor schilling so his line on definite Anticoagulation is more likely than not. However I am also under a heart valve consultant and his cardiologist registrar was very definite that Anticoagulation was a must but also if it needed to be stopped for a procedure then bridging was a must so when he arranged for an angiogram I had to stop warfarin 5 days before but that 48 hours I had to inject myself with clexane for three days.
I agree with BobD's comment about the UK being bad on Anticoagulation and that is in various reports / studies. How do we get medics to sit up and do?
Professor Schilling was happy for me to stop the bisoprolol, greatly reassured me about AF, BUT was quite definite about continuing anticoagulation. I am sticking with that!
I had gathered that you were (correctly in my view) sticking with that and I was only making the point that no matter what was said I will / would continue on anticoagulation for life to reduce the stroke risk.
Incidentally (for the benefit of others) I think it may have been Professor Schilling who made the point that once someone has had AF then even if they never had symptomatic AF nor asymptomatic AF again that they were had a higher risk of a stroke to a normal person (and that this was double?).
Unfortunately some EPs, Cardiologists and other medics do not keep up to date (and with so much information and so much changing quite quickly it is very difficult for them to do) especially with respect to anticoagulation. Also the concept that a person can have symptomatic and asymptomatic AF or have it in their sleep when their HR drops.
I think rellin is right. My EP also told me when you have AF, you have it. It cannot be cured, only managed. So the ablation worked for me, because it stopped the obvious extra electrical activity at the entrance to the left ventricle of the pulmonary veins--like putting traffic cones around a highway accident. BUT then we still have all the other causes that cannot be surgically corrected.. But if I consume any of the triggers I go out of NSR,(triggers for me: alcoholic beverages, quinolone antibiotics, asthma spray drugs, epinephrine - have to have dnetist use carbocaine instead of novacaine b/c novacaine includes epinephrine to control bleeding-; chocolate, caffeine, sugar,processed foods, wheat, gluten; not eating enough protein during a 24 hour period; large macrolide antibiotics , such as zithromax and biaxin, INFLAMMATION< and then things I am allergic to such as aspirin or nsaids). I find that weight training-not too heavy weights-- elliptical, and tai chi and chi gong are very beneficial; also certain types of music, as per large scientific study in peer reviewed journal calm the heart- ex. Mozartz symphony #40 in G minor. I imagine these triggers may be different for different people. Regardless of all this, I still take 2.3 mg warfarin once a day and 40 mg. sotalol twice a day.
Even if you weren't' allergic to nsaids (eg ibuprofen, etc) you should not be taking them once you have had AF (even if you have had an ablation or it is being managed by drugs).
For those who have had a PVI ablation the "rogue" signals continue to be generated in the veins but that because of the ablation they do not penetrate into the heart to cause the "misfiring / interference" with the heart's electrics. Similarly with rogue cells in the atria that ablated the signals are still generated but it is the scar tissue that prevents them from creating misfiring / interference. As I read it for both types this is a prevention rather than a guaranteed cure and the AF may come back in the future, though for many it does not.
It must be remembered that this type of ablation has been around for less than 20 years and it is only really in the last 5 years that significant numbers have been performed and therefore this is considered a new area of medicine and yes there are long terms unknowns as to the likelihood / frequency or AF reappearing.
Sitting in my lounge listening to Rewind Festival Perth bounding out above my TV and fan (put on to try and deaden noise!) My heart and nerves are not liking it all, my beat is not that of the music so don't recommend this music to calm the rhythm. Don't recall it as loud last couple of years, note to self to book weekend away this time next year!
Obviously you haven't posted info such as age, history, etc which prevents any us to make suggestions that might be more informed. From your profile I can see that you are a female so that might give you one point. However factors that you may have had that are corrected (eg blood pressure) are not returned to zero once treated and some doctors make that mistake.
Also look at NICE guidelines and NHS England Guidelines which are stronger supporting anticoagulation. You can also challenge on the basis
I was told by one doctor in hospital that I was only 61 and therefore should not be on warfarin. I politely told him that he had not read my notes, didn't know the reasons why I was on it and in any event I was on the waiting list for an ablation. He then said OK and admitted that he shouldn't haver said that and that he was wrong. I then also quoted Professor Schilling's comments about AF and permanent strokes and permanent anticoagulation because once you have had AF then stroke risk never goes back to 1.0 (ie that for a normal person). They are not allowed to stop for monetary reasons (and it is an extremely small amount if on warfarin).
I wish I had remembered about the UK being almost the worst in Europe about anticoagulation and strokes.
I have lost count of the times I have been told by doctors and consultants that I should not be on long term prednisolone for my asthma and fludrocortisone for adrenal insufficiency. long story, then I show them my Medic Alert braclet with all the information on it. I am on Warfarin for life, (Yellow book). My surgery goes wild when they have their annual spending review and I refuse to go off my life dependant medications. I keep a list of dates (medical history) so I can show GPs,A&E,or consultants. I surprise many because I actually have all my blue steroid cards going back to 1969, Many were not born then. Lynn.
I will remember to look up Mozart next time my heart goes out of rhythm... Worth trying! I am on warfarin despite only being 59 (so only a score of 1 for being female) - but my cousin, who also has AF, had several TIAs at the age of 58. All of this 'could' and 'should' and 'would' is hedged about with uncertainty and GPs certainly don't know more than EPs, when it comes to AF.
Occasionally my GP will suggest something regarding my inhalers, or heart meds. I refuse to change anything without discussion with the Brompton first. The GPs completely understand
I agree with pip_pip . My AF is very difficult to find and record. It was found momentarily on a 5 day Holter monitor. I have had a stroke so I am on warfarin for life. I hated it at first but now I only get tested every 2 months and I just get on with life, feeling so much safer. Please talk to your consultant again. I would only take his or her advice on this one. Good luck with it
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