Are blood thinners safe for the elderly?

I am new to this forum and have very little knowledge about atrial fibrillation. My mother who is 86 was diagnosed with AF 3 months ago and it seems that it is permanent. She took antiarrythmics but stopped them after one month. She is now on Beta blockers and warfarin. I read here and there contradictory recommendations when it comes to elderly, whereas all the doctors we consulted say the same thing: the risk of haemorrhage is lesser than the risk of stroke and it would be foolish at her age to stop blood thinners.

Can anyone please advise on his or her experiences with an elderly? Would Nattokinase be an option? Does it interact with beta-blockers? Can fish oil help in her case?
Many thanks in advance for any insights you may have.

Mary Y

The doctors are telling you the truth: her risk of stroke is higher than her risk of bleeding. In fact, her age makes that difference in risk even more pronounced. Taking her off an anticoagulant would be a very poor decision and reduce her chances of survival rather than improving them.

What you can do to minimize the bleed risk is get her off warfarin and onto Eliquis. It has a lower bleed risk than warfarin (in fact, all the NOACs such as Xarelto, Pradaxa, etc. do, but Eliquis has been shown to be superior in this regard, particularly with the elderly).

Nattokinase is an option but you're largely on your own when it comes to dosage and effectiveness. How much is enough? That's not really known. Will it work as well as warfarin? Maybe, maybe not. I personally wouldn't roll those dice with someone that old. Her stroke risk is quite high.

My mother was diagnosed AFIB about twelve years ago when she was being treated for Aortic Stenosis.
The dread that engulfed me when I saw her monitors beep afib every once in a while was the start of her permanent condition. She lived with it, was asymptomatic for the most part but I agonized over it knowing full well it would weaken her heart. A cardioverion lasted all of 24-48 hours so it was rate control and coumadin.

She had a bad GI bleed about 7 years ago and her heart surgeon ordered her to stop anti-coagulation permanently. After her colonscopy I spoke to her GI and told him I want her back coumadin within 5 days after showing him two small studies from Lancet.
Her heart surgeon disagreed, and I told him about the studies and told I'm going to stop her Dual Therapy,(aspirin regimen) we're going to get her anticoagulated again. I told him I'd rather risk another GI bleed then a stroke. He asked me "do you think you're a DOCTOR", my response was I have AFIB myself and know more about this disease than most doctors and some cardiologists I've spoke with.

The next 7 years during our many visits he told my mother, that son of yours should have been a doctor........
Mom passed 3 months ago at almost 91 with all her mental capacity intact till the last day, never had another bleed but we did switch her to Xeralto 15MG last year after she collapsed and almost died from Bradycardia, had a Pacemaker implanted. She did fine on that NOAC, wish we did it sooner cause her INR was always erratic.

McHale



Edited 1 time(s). Last edit at 06/10/2019 11:20PM by McHale.

My mother had permanent AF starting in her mid 80s, she was put on Coumadin, she took it until she had to stop due to bleeding in her intestines, she lived for perhaps 10 months afterwards, died at 92. The doctors should check the blood before putting people, especially older people on AOCs, for their platelet levels and kidney function. I take a baby aspirin usually once a day and when I cut myself or scratch I bleed quite a bit, I do have low platelets.

L

Many thanks to each one of you for your help. This forum is a balm and I am trying to learn from it as much as I can.

Carey, you are probably right to say it would be a poor decision but my mother is unhappy with warfarin. She sometimes has skin rash and mouth sores and most probably it is due to warfarin. On top of that she complains of going frequently to the doctor for monitoring and considers that an elderly person shouldn't play with his or her health too much. I am just trying to find natural alternatives for her as I am not very comfortable giving her NOACs. I know two old ladies who had bad experiences with Pradaxa and this is enough to discourage me from NOACs. I read Dr. Larsen's book on thrombosis and stroke prevention and am willing to consider aspirin + different vitamins he cites in his book although aspirin gives only 25% protection as he says; or Nattokinase although as you said, I will have no guidance on dosage nor information on possible interaction with beta blockers. My only chance of having in depth information on these 2 options is through this forum and I am very grateful for that.

McHale, I wish I had your knowledge and decisiveness. Your mother was lucky to have a son like you. Unfortunately, unlike you, it is the risk of bleeding that terrifies me. My mother lives 6 months of the year in a mountain village where she spends most of her time gardening. Besides, although her blood pressure is fine on beta blockers, it is not constantly monitored and the village is at a height of 900 meters and the closest hospital is an hour away. Needless to say that the 6 months in the village are non negotiable for her.

Elizabeth, you expressed reservations about AOCs for older people. I think I read from Dr. Larsen that AOCs are of no benefits to the elderly but cannot find it again. Was aspirin not a possible option for your mother? Do you just take baby aspirin, or do you take some food supplements like fish oil to enhance it?

There are reduced dose guidelines for some NOACs. I remember that there is a guideline to reduce the dose of Pradaxa at 75. They also suggest a lower dose if you weigh below xx? Something to ask your doctor about.



Edited 1 time(s). Last edit at 06/12/2019 01:07PM by Daisy.

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MaryY
I know two old ladies who had bad experiences with Pradaxa and this is enough to discourage me from NOACs.

Those aren't good examples to go by because Pradaxa is the one NOAC contraindicated in the elderly precisely because of an increase bleed risk. Although it may have been long enough ago that their doctors didn't know this at the time, "old ladies" should never have been on Pradaxa and wouldn't be put on it today. And keep in mind that warfarin has a higher bleed risk than any of the NOACs. In fact, I'm rather puzzled why your mother was put on warfarin in the first place.

As for aspirin, as you said, it's not effective at preventing strokes, and if you're worried about bleeds it's the absolute last thing she should take. Preventing strokes with vitamins? I'm sorry but that sounds like a great recipe for a stroke.

I don't know what you remember Larsen saying but there's absolutely no truth to the notion that OACs offer no benefits to the elderly. Keep in mind that Larsen's book is rather dated at this point and was written before a great many things we know today were known (or even existed). A big grain of salt is advisable.

I wish you and especially your mother luck but I do hope you've seen what strokes do to people. Trust me, there are things much worse than death.



Edited 3 time(s). Last edit at 06/12/2019 01:22AM by Carey.

Pradaxa is hard on the stomach and is eliminated primarily by renal excretion (about 80%).
Most elderly have renal insufficiency so the drug will build up to dangerous levels and cause these bleeds.
My GI was on call in the ER the first month Pradaxa was released and the nightmare he described was horrible.
He had so many GI bleeds he lost count mostly elderly who almost bled to death. They later attributed it to renal insufficiency...... Creatinine clearance should be checked in all patients before treatment with dabigatran

Forget natural treatments for stroke protection. Aspirin is what probably caused my mothers bleed....
Mom was still sharp till the end, even after her Hemoglobin dropped 8.1 after I brought her to the ER and got diagnosed with cancer. I had them do a fecal occult test which showed no blood in her stool, and consulted with her Hematologist and Oncologist and I got them to approve restarting Xeralto for home Hospice.

She passed after 6 weeks at home,. recalling precious moments and stories in her childhood and life...Priceless! We never told her she was terminal, she would have been terrified, died peacefully in my arms with her sister next to me from Greece......

[www.popsci.com]

A stroke is nasty business......believe me I had one........Thank God my loss of speech lasted for 20 mins, my MRI showed it was miscrovascular which also detected two other older ones.....scary. I didn't want to go on coumadin for years before the NOACs were introduced.

McHale



Edited 1 time(s). Last edit at 06/11/2019 10:42PM by McHale.

Nattokinase may prove to be better than any blood thinner and it has many other advantages, read Dr John Day blog.

[drjohnday.com]

^^^ He specifically says that it's not appropriate for Afib. Too weak. But great for other things.



Edited 1 time(s). Last edit at 06/14/2019 02:32AM by Brian_og.

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Brian_og
^^^ He specifically says that it's not appropriate for Afib. Too weak. But great for other things.

He has to say that doesn't he. There are some long term test results coming in the next few months and we should get a good idea then, that's if they are not screwed by big pharma first.

He doesn't have to say anything. It's his personal blog. He's not giving medical advice and he's not speaking on behalf of anyone else. Day is a pretty straight shooter who isn't shy about bucking the status quo. I see no reason not to take him at face value.

Dr. John Day is a very straight shooter and a very fine man and an excellent clinical EP as well and a past president of the large EP-centric Heart Rhythm Society. He is also Director of Intermountain Medical Centers EP group in Utah that is a fine EP grioup that does a good deal of high quality Cardio/EP related research. And Dr. Day had his own real epiphany a bit less than a decade ago in how to better take care of himself, and his patients, and since then has become is a big proponent of Functional Medicine in its best form, in my view.

His take on the potential important value of Nattokinase, based on all that we truly know about it, to-date, is right on the money in my view and experience. I agree there are some recent quite impressive, yet still small studies on Nattokinase that support it’s potential value as a modest strength blood thinner and, indeed, larger more sophisticated studies are in the works now and should show some results in the next year or two.

However, while Nattokinase as a supplement may well become more widely used and recommended for an array of health benefits in the future, and for many folks it is perfectly safe to add to one’s daily regimen now ... I do think it’s a good option for those Afibbers (and former Afibbers) who stroke scores are low enough as to not require a full strength blood thinner currently. However, in agreement with Dr Day, I do NOT recommend active Afibbers with a CHADS-VASc of 2 or greater to use Nattokinase as a substitute for a better vetted and more powerful anticoagulant drug!

I whole heartedly agree with Dr Day's advice from his audio blog issue 262 in the link above ... that we have, as yet, not been able to recommend active Afibbers with ample evidence that they really do need a more powerful level of protection, to throw caution to the wind and switch to taking Nattokinase on it’s own each day and in lieu of a stronger and better vetted OAC agent.

I’ve been a fan of Natto for over 15 years now (the food as a fermented soybean delicacy in Japan), dating back to my days of living in Hawaii for 38yrs of my adult life, and from
the influence of many close Japanese friends in Hawaii. It is an acquired taste, at least certainly for most Haoles (Caucasians) I’ve known in the islands, but I took to it rather quickly and came to like it more or less taste-wise.

And it was good to hear Dr Day recommend folks to look for the food Natto at better Asian markets typically found in most good-sized US cities. Having Natto shipped on ice is doable too, but beware of the summer months as he noted where it may thaw out quickly in transit.

There is real progress being made, particularly with recent Chinese research on Nattokinase, that may yet lead to more confidence in recommending it’s use for a larger number of Afibbers than we can support doing so at this stage of our understanding.

Be well
Shannon



Edited 1 time(s). Last edit at 06/15/2019 02:07AM by Shannon.

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colindo

^^^ He specifically says that it's not appropriate for Afib. Too weak. But great for other things.

He has to say that doesn't he. There are some long term test results coming in the next few months and we should get a good idea then, that's if they are not screwed by big pharma first.

Well one of his patients got a stroke when she chose Natto over AC. So yeah... Maybe he had to say that.



Edited 2 time(s). Last edit at 06/15/2019 03:31AM by Brian_og.

Thanks again to each one of you for your valuable thoughts. The level of information and analysis I am getting from this forum surpasses by far any conversation I've had with the local doctors here (outside the United States): Nattokinase? Never heard of it. Magnesium? If you want. Replenishing with electrolytes? You are looking in the wrong direction.

Anyway, I hope that at some point I can be of added value on this site, not just learning from it.

Carey, why Warfarin? Because the only antidote available here is for Pradaxa and Warfarin. But because I read very bad things about Pradaxa, we decided to stay on Warfarin.

I will continue educating myself through all the posts in this forum until I reach a level of knowledge that will allow me to take sound decisions, hopefully.

Again, many thanks to all of you for your advice and comments.

Brian:

Unfortunately, there are people that have gotten strokes when taken AOCs, they have posted about it on this site.

Liz

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Brian_og

Well one of his patients got a stroke when she chose Natto over AC. So yeah... Maybe he had to say that.

I should point out she was taking nattokinase and not natto. There is a difference. If she was taking natto she may not have had the stroke for reasons I won't go into now.
She should have taken the advise of her Doctor who knew what her blood pressure, sugar level cholesterol etc. and take the AC, but even then there was no certainty she wouldn't have had the stroke.



Edited 1 time(s). Last edit at 06/15/2019 03:38PM by colindo.

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Elizabeth
Brian:

Unfortunately, there are people that have gotten strokes when taken AOCs, they have posted about it on this site.

Liz

Hi Liz

Yes. Even on AC people still get strokes. But fewer. One of the things we can infer from Dr Day's article is that since nattokinase is a weaker AC then the number of strokes would be larger. If we believe the entirety of the article then why, at least with present data, take nattokinase instead of a regular AC?

Brian

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MaryY
Carey, why Warfarin? Because the only antidote available here is for Pradaxa and Warfarin. But because I read very bad things about Pradaxa, we decided to stay on Warfarin.

Mary, there are four things you need to know:

1) The existence of reversal agents isn't as important as you think. The reversal agents for the NOACs and warfarin are used extremely rarely. Ask any trauma surgeon and they'll likely tell you they've never used it at all, or they've used it only once or twice.

2) Reversal agents are available now for Eliquis and Xarelto.

3) It's tempting to think there's a magic elixir that will reverse warfarin quickly. I'm sorry but there is not. Vitamin K takes many hours to reverse warfarin. In fact, it takes longer to reverse warfarin than it takes for the NOACs take to wear off on their own. One of warfarin's biggest drawbacks is its long half-life. It takes days to clear your system when the NOACs drop below effective levels within about one day. Warfarin is never, ever a safer choice than NOACs when it comes to bleed risk (or much of anything else) in afib patients.

4) And last but not least, Pradaxa is not an appropriate choice for someone your mother's age, and it's been quite a while since it was the only NOAC choice (years). Eliquis would be the best choice, and it is superior to warfarin in virtually all measures, particularly with the elderly (effectiveness, bleed risk, ease of maintenance).

Please re-visit this subject with your mother's EP. Your information is years out of date and your mother is not receiving the safest, most effective treatment. Considering that she's having side effects from the warfarin and having to travel for INR testing should be reason enough to reconsider.



Edited 1 time(s). Last edit at 06/15/2019 05:59PM by Carey.

Gosh, 86 yrs old, I should hope to see that age gladly. Id feel like I was playing with house money and roll the dice with some good Natto before i got on the NOAC rollercoaster.

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hwkmn05
Gosh, 86 yrs old, I should hope to see that age gladly. Id feel like I was playing with house money and roll the dice with some good Natto before i got on the NOAC rollercoaster.

You're going to advise an 86-year old with persistent afib to skip anticoagulants and rely on natto? Wow, speaking of rolling dice.

And in what way are NOACs a rollercoaster?

I'm 84 years old and have been on blood thinners for 12 years. Originally on Warfarin but for the past three years on Eliquis. I've had a minor stroke and a couple of TIAs during this time. I'd be scared to go a day without it in my blood stream.

Well, I need to find out more about Natto. I had an ablation in September of 2016 and it lasted until June, 2018. Then, I was going in an out of
a-fib for awhile until I chose to have a Cardioversion in November, 2018, because it was going to be 3 months before my EP could schedule another ablation. The Cardioversion worked great until around June 1,...and I've been in and out since then. I took Eliquis for the required 3 weeks before the ablation and then again before the Cardioversion, but stop taking it as soon as possible afterwards because for me,it did cause a bit of bleeding from the rectum, so I'm terrified of taking it.
I've always been athletic and even though I'm 83 now, have never stopped race-walking, bicycling, hiking and still work-out with free-weights, balls and bands 3 times a week...even with the A-fib, which of course makes it a lot harder and I've had to cut back somewhat since I get so out of breath...I've always felt my hobby of staying physically fit protected me from having a stroke,...and of course if your heart's NOT in A-fib, it is almost an assurance against stroke,..but the doctor's say no matter how physically fit you are, and even if you're walking four miles every day, climbing stairs,..etc...etc...nothing protects you when you have A-fib going on. So far, I've been very defiant, however, and although I know I'll have to take it when my EP schedules another ablation, I'm not taking it now, so naturally do feel like I'm taking a chance. Is there anyone out there who has a-fib and not taking a blood thinner??
.

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Sunny82
Is there anyone out there who has a-fib and not taking a blood thinner??
.

I am not taking any blood thinner other than natto every second day (45gms) and nattokinase the other days.
I should point out that I have never had an ablation. I have good blood pressure, a normal blood sugar level. I have a CHAD score of 2 only because I am 75 years old. I am active but don't workout, maybe walk 5000 to 10000 steps a day.
I used to have afib about once or twice a month but with diet change and natto - nattokinase consumption, My afib burdon is now one event this year.
I should also point out it's a very slow process, (not a quick fix) It has taken over 12 months to get to this point.

I hope that helps

Thanks for your reply..How great that you've only had one afib event this year!.