Atrial Fibrillation (AFib) Support Group

Atrial fibrillation (AF or afib) is an abnormal heart rhythm (cardiac arrhythmia) which involves the two small, upper heart chambers (the atria). Heart beats in a normal heart begin after electricity generated in the atria by the sinoatrial node spread through the heart and cause contraction of the heart muscle and pumping of blood.

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SeanOpositive 09/07/2014

Hi All,

I was at the E.R two weeks ago. In the 2 weeks prior to that, I had two separate 2+ day bouts of a-fib, one bout lasting 4 days. I am 36 years old, 0 CHADS, and was on low dose aspirin. I went to the E.R. at 230am because I was having weird pains in my head and my heart was clearly in a-fib and pounding more irregularly than usual. I also couldn't feel my pulse well. Just felt like something different was going. I'm curious if I was having a mini-stroke. What does a TIA/mini-stroke/stroke feel like?

Anyhow, the consulting EP in the E.R. suggested that if I'm having 2+ day bouts of a-fib often, then I should be anti-coagulated. Is this what you all hear from your EPs?

Also, he suggested a pill-out-of-pocket (POP) approach -- to start Xarelto when the a-fib begins, and discontinue a day after it stops. Does this make sense? I'm concerned because it is my understanding that a clot can form in the left atrial appendage and pop out just about any time it wants, not just within 24 hours of a-fib, or does it indeed break down within those 24 hours, especially with an anti-coagulant preventing any further expansion of the clot.

Thanks for input! I appreciate. Oh and I hate this Xarelto because it seems to always give my lower left quadrant pain and constipation, but this is better than 230am visits to the E.R. for what could have been a mini-stroke.

-Sean

pacyetep 09/07/2014

I doubt you were having a TIA. Here are the symptoms:

Transient ischemic attacks usually last a few minutes. Most signs and symptoms disappear within an hour. The signs and symptoms of TIA resemble those found early in a stroke and may include sudden onset of:
Weakness, numbness or paralysis in your face, arm or leg, typically on one side of your body
Slurred or garbled speech or difficulty understanding others
Blindness in one or both eyes or double vision
Dizziness or loss of balance or coordination

I would take the anticoagulant if you are going in and out of afib every day.

Paul60 09/07/2014

Sean, when I had my stroke, I didn't feel a thing. I dropped the teapot I was pouring because my right arm stopped working. Then Sharon looked at me and saw the right side of my face drooping. When I tried to talk to her only mumbles came out. She pushed me down so I wouldn't fall, latter I found my right leg was weakened and I could see on the side. You really don't want a stroke. BTW, my Chads was also zero and I was taking aspirin (useless).

I have followed your posts here for a year. I my opinion, you should have been on anti coagulants a long time ago, daily, for life. Don't take the risk of having a stroke (even a small one). Preserve the brain. If Xarelto bothers you, try Eliquis or Pradaxa. Or, if they all bother you, bit the bullet and take Coumadin and do the blood work every few weeks and watch your diet. Very few people react poorly to Coumadin.

acrossthepond 09/07/2014

I was already lying on my bed when I had my TIA I felt a little drowsy and closed my eyes, then the right side of my face felt numb, then my right arm. Then it felt like my whole body spun around on the bed (although I didnt move!), I tried to open my eyes and only saw red! I closed them immediately and thought, hmmm, this is not good. While I was trying to figure out what was going on and what I should do next (go out on the balcony and yell for help? Naw. Wait it out?) The numbness subsided and I was me again. Whew. I got up and was more or less a wreck because I realized what had happened. It felt like the whole thing took 20 minutes but it was probably more like 5. Although I felt completely ok my hubby took me to the ER and they kept me in the hospital for 4 days (the possibility of a full blown stroke after a TIA is extremely high).

So, with the exception of the slurred speech (I was alone and dont usually talk to myself out loud so who knows if my speech was slurred or not, but it probably was considering one side of my face was numb) my TIA was exactly what Petey said. I had a CHADS2 VASc score of 1 at that time and was on aspirin AND Plavix (for a different reason, not for AF) at the time. I agree with Paul useless.

atp

SeanOpositive 09/07/2014

How about POP approach? I think this might be a new approach with the next-gen A/C's. And in particular, I think Xarelto has the fastest pharmacokinetic profile, in that it is absorbed and reaches saturation quickest among the next-gen A/C's.

Has anyone tried having INR checked with next-gens? Is it an option? It'd be nice to know that the Xarelto is working.

acrossthepond 09/07/2014

Personally Sean, I wouldnt want to take the chance with a PIP approach. What if you had an AF episode and didnt realize it or were sleeping or werent in the position to pop a pill? Nope, not for me.

NOACs go at blood thinning differently than Coumadin no need for INR check. You take them they work, you forget them, they dont work. Easy nough.

SameDayNurse 09/07/2014

So, I am going to go at this from a different point of view......but please remember this is ONLY what my EP guy and I decided on, well actually HE decided but I agree whole heartedly. I have had a fib episodes for nearly 12 years, they are VERY VERY symptomatic , as in you can literally see my heart beating out of my chest, however, my Flecainide is a blessing to me and my episodes are very well controlled , I dont even want to say how long its been since Ive had one. Based on that we had a long talk this year when I turned 65 about CHAD scores etc and he felt that in MY situation the pros and the cons of me taking or not taking an anticoagulant balanced out equally. So we are doing a PIP approach for now....for example, I am going to Europe next summer and I wanted to feel safe if I had an episode different than previous episodes so since I will be making a long flight we are for that trip, going to start Eliquis ( OUR drug of choice ) before I go and I will take it for a couple of weeks while we are gone but when I am home and near my preferred Medical care I would only take it if I didnt convert in the amount of time we have decided on. Is this perfect ? Is it correct ? I cant say, I can only say this is what we are doing for me.
Best wishes always , jan

Paul60 09/07/2014

Jan-Sean:
I can't remember where I read this, but I going to put it out here anyway. The thinking used to be that the stroke risk increased if you were in AFIB for a long episode (24-48 hours). Lately I read that the stroke risk increased even with a much shorter episode...like only a few hours. So what happens when you have a episode while sleeping...I do, often they wake me up, I can't say if they always wake me. And, not everyone is symptomatic, do you always know when you are in AFIB? I do (if I'm awake). But people like Petey don't feel a thing.

SameDayNurse 09/07/2014

Petey is a chronic a fibber, most people with that type of a fib are not symptomatic, the blessing and the curse. I am paroxysmal which comes with its own blessing and its own curse ..... there is absolutely no question that I know when I am in a fib and the exact moment I go out of it, always have, if I had it at night, which was fairly rare, woke me up immediately .....am I taking a risk ???? I guess you could argue that point but I feel very comfortable with this decision and if I were to have frequent episodes begin again I wouldnt hesitate for a moment to be on an anti coagulant continually. But thanks Paul, this is how we learn by reading others peoples opinions, knowlegde and sharing our own.
jan

yogacat 09/07/2014

I would do the same, Jan.

Paul60 09/07/2014

I just reread my response to Sean. Correct it to read that I could NOT see on the sides (peripheral vision gone). The vision took several weeks to return and I had to go for an extensive neurological and handicapped driving evaluation to get cleared to drive again. It has been 8 months since my stroke, luckily all of the physical problems appear to be gone. However, my focus, concentration, balance, and self confidence are a bit less than before. And, I was lucky. Like I said, you really do not want a stroke.

DeTalentedOne 09/07/2014

I'm surprised he suggested using xarelto as a pill in pocket. I was told in order for anticoagulants to work u need to be on regularly. I have been xarelto for 6 months and haven't had any problems. Now I do remember when I first went on it last year for the first weeks I had some stomach idsues but after that no problems. What dose do they have u on. I'm on 20mg a day. Have they tried Multaq. It seems to wo rk pretty well for me. Hopefully u can get things figured out.

yogacat 09/07/2014

I don't think Anticoagulants are accumulative. I was told not to take Pradaxa for 48 hrs. when I had a tooth extracted. It was estimated it would take that long for it to be out of my system to minimize bleeding.

It was 56 hrs. before I was able to resume it once. Pradaxa is a 2x a day pill. I have had to stop taking it 3x for a procedure. I went into afib 2 of those times

For 2 yrs. my episodes were about 30 days apart...pretty regular. I am symptomatic, and I often thought PIP for Pradaxa would be OK. I never discussed it with my Doc.

SeanOpositive 09/07/2014

What a great discussion. Hopefully the pharma companies and EPs are listening to all the ambiguities.

Jan - did you write that you and your EP aligned on an duration of a-fib to begin AC therapy? longer than 6 hours? 12? 24? I was told by end of day.

SameDayNurse 09/07/2014

Sean, my EP and I do have a time limit that I can wait before seeking treatment but most people on here would disagree.....you have to remember every person is an individual and you can look at general statistics and history or you can look at and know your patient......in my case I am incredibly symptomatic when I have an episode and in the entire 12 years I have had these episodes I have never been in one for longer than 3 hours at the longest.......so I have a time frame that would seem long to some people but its based on my history and my comfort with knowing whats going on. You are younger and seem to have very bad episodes so my time and your time wouldnt be the same on any level.

artis 09/08/2014

Just wanted to add that I follow a similar path as Jan, with my EP's blessings of course.
I am highly symptomatic , so I always know when I have an episode and when I convert. I only take Sotalol and had no episodes for 2 years. I do have a script for Xarelto on file and was told to start taking it, if I have another episode.
I agree with everything Jan wrote. We are all different and I know and trust that my treatment plan is the right one for me. Heide

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