anticoagulant vs AF

[fiftyone]

I experience occasional atrial fibrillation. Doctor has told me to take anticoagulant daily but I am concerned about this. Firstly, I fear there are as many deaths from anticoagulants (internal bleeding) than from AF and secondly, I hate the idea of taking a medication daily for a problem I experience only occasionally. Some views would be welcome. thanks.

[cjrsquared]

I think you need to get some robust statistics before making a decision. The main risk from atrial fibrillation is stroke and although outcome from stroke has improved ( with thrombolysis, clot busting) it still has a high risk of long term disability. I do not have any statistics to hand but my experiential experience working with an aged population with multiple co morbidities is that death or long term disability from anticoagulation is very uncommon whereas the effect of a stroke is catastrophic.

My second thought is your medic thinking of full anticoagulation with warfarin or apixaban, or the more minor effect of low dose aspirin or clopidogrel? If it is the latter the risks are less.

I completely understand that you have to look at your own risk including other medical conditions and interactions with any other medications that you take. Good luck.

[fiftyone in reply to cjrsquared]

thanks a lot for the info.

[jimh111]

AF is a concern and is likely to get worse without intervention. As mentioned there are different degrees of anticoagulant. Also beta blockers have different modes, some slow the heart some make it beat more regular. A sensible approach to anticoagulation and beta blocker to prevent irregular heartbeats (as opposed to slowing the heart) may be the best approach. I have very limited cardiac knowledge so can't say any more.

Are you taking too much levothyroxine? How much are you taking and what are your TSH, fT3, fT4 levels (numbers with reference intervals)? Looking at your previous posts it gives the impression that you have high fT4 levels. There is a myth that all is OK provided your fT3 falls within its reference interval, this is not so (it's also wrong to say you can't be hypo if fT3 is normal). Each person has their own ideal fT3, fT4 levels which tend to be around the mid-points of the reference intervals, particularly for fT3. For fT3 it's not a case of anywhere within the reference interval is OK, this applies to both hypo and hyper possibilities.

If you have high fT4 with above average fT3 and very low TSH there is a veery good chance that you are in a hyperthyroid state (technically thyrotoxicosis but I dislike the term). Some patients need these hormone levels but the majority of the population will be hyperthyroid. To judge we have to look at the blood levels and more importantly at signs and symptoms. You are showing potential signs of being hyper, i.e. atrial fibrillation. The obvious question is whether this is due to your high thyroid hormone levels. The obvious way to determine this is too reduce your levothyroxine dose and see if it reduces the frequency of AF. Rather than taking anticoagulants and beta blockers it will be much better to tackle the problem at it's route source and that means establishing whether it is caused by the levothyroxine dose.

It would be helpful to know what signs and symptoms of hypothyroidism you have. It will be difficult but a better approach may be to reduce your levothyroxine substantially and add in a little liothyronine. It's not evidence based but I (and my former doctor) noticed that high doses of levothyroxine seem to 'backstack', the levo has little effect for some time and then seems to kick in producing hyper symptoms. For this and other technical reasons I would not let my fT4 go much above its upper reference limit, it doesn't seem to help patients.

[fiftyone in reply to jimh111]

thank you for your interesting reply