That pacemaker,,,again!

[Hdev]

I recently wrote about my dissatisfactions with my 13 month old pacemaker,,,now I have a huge problem to add,,,last week I got sudden jabs of pain in my left temple and heart at the same time,,,suddenly I could not get my breath,,so scary,,,sat down and called for an ambulance,,,in the ER a cat scan revealed multiple thrombi sitting on the 2 lead wires where they enter my heart,,,being on warfarin these past 5 years should have prevented this,I am told,,,but it happened,,,evidently a clot broke loose and hit my lungs,,,luckily a small clot so no big damage,,,now I am faced with upping my INR to read 2.5-3.5 weekly with increased warfarin plus the addition of a baby aspirin 81 mg daily,,,,what a choice? Do I agree to the added aspirin and increase my chances for a really bad bleed if I hurt myself or do I stay conservative and just increase warfarin so the clots dissolve or at least,,don’t grow bigger? I’m waiting for the EP to call with his recommendations,,,,I am 75 years old and have had GERD past 25 years and am on omneprazole for that,,,,not sure if my stomach can handle the aspirin,,,has anyone had experience making a choice like this? I would like to feel confident about further anticoagulation,but how much is too much? I’m already in a situation that was not supposed to happen and the EP has no explanation for me,,,the warfarin is the only drug that is supposed to prevent this and it happened anyway,,,I’ve never had a clot anywhere before,,,,thank you for any thoughts,,,

[BobD Volunteer]

I think we mentioned before that warfarin will not disolve clots. Aspirin will help but why they have not given you proper clot busting drugs I do not know.

[Hdev in reply to BobD]

Excellent question,Bob,,,,I will be sure to ask it ,,,no clot visible in the cat scan? ,,I assumed it was too small to see or they missed it somehow,,,,the report reads that they did see multiple thrombi in the 2 leads,,,,thank you very much for this info

[mjames1]

Sorry about your situation. Like Bob says, ask about the newer anti-coagulants and make sure to tell your ep that your stomach may not be able to handle aspirin. Beyond that, I think advising you further in terms of taking action on your own is beyond the pay grade of anyone here.

Jim

[etheral]

There are criteria for administering so called clot busting drugs such as TPA which fortunately for you apparently were not met. I would ask about switching from warfarin to Eliquis (apixaban) as some studies have shown a superiority in the prevention of clot formation. Personally I would be leery of adding ASA to the regimine as I am not aware of any studies showing its efficacy for the type of clot you experienced. Best, etheral

[opal11uk]

I agree with all comments, I have a pacemaker, also had a series of TIA's . I had a stroke in 2000 caused by P/A/F and was put on Warfarin and stayed on it for 20 years however after the TIA's was seen by a stroke doctor and he put me on to Pradaxa (Dabitran) stating that these alternative anti coags were better than Warfarin at my time of life, I was 75 then and since have had no further problems so, talk to your cardio, tell him/her your concerns and get it sorted out so that you feel more confident in taking medication. As for the Aspirin, I was taking 375 mg a day prior to my stroke and I believe they saved me from a much more severe stroke, apparently they work in a different way to anti coags so its a two stroke prevention taking them with Warfarin etc. Good luck

[hoppy77]

I no longer take Warfarin. I have permanent AF and take Edoxaban

[HastyHeart]

Hi Hdev! I posted on here a few weeks ago over my negative problem with Edoxaban: swollen,, sore, bleeding gums behind my upper front teeth. Just worsened despite trying everything including visits to dentist, using special toothpaste, mouthwashes, and my front 8 teeth have moved slightly. I'd been stable on Warfarin previously for 5-6 years and after having colonoscopy Nov 2021, decided to give a DOAC a try. And Edoxaban was my choice. However I decided I couldn't afford the risk of losing my front teeth (all other gums in my mouth weren't affected!) so returned to Warfarin about a month ago, gums started to improve within days and no longer swollen or bleed! My message would be to try DOACS, yes, but if you have my experience on any of them, keep an open mind about switching to a different one, or a return to Warfarin ( and put up with the INR testing!). Hope Edoxaban continues to work for you, Hdev. Happy Easter Everyone!