NSAIDs with a fib

Hi Everyone,
I suffer from paroxysmal a fib. I take metoprolol succinate and a baby aspirin. I have had only 3 episodes this year. Just recently I did something to my neck and if I turn it to the right I have this terrible pain so the Dr. gave me a prescription for naproxen 500mg 2 x per day for 10 days. I know that if you are taking a blood thinner you are not suppose to take any NSAIDs but my dr said that for short term I would be alright. I am more concerned with having an episode of a fib. Has anybody had to take any type of NSAID or meloxican and been ok with it not causing an episode of a fib ? Thank you .

What about Acetaminophen?

I tried Acetaminophen but just took the edge off the pain that’s why my Dr recommended the naproxen.

NSAIDs are perfectly fine with afib. No problem for anyone I've ever heard of. And your doc is right that it's okay to take them short-term with blood thinners.

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Carey
NSAIDs are perfectly fine with afib..

Where are you getting this? There is plenty of evidence in the literature of increased risk of AF associated with NSAIDs. At the least, some caution should be observed wrt dosage and duration.

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safib
Where are you getting this? There is plenty of evidence in the literature of increased risk of AF associated with NSAIDs. At the least, some caution should be observed wrt dosage and duration.

I get it from the real world where multiple EPs have told me and others that NSAIDs are perfectly fine for short-term use. I already mentioned that duration needs to be limited. Yes, there's an increased incidence of afib among people who use NSAIDs, but that doesn't mean NSAIDs cause afib, and it definitely doesn't mean that it triggers afib in people who already have it. I've seen just about every drug, every substance, every food and beverage, and every activity known to man blamed as a trigger -- but never NSAIDs.

Your real world experience is different than mine, as I have been told to avoid them. One of the better studies showed increased risk during 15-30 days of coincident use, but not beyond that. This suggests a triggering effect. Rigorous analysis of triggers of any type is not yet available.

Sure, EPs will always tell patients with afib to avoid them because of the bleed risk, but I've never heard any EP suggest avoiding them because they trigger afib. Never heard a patient say they're triggered by them either.

I think it's very likely that the only association between NSAIDs and afib is a common factor. For example, one thing we can be sure of is that someone taking NSAIDs has inflammation of some sort, and inflammation is a known trigger (one of the few I believe in). And I would bet there's a strong correlation between long-term NSAIDs use and obesity because obesity makes arthritis more likely. Well, sleep apnea is common among the obese, and sleep apnea is another well established trigger. So there are all sorts of ways there could be a correlation between afib and NSAIDs that have nothing to do with NSAIDs causing afib.



Edited 1 time(s). Last edit at 12/06/2019 08:07PM by Carey.

My EP was concerned about inducing arrhythmia and recurrence of paroxysmal AF, not bleeding. So there's a counterexample for you.

But much more importantly, the evidence shows that the increased risk of AF was highest for new and current NSAID users at the time of their first diagnosis, meaning that their first ever prescription for NSAIDs was within 60 days of the diagnosis. The expert assessment of the mechanism in this most susceptible group is short term renal effects of NSAIDs, which subsequently trigger atrial fibrillation. Longer term there seems to be some adaptation to the effect. It is not an unambiguous picture by any means, but it is better than speculation. Incidentally, the risk was lowest for non-selective NSAIDs and highest for COX 2 so this may also provide some guidance for those who want to take an evidence based approach, even if it is preliminary.

NSAID's cause electrolyte shifts in the NA+/K+ ratio in the Atria, both at onset, and upon withdrawal of the Drug. Also other factors are at play like shifts in Blood Pressure. Not saying its a major factor, but it can contribute to AFIB, not only when on the NSAID's but also after stopping the Drug.

This is all interesting theoretical stuff. Now find me some people who experience afib after taking NSAIDs and you'll begin to convince me.

Up until I started taking elequis I always used NSAIDS for pain. Don't ever recall having onset afib that coincided with taking them. Also, was instructed by my EP that even though I was on elequis I could still take NSAIDS but needed to limit the duration.

My EP said ok to NSAIDS while on Elequis....but limit duration. He never mentioned them as a potential trigger.

I avoid NSAIDs for several reasons, but causing afib, isnt one of them. I usually take them twice per year for the onset of a cold and reducing inflammation in my throat.