Warfarin and burst blood vessels

[tunybgur]

Since being diagnosed with Afib I have been on Warfarin and my INR is fairly stable at between 2 and 3, although most of the time I am in sinus rhythm controlled by flecainide, but my doc says best to keep taking the warfarin.

I have been suffering with burst blood vessels in my eyes on occasion making me look like an extra from a Dracula movie, but nothing worse than that, clears up after a few days....

My question is 'does the Warfarin make this more likely, and if so does this make other hemorrages more likely?.....anyone else experienced this problem since being on Warfarin?

Do I really need to be on an anticoagulent when I don't have AF?

Advice would be appreciated.

[BobD Volunteer]

In answer to your last question IMHO yes. Having AF you have a risk which is non removable by any form of treatment.

Anticoagulants do not thin blood as we keep saying so are unlikely to make bleeding more likely. If, however, you have a weakness such as nose bleeds then anticoagulants will make them appear more dramatic and they may take slightly longer to stop. Small bleeds in the eye affect quite a few people and obviously these will seem much worse as the blood takes longer to clot. Hope that re-assures you.

[tunybgur in reply to BobD]

Thanks for the assurances Bob, I'm still not sure why I need Warfarin when I'm not in AF....I can understand the doc being cautious, but I know when I'm in AF, and I keep it at bay juggling my doses of flecainide which so far has restricted AF episodes to a couple of hours max.

I have a prescription but I like to minimise the dosage so take control myself, I have a Heal Force PC 80B which is a brilliant piece of kit (from China of course) which clearly indicates when the P wave is absent, although it's only a confirmation as my finger on the pulse unfailingly tells me when there's a problem.

I don't know how quickly a blood clot can form in the atria, I've been checking medical data but can't find anything useful....the more research I do the scarier everything gets, but as an Engineer I must know everything!....risk analysis etc...but I think it takes days, maybe weeks for these dangerous clots to form, and I would be quaffing Warfarin tabs by the bucketload if I couldn't resolve any AF in a few hours max....still considering stopping..maybe some of the other anti-coags are better? My doc wants to keep me on Warf I think because it seems stable with me, and it's cheaper than the alternatives.

[BobD Volunteer in reply to tunybgur]

You have AF you have a stroke risk. How often and how long is of no importance. The risk is real.

[Hidden in reply to tunybgur]

I have just read your history where you talk about a heart attack and other serious heart conditions, but I think your final sentence was quite compelling. I don’t think you fully appreciate the risk you would be taking if you decide to stop taking your anticoagulant. I don’t want to sound over dramatic, but having worked with stroke victims, I have witnessed the devastating affect a stroke can have, not only to the patient concerned, but to the family who have to cope with the fallout. For some, they would much rather have been taken! In my opinion you are playing with fire. Not only are you at risk of having a stroke because of AF, that risk is increased because of your other heart issues. Believe when I say a bloodshot eye is nothing compared to the risk you seem prepared to take. Taking control of your medication is one thing, but tinkering around with anticoagulation when, by your own admission, you do not understand the all the issues relating what causes clots and how long they take to form etc seems incomprehensible.

Sorry for the lecture, only trying to discourage you from making a big mistake. Go read that last sentence and make sure that last day is still some way off!

[tunybgur in reply to Hidden]

You're quite correct, after a time the dangers seem to retreat into the distance, but of course they are still there, just waiting for you to drop your guard.

I shall continue with my Warfarin....and thank you for taking the time to reply, I feel suitably chastened.

Keep up your good work.

[Hidden in reply to tunybgur]

Don’t be.......👍

[tcpace in reply to tunybgur]

My daughter-in-law was on warfarin for several years (she has defibrilling pacemaker). About 12 months ago, she developed severe headaches which, it turned out, were caused by small bleeds in the brain. The medics switched her to apixaban which seems to have solved the problem. I'm no medic but that tells me that you may well be better off on apixaban so you may want to have a chat to your medical advisers about it.

[tunybgur in reply to tcpace]

Thanks tcpace, that's a good bit of info and does help answer my original question about whether anticoags cause various bleeds unseen in the body.

I shall do some research on the various anticoags because there must be several differences in the way they work, this forum is a good place to start, I think the newer drugs are more expensive but obviate the need for continual INR checks.

[Barb1 in reply to tunybgur]

We were told at a support group meeting that a clot can form within hours. 4 I think the Consultant said.

[tunybgur in reply to Barb1]

That is a bit scary if it's true....going to have to do a lot more research.

[Hidden]

As has been said, once you have been diagnosed with AF, you have it. Contrary to what others may say, we are told there are no cures, but there are a number of ways in which the symptoms can be controlled, but unfortunately AF remains as does the potential risk of stroke. It can be difficult to comprehend, when logic tells you it no longer exists. However, there a couple of things to remember. Again, as we understand it, AF over time affects the structure of the heart and the tissue which exists within it and medication, ablations or cardioversions cannot reverse that so the areas within your heart where clots can form remain. This is why EP’s/Cardiologist’s tend to use CHADsVASc to assess the stroke risk whether in AF or not. The second consideration is that whilst people who are benefiting from a successful ablation or cardioversion, they have no idea what their heart is up to whilst they are asleep. It’s a bit like folk who are a symptomatic, they are unaware of their AF but the risk of stroke remains very real. As for blood vessels, I take apixaban and am just recovering from a beauty in my right brought on, I think, by a hefty sneeze. They are always a worry and it’s wise to be cautious, but this is the third time it’s happened in 6 years and when checked, the message has always been the same - don’t worry, it happens.

My old man was an engineer, so I know exactly where you are coming from.....although babies may be man made, the design wasn’t, so perhaps engineer’s logic doesn’t apply!!

[tunybgur in reply to Hidden]

Thanks for the reply FlapJack, I follow your argument, but logically if I'm in sinus rhythm my heart is pumping properly so I would have thought the risk of blood pooling in the atria is fairly small.

You're saying there may be changes in the heart which still makes it susceptible to producing clots even in SR? If this is the case then I must obviously continue with anticoags....confused now.

I shall do some more research but I have the feeling you're right.

Thanks

[Hidden]

When you are on Warfarin ( or any other anticoagulant) your blood is being anticoagulated NOT thinned. Very important to get that correctly in your mind.

[etheral]

You can ask for Eliquis (apixaban) or other NOAC which would make your life easier..no blood tests for INR..but IMHO the risk of a stroke far outweighs the inconvenience of a subconjunctival hematoma.

[tunybgur in reply to etheral]

Thanks etheral, at least I have a name for it now. I will continue with Warfarin, but my original query was whether anti-coagulents generally make similar small hemorrhages more likely.

The bloody eye is a visible manifestation of this, but are there others which will be hidden?...a bleed on the brain for instance....

[MarkS]

You are still at risk even when in NSR. The cause of both AF and strokes is believed to be inflammation of the heart wall. So the fact that you're in NSR from the flecainide doesn't make any difference to stroke risk.

If you're stable on warfarin then that's the best anticoag for you. I got some bloodshot eyes last summer. At the time I was taking a curcumin supplement, which acts as a kind of anti-platelet. I was also doing back exercises involving swinging a heavy kettle-bell weight between my legs. It was shortly before my son's wedding so that could have played a part too. I gave up the curcumin and stopped the weights until after the wedding and all has been fine since.

[tunybgur in reply to MarkS]

Thanks Mark, interesting about the inflammation, didn't know that.

I am pretty sure my rhythm problems are the result of my heart attack. They started a couple of months after the MI which is about the time required for scar tissue to form on the heart potentially disrupting coronary electrical pathways....at least it seems to fit.

I guess I'm on anticoags for the foreseeable future.

[secondtry]

I have much less knowledge than the regular contributors here and can only repeat what I have recently read (as I forget the rest!!).........firstly that all ACs block Vit K and a lack of that results in calcification & stiffening of blood vessels, so maybe reduce your calcium intake and take a supplement to compensate.......secondly when coming off ACs for a short time perhaps for an operation the blood clot risk is actually higher than if you had not been on anything, so maybe you request a heparin shot or if just going for a dental treatment you take other precautions.

[tunybgur in reply to secondtry]

Thanks, there seems to be lots we don't know....that's why this forum is so useful, and why we must always ask questions.

[BobD Volunteer in reply to secondtry]

Sorry to have to corect you secondtry but only warfarin is a Vit K antogonist. The DOACs work on a quite different part of the clotting process.

[secondtry in reply to BobD]

No apology necessary Bob, apart from mine.