As well as having PMR I also have Atrial Fibrillation. I am currently on 6mg of prednisolone.My GP is reluctant to prescribe a DOAC blood thinner for the Afib, because he says there is a risk of gastric bleeding.I am friendly with two retired GP's who are both of the opinion that this shouldn't be an issue.I wonder if anyone who has both these conditions, is taking both of these and if they have had any issues?
Prednisolone and blood thinners: As well as having... - PMRGCAuk
Prednisolone and blood thinners
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There are a few people with AF. I have taken Rivaroxaban which is an anti coagulant, but I do have the coated variety of steroids, so they go through the stomach before being absorbed in the gut.
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Drivel. I hope he has you on warfarin at least? If he hasn't, he is playing with your life.
I have probably had atrial fibrillation for about 18+ years as the first vague symptoms coincided with the onset of the PMR aches and stiffness. I have been on pred for some 15 years and the atrial fibrillation was first firmly identified over 10 years ago and at that time the DOACs were still very new (the first was approved in 2010). I was immediately started on warfarin as standard protocol. A few years later I started to have problems keeping the INR stable and it was suggested I start on a DOAC. I chose dabigatran - 2x daily and there was already an antidote which seemed a decided positive if anything did go wrong. I have never had any problems.
It is important to check the interactions and take the DOAC a couple of hours after other cardiac meds otherwise the blood level can rise considerably, something that happened to my husband and was a big problem. I had also not been warned but changing the timings, cardiac meds first, DOAC 2 hours later solved the problem.
Thanks PMRpro.I'm currently not taking anything for the Afib,but recently the episodes have become a bit more frequent, and it was my retired GP friend who said I should be on a DOAC,so I couldn't understand why the GP didn't want to prescribe it. You're reply has reassured me,so I'm going to contact my GP and insist he prescribes it or I'll go to another GP in the practice.
Hello Seamab, I too have Atrial Fibrillation and take Apixaban, another type of anti coagulant - have been doing so for the last 4 years or so. I was diagnosed Feb ‘23 with PMR, prescribed Prednisolone and as far as the medics who take care of me ( GP and Cardiologist) it’s absolutely fine me taking both medications, its never been questioned. Hope this helps and best of luck!
Thanks that's very reassuring,I'm puzzled as to why he said that,because it doesn't seem to be an issue at all!
Gastric bleeds ARE a risk with being on pred and being on a DOAC - or any blood thinning medication - has the potential to cause a problem. However - that risk is not quite up there with the risk of a stroke as the result of a clot in the base of the ventricles being disturbed by an episode of a/fib and sent off on a journey round the body.
If he is that worried he should have you on enteric coated pred to reduce the gastric irritation. Has he put you on a PPI for stomach protection? Forbidden you to take an NSAID such as ibuprofen? Lots of factors he should considering to be consistent.
Yes I'm taking Omeprazole for stomach protection.He didn't mention anything about Ibuprofen etc,although I already knew to avoid NSAID's.Similarly he didn't even mention switching to e/c prednisolone.
Good luck demanding a DOAC. What management are you on for the a/fib? Have you seen a cardiologist?
Yes it was actually diagnosed by a cardiologist in January 2022,but he didn't put me on anything.I didn't have another episode until June 2022(lasted about 5 hours),then it was June 2023 before my next one(lasted about 10 hours).Then I had another at the beginning of February this year,followed by another one two weeks later,so it would seem it is worsening!My GP said it would gradually worsen until it was permanent.He actually said I didn't need to be referred to a cardiologist,but if it happens again any time soon,I'll insist on a referral!
Here you wouldn't be let out of hospital until you were on an anticoagulant and other medication if it were assessed you needed something. But the anticoag is non-negotiable here. If it worsens that much you need to be under a specialist - because these days someone living actively and independently should be considered for ablation since it has improved so much.
My ChadsVasc score is 1,which is 'should be considered for an anticoagulant', but as I don't really have any bleeding risk factors then I think I should be on a DOAC. I checked drug interactions for DOAC'S and it says no interaction between a DOAC and prednisolone,whereas if you check DOAC and eg Ibuprofen ,it gives risk of bleeding as an interaction!
Do you know the name of the Cardiologist that diagnosed you? You should still be on their book and be given some monitoring from the Cardiology Department for your condition if you have intermittent PAF in the UK.
That's what happens for me and others in the AF forum on HU get the same.
Personally, I'd ring the Department and ask to speak to the Secretary of the Cardiologist you've seen , explain the situation and that your events have increased and that your GP is reluctant to prescribe anything for you without some advice. Ask the secretary if you can get the Cardio to phone you back or give you a message and also write a letter to your GP with a recommendation of which medication is suitable for you on steroids at 6 mg.
They should contact you within 48 hours , if they don't call the Secretary back ( ask for her direct line during the first call).
They may actually want to see you again for an appointment at to check you properly before making any further decisions.
Are you on a beta blocker?
They will give you medications now that things have progressed but not necessarily Warfarin , they may also choose to give you a P.I.P ( pill in the pocket) to take when an event occurs. Depending on your situation the may consider other procedures to try and correct it. These days it's considered to be better to do an Ablation sooner rather than later to achieve the best change of success.
It is a surprise that they did not prescribe previously unless they concluded the aFib was a one time situation at the time caused by another health issue but in which case you should have been seeing Cardiology rather than the GP to make the ultimate decisions on what you need. The GP would require approval for the medications from the Specialist but I'm surprised, therefore, that they thought it was unnecessary to refer you again.
Not everyone ends up with permanent Afib if they have intermittent or persistent paroxysmal aFib if the treatment is managed well early enough or their condition is well managed and mild.
If you have no luck on the phone to Cardiology, try their Cardio Nurse whom should get you through, or insist on an urgent referral.
Let us know how you get on , Bee
I find the PIP approach useless!!!!
Which PIP?I have Flecainide as a PIP, it's probably been 70% successful on bringing me out of PAF on the few occasions I've needed to use it which has saved me an unnecessary and long trip to A and E.
It all depends on the individual I think , and how intermittent your condition is , or whether other cardiac or chronic health problems are involved. Catching the episode early on seems to be the key as to whether it can work or not.
I am on daily Flecainide now and while it was brilliant for the first few months, it was nowhere near 100% successful later. I had an ablation at the start of January and had 3 weeks of blessed peace before the odd episode appeared. And a couple of weeks ago I had an infusion of zolendronic acid - never thought look up arrythmia and it wasn't mentioned in any of the stuff I had looked at. It has definitely had an effect though. The a/fib is now slow a/fib - but having early morning bradys ...
So do you think the Ablation has been successful or are you going to need another one?Its such a sensitive condition to have, I'm stuck having to work out whether it's my Tachycardia or aFib playing up , most of the time it's the Tachycardia not helped by middle of the night Brady's!
I tried a Migraine biologic injection called Ajovy , it's a month long medication, it had high heart rate as a possible side effect so I probably should have known better but I could really do with a rest from my Migraine symptoms.
Of course , it set off the Tachycardia and caused a few aFib events so that's one to stick in the bin!
Advice to Self : always say no to new medications that last for a month in your system ( 8 weeks until it had finally left entirely) just in case you cant tolerate it as you just can't get rid of it.
I've found my Kardia 6L invaluable because it helps me so much in seeing that one issue is happening rather than the other so that I can take the right PIP for the right condition. The symptoms of my Tachycardia Syndrome flares and aFib are virtually identical.
I don't think it has been entirely successful longer term, I was already having episodes again before the zolendronic acid. I hope they offer me another because I would do it again in the hope, The a/f is rather limiting at times and I am fed up with it since the Covid bivalent jab that I am sure kicked it off although this year's booster had no effect at all. The tachy/brady and a/fib are all mixed up together I think.
I think it's definitely worth requesting another Ablation, many people seem to have to have more than one to get things under control and from what people say from experience of it on the AF forum having the next one sooner rather than later seems to get better results.It's definitely the cardiac part of my Dysautonomia and how it triggers my vestibular migraines that has been the most limiting thing for me, stripped me of my independence which is very frustrating for a person whom loved to be out and about on their own like I was.
Good Luck with it , take care , Bee
I have a check up at the beginning of April - it is a bit complicated here, I was admitted locally and just taken to the cath lab in the big regional hospital The ward doctor here was useless and I didn't really get to speak to a doctor there - she introduced herself and I was asleep by the time she came back! They aren't very communicative here, bit patriarchal and down there is a bit Italian!!!!
I'm not on anything at all. I purchased a Kardiomobile device some years ago and downloaded the app,not for any particular reason,I just thought it might be a useful thing to have.In January 2022 I was lying on the settee and my heart started to pound,I got up but it continued,I remembered the Kardiomobile device and checked,my heart rate was approx 150 and it warned of possible Afib.It resolved after about 45 minutes.I showed the ECG trace to a friend(a retired GP) and he told me it was definitely Afib.I am in the fortunate position of having private healthcare,so I arranged to see a cardiologist,among other things he did an echocardiogram, which showed no structural issues.He didn't put me on anything.I had another episode during the night(lying on my side seems to be the trigger) in June 2022,lasting about 5 hours.Then nothing until June 2023,again during the night,which lasted about 9 hours.It happened again at the start of this month,again during the night,then again about 2 weeks after that.My private healthcare provider said I needed a referral again from a GP to see the cardiologist.I'm wishing now I had contacted a private GP,through my provider,and he would have given me a direct referral.My own GP basically said I didn't need to see a cardiologist!!I contacted my Health Centre this morning,my GP is off today,but I'll hear tomorrow if he is going to give me a prescription for an anticoagulant. If not I'll go the private GP route.Sorry for giving you my entire medical history🥱
I get the impression some GPs are rather too laid back about the risks of a/fib. They take it incredibly seriously here - especially the cardiologists who have a hissy fit if there is a need to miss a dose of anticoagulant because of needing some other procedure!
Yes he seemed totally laid back about it,as if it was no big deal!!
I imagine he may have misunderstood "you don't die of a/fib" - possibly not but you can die of things caused by a/fib like stroke or heart failure.
Even the very conservative NHS says it can increase the risk of stroke by 4 or 5 times.
nhsinform.scot/illnesses-an...
Even if you can live with the really sometimes unpleasant effect of a racing heart that wakes you up and keeps you awake, leaves you even more fatigued than PMR and can happen without warning and stop you in your tracks while out and about, reduction of stroke risk alone is essential since that can kill or leave you seriously disabled and reliant on others,
In your place, I'd be seeing another doctor and expressing my concerns about this laid back attitude. An anticoagulant prescription might save the NHS a lot of money and you and yours a lot of heartache.
I'm definitely insisting on an anticoagulant,I phoned the health centre this morning,but won't know until tomorrow afternoon if he's agreed to prescribe one.If not I'll get a referral to the private cardiologist who diagnosed it initially! What I'm not sure about is when I should be put on medication to control the heart rate,as I've only had five episodes in the last two years,albeit the last two only two weeks apart!
For me the other medication never got rid of it completely and pill-in-the-pocket never helped although until last year the episodes lasted a couple of hours at the most - I did go to the ED a couple of times when I felt really rough but by the time I got there it had stopped, My heart rate wasn't high enough to worry too much, never above 140 even in spikes, but one morning just before my husband died I woke with a heart rate of 190 so that was an immediate emergency services call and I was blue-lighted to hospital! I was sent home in the afternoon though. No idea what they did except leave me to rest for a few hours - all a bit of a blur!
190! That must have been scary.Mine is usually between 130 and 150! I don't feel unwell though ie no dizziness,shortness of breath etc. The only problem is that,apart from the last episode,it is during the night,so that means pretty much a night without sleep!
I don't remember feeling scared, more a bit pissed off as it was exceedingly inconvenient with my husband being so ill. Luckily our daughters were there so me being wipped off to hospital didn't matter. I'd had worse - I'd had a/fib flutters for a long time but never worked out what it was. very short episodes so never caught on screen. Then I was in hospital and given i.v. diazepam for a severe back problem. First time was fine, second night I felt unwell shortly after and it turned out to be a/fib which went on for about 4 hours with a heart rate over 200. They assumed it was due to the high dose pred I was also given and stopped it but it happened again the next night. Five hours and a peak of 232! I wasn't scared then either but I was having pauses of several seconds and that scared one of the nurses - I was too fascinated watching the trace on the screen! Then my husband pointed out it was a known adverse effect of i.v. diazepam. They kept me in for a couple of weeks doing the full work-up and sorting the warfarin but they didn't put it in my notes. A few years later I had a TGA (transient global amnesia) after falling and hitting my head. I was agitated in the ED - and they gave me i.v. diazepam before my husband arrived to say don't do that. You can imagine what happened - scared them to death apparently, I was still in the middle of the TGA so missed it all. Anyway - 7 second pauses accounted for the waves of faintness I'd been having and won me a pacemaker. That cured the waves of faintness and I haven't had a TGA either - they thought the pauses had caused them too. All good fun ...
Do you still have contact with the private Cardiologist you saw?You should ring them and bring them up to date on the increase in frequency of your aFib.
They could contact your GP as early as today with recommendations of which blood thinner is appropriate for you.
I'd suggest that you request politely but firmly to get an urgent referral to an NHS Cardiologist or E.P via your GP when you next see them so that you are put on the proper NHS treatment pathway if you aren't planning to get all aFib treatment via a Private Practitioner, or choose to arrange another appointment within the Private Care system you are in.
Make sure that there is a proper line of communication going on between your Private and NHS providers because this could be the cause of you not receiving treatment early, info is not being passed on or recommendations being taken up because of that.
If your NHS providers assume that you are having these things dealt with privately they won't be organising referrals as well but waiting to hear for private checks before organising your secondary care with an NHS Cardiologist.
You don't necessarily need a private provider to organise an urgent cardiac referral unless you want see the private cardiologist and get them to place you on their NHS list. The NHS GP just requires a further request and to know that the NHS route is the way you are choosing to go.
The GP will prescribe the anticoagulant but they clearly need more information to make a decision on which one you should be put on.
Have you been given any recommendations about how to stop your aFib being triggered at night?
Do you know what your blood pressure or heart rate was before the aFib started?
Do you suffer with periods of low blood pressure at night?
Do you suffer with more gastric reflux during the night or first in the morning?
How late do you eat in the evening and could the meals or foods or alcohol you had prior to these aFib events been the trigger?
It may help to begin to sleep with your head and shoulders/ upper body raised comfortably on pillows at night and to try to sleep to your left side, and make sure you are drinking enough cool fluids throughout day.
These are tips that can help blood pressure , heart rate and gastric symptoms that commonly cause night time symptoms.
Requesting enteric coated steroids will also help and they may also be better using a gastric resistant medication for the aFib too.
You'd still obviously need to have daily medication and preventatives now but finding your triggers and avoiding them , or making adjustments to prevent them is also important in helping to control how often intermittent paroxysmal aFib happens.
Good luck , keep us updated on how things go , Bee
Tbh the GP didn't seem particularly interested in triggers or anything like that.I really wish I had gone down the route of a private referral, which I will do if the GP doesn't prescribe an anticoagulant. I don't think there is that much difference between the DOAC's on the market,with regards to prescribing,it probably boils down to what the health board thinks is the cheapest! I'm not sure if I should be put on medication to control my heart rate yet as I've only had five episodes in the last two years,albeit the last two only two weeks apart!
YourGP doesn't sound particularly interested, full stop!
Whether you need to be put on a medication to control your heart rate depends on whether you have heart rate or blood pressure problems when you aren't in aFib.They would probably want to give you a Holter test and some more current ECGs before making that decision.
I think you should definitely request to speak to another GP at your surgery if you feel the one you are seeing is not being proactive enough.
And definitely firmly request a urgent referral to Cardiology on the NHS.
My experience has been that when it comes to aFib ( unlike with my other cardiac problem) that all sections of the NHS are used to treating it and they are on the ball with testing , treatments and getting you on medications because it is such a common problem that they are used to treating.
In fact , if you read some posts on the AF forum you will often read that many people , feel in their opinion, that they are put on too many medications too quickly!
It's probably worth looking up the web pages for the Atrial Fibrillation Association and Arrhythmia Alliance to get some more information about the medications but also good tips on the Self Care that helps to reduce your risks and events.
It will also help you to have this information in making a decision about which medication may be more suitable for you so you can request the right type to try first when talking to the GP.
Ok,thanks for taking the time to give me all the advice,much appreciated. Normally my heart rate is around 60 bpm and my blood pressure is at the lower end of the normal range.
I was diagnosed with Afib / a TIA in August ‘23. I take enteric coated pred (currently 3mg) and Edoxaban 30mg, Bisoprolal 2.5mg. I take them in the morning. I am currently on 5mg Rosuvastatin which I take before bed.
I was already on enteric coated since diagnosis with GCA. I avoid taking a PPI which is one drug less!
Hi. I have atrial fibrillation and have been taking blood thinners plus other tablets for years. In May 2023 I was diagnosed with GCA. I started on 60 mg Prednisolone and have tapered down to currently 5 mg. I have had no problems at all. Hope this helps and good luck.
Thanks,yes that is very helpful and reassuring.
hi yes I have been taking apixaban and steroids with no issues.
Yes. I had atrial fibrillation even before PMR, got cryo-ablation with good result but I must take a blood thinner Lixiana daily. Because of gastric problems (since long) I need to take Omeprazol daily too. I have no problems being on prednisolone(1 mg/day coming from initially 20 mg/day) and the other medications.
Thanks for the reassuring reply.
I am on Plavix, Prednisone and Famotidine- no interactions( at least for me).
Hi. I have AFib and have been on Edoxaban and previously Warfarin for several years and have been on Prednisolone for 2 years without any known gastric or intestinal problems although GP also has me on Omeprazole to guard against stomach issues while on Pred.
Thanks for the reply and reassurance.I am actually on Omeprazole anyway.
I have AF & PMR and take Pred and rivaroxyban with no problems.
OK thanks for the reply and reassurance.
I am on edoxaban, bisoprolol, atorvastatin and amlodipine. I was put on 40mg uncoated pred, along with a PPI, calcium and AA. I have not had any interactions or problems associated with any of these drugs except frequent diarrhoea, but that didn't start straight away and may be unrelated. I'm now down to 1.5mg pred and have stopped the AA.
The PPI could be the cause of the diarrhoea - it has form!
Hi. I don’t have A-Fib but have had two significant PE’s with the second one being unprovoked. I am being treated with apixaban and will probably be on that for life. Have had PMR since 2017. Had a blip of visual field loss bilaterally (2023) which shot me up to 60 mg pred. Am presently on a taper from 9 to 8 mg pred. I’d say throwing a clot trumps a GI bleed. Good luck with everything
Think I feel the same!!! Up to the GP to monitor the patient for the GI bleed - testing for faecal occult blood isn't exactly hard work is it!
Had a heart attack last year following Atrial Fibrillation. Am now taking Apixiban (Eliquis) 5mg twice daily and havent had any problems mixing it with my uncoated Prednisolone which I take with Greek yoghurt - no PPI.
Great questions! I have been on pred about 2 years. I had an afib episode in Sept of 23. I am now on Eliquis. Was also on Multaq, but the side effeects were scary. My electrophysiologist took me off it. So far no issues, but it does concern me some. Was the afib after you were diagnosed with PMR?
I have read the PMR can impact the sinus node in our hearts.
Who knows? Any others have this issue?
I have replied on the other thread you asked the question. As I explained there, few will see questions asked in the middle of an existing thread.
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