Sadly, my grandmother died of a brain bleed at age 74. She had been taking Coumadin ever since she had carotid surgery. She and my grandfather were on vacation visiting relatives when she got up in the middle of the night to use the bathroom. When she went to get back into bed, she slipped on the hardwood floor, fell and bumped her head on the bed frame. She woke the next morning and didnt feel well. She ate breakfast and felt nauseated so she told my grandfather she was going to lie down for a while. She never woke up again. She was taken to a trauma center where they discovered she had a brain bleed (subdural hematoma) and was in a coma. She and my grandfather did not realize she had hit her head hard enough to cause an internal bleed. I myself am also on Coumadin/warfarin. It scares me to think what happened to my grandmother but rest assured, if I hit my head, I will be going to the hospital immediately. Unfortunately the benefit of anti-coagulants can also be a risk in the course of every day life. The benefit does outweigh the risk.

I just returned from mu cardiologist. One of the items we discussed was the possibility of going to Apixaban after the ablation. The EP likes Apixaban. The cardiologist really is not a fan. She told the story of a patient who went for an endoscopy in the hospital and got a nick in the esophagus. They couldn't stop the bleeding no matter what they did. He passed. We all have to be cognizant of how dangerous all of these anticoagulants are. But we need them. I have no intension of spending my remaining days in a nursing home!

The good news is that the cardiologist has cleared me to resume my normal workout in the gym, just don't try to lift anything too heavy. I xsee the EP in two weeks.

Petey and Across the POnd,
I want to make sure I correctly interpret what you both said.

Petey said
"Pradaxa is the most effective in reducing strokes (34% less than Coumadin as compared to Eliquis at 21% less and Xarelto 12% less) according to the neutral websites that compare the 3 drugs as measured against Coumadin."

AcrossthePond said,
" ...compared to Coumadin the total time in range was 50 - 65%."

My Interpretation and please correct me if I am wrong:
Compared to a group of patients on coumadin whose INR was in range 50 to 65% of the time, 34% fewer patients on Pradaxa had a stroke; 21% fewer patients on Eliquis had a stroke adn 12% fewer patients on Xarelto had a stroke. Is that the correct interpretation? Thanks very much for taking the time to answer it.
So if the group of coumadin patients who had strokes was 100, then the comparison results would look like
Patients who had a stroke by drug taken:
Coumadin Pradaxa Eliquis Xarelto
100 66 79 88

Steve:

That's correct, however, for those on Coumadin that can stay in range and who self monitor to verify, Coumadin would perform better for those people. So they would have essentially the same protection as Pradaxa.

As a group, though, people don't stay in INR range very well.

Another consideration is your CHA2DS2Vasc score. If it is 1 or 2, the anticoagulants don't move the "absolute" risk that much.

There are so many factors. For example, for someone over 75 years old, Eliquis is probably a better choice as it is the safest "bleed-wise".

Everyone is different.

petey

opsyn said: "If half life is a major concern then you may want to check out xarelto whose half life is 5-9 hrs for young and 11-13 hrs for elderly (65 and over) and once per day. I think you still fall in the young. "

I'm not sure I understand how a drug that is taken twice a day (that's 12 hours per dose) has a half-life of 5-9 hours and still works well in the last 3 hours of each dose.

Half-life is the time it takes for the concentration of a drug in your system to drop by 50%. So if it has a 5 hour half life for a young person, Xarelto would be at 50% strength by the 5th hour. In the 10th hour, 50% of 50% would be eliminated, for a total of 75% eliminated in just 10 hours.

Does anyone understand this?

petey

Hold on... check that. Xarelto is taken ONCE a day. Now I'm really confused. After 15 hours, it would seem that 87.5% would be eliminated and at 20 hours, over 93%. That can't be right.

Steve, they key to Coumadin is staying in range and like Petey said, due to many things sometimes thats not so easy.

Paul, great news about being able to do your normal workout again !

Yep, that clearance definitely made my day. And, the cardiologist is very conservative. I would say that at this point nearly 99% of the stroke issues are resolved. One must take into consideration that it kicked my CHADS score up a point or two.

As I mentioned to Petey in another thread the other day that focusing of writing software has helped me clear up some of the concentration and mental drifting issues I had experienced after the stroke that lingered for a good eight weeks. Nothing like a little C programing to make you focus ;-}

Paul I write UNIX and Informix scripts to keep my brain going............., anything any of us can to to keep it working is a good thng..........

In college, I wrote programs in Fortran IV, Basic, and COBOL (to let you know how long ago it was). We used IBM cards. :-O petey

I had my routine 6 month appointment with my cardiologist this morning. Re: Warfarin he repeated what petey had noted earlier. "As a group people don't stay in INR range".
My monthly blood tests since August of 2010 has been in INR range 95%-99% of the time. With that being the case he sees no need for me to consider the newer anticoagulants. One thing he said, (probably my only fear re: AF) was that one day I wouldn't self-convert. He followed that by saying that might be 10 years down the road. I think that was to make me feel better. In any event when not if that happens hr assured me we'd deal with it.
Re; Computers. My ex was a mathematician. Not too many jobs available aside from teaching. In the 50's he got in on the ground floor of computing. A Burroughs computer was installed at than Wayne University(now Wayne State). It took up a whole floor with huge equipment and air conditioning. Also used IBM cards. Later my ex got a job with IBM in NY. Now my iPad can do more.

Annette, do you have access to PIP, in case you do not self convert within 24 hrs.......someday?

I seem to remember, you keep a pretty low HR when you go into Afib.

Glad you are doing so well!!!!!!

Carol - Yes I have Rhymol as a PIP but because of my low HR.In AF I hesitate to take it since my is between 60-90 beats. I discussed this with my Cardiologist and he agreed the PIP might make my HR go to low. In ER when first diagnosed I was given an IV of diltiazem. not sure what else. While in ER I set off the bells and whistles going to low. I was fortunate to have converted to NSR before a bed was available for them to admit me. I don't know what procedures would have followed. I know now from this truly wonderful support group of information.
"Knowledge = Options = Power"

Annette

I am on my way to my doctor today. I was just diagnosed with Afib and he put me on Xaraltan and I had severe indigestion. He switched me to Elequis and am having the same problem. From what I read I guess Coumadin is next and it doesn't sound like fun. If I were you I would just stay on the Coumadin. It's been a terrible time for me. Some nights I don't get any sleep because the stomach problem is so bad.

Kcarr I take an anti K antagonist (similar to Coumandin) and have had absolutely NO indigestion problems with it. For most people the problems or nuisances come from the blood tests or problems staying in range. It works very well for me. Important is being anticoagulated because the thing you dont want is a stroke (and a-fibbers are more apt to stokes than the normal bear)!
I hope all goes well at the doctors today for you,
take care,
atp