NOAC's

Hi,

I am a 74 year old female working 4 days a week and reasonably healthy although a bit overweight at the moment but not by a huge amount. I believe my AF is 95% associated with eating mainly, and sometimes with physical stress although there are times when I can work very hard in the garden digging and building rockeries etc and has no effect.I was walking around 8km a day but the side effects from the drug have prevented me from continuing to do that.

I must add that I lost a lot of weight 2 years ago and only had 3 episodes of AF in a six month period.

I am currently taking Eliquis for my AF, prior to that I was put on Xarelto and suffered a PE whilst taking it?

I have no idea why I was put on these drugs initially as I have managed my AF very well and have there has been no burden to my heart (Cardiologists words) I am also very annoyed that my Cardiologist did not explain at all the associated side effects, and most importantly,, the possibility of a rebound effect if you wish to stop the medication.
When I tried to explain to my cardiologist about the side effect he became very annoyed and said "it's only a blood thinner"

I get bouts of AF 3-4 times a month and usually last around 8 hours. I use Flecainide as a PIP and rarely, but sometimes Metoprolol.

I suffer excruciating pain from reflux/GERD since starting these new medications and they are literally ruining my life.Moving, bending sitting is very painful. Eating is a drama and I belch and regurgitate.

I have been subscribed Nexium 40 at first and now 20 both of which also have nasty side effects.

I live in fear of a bleed from the Eliquis (and Nexium combination.)

Any suggestions on what I can try? And has anyone weaned themselves off the NOAC;s successfully?

Regards

Joy

Kind Regards

Joy Win

Joy - Sorry to be late in responding. One of the comments none of us like to hear is that regarding the "age factor"... but realistically, we can't ignore the fact that along with age, often comes detrimental accumulations of habits and 'wear and tear' on our body. It's a multifaceted topic... the ravages of aging, but a short version is that it's commonly known that prolonged arrhythmia... that which lasts more than an hour or two, can produce blood clots which may manifest in stroke or heart attack. For that reason, doctors typically prescribe anticoagulant therapy as preventive 'insurance' against stroke.....and consideration is given to age, health factors, weight, etc.

Since I typically have negative effects from blood thinners, I've done some reports about what we can do to help prevent "thick, sticky blood" by monitoring factors that measure that tendency. Dietary choices obviously are strong influences and avoidance of anything that results in 'silent inflammation' in the body is strongly recommended. I've listed at the end, some of the links on this topic. Testing is a must and it's often difficult to convince doctors to run the specific tests, but those practicing Functional or Restorative Medicine or Naturopaths are familiar with the importance of these and can order them. The problem is that these doctors aren't always easily accessible.

My situation is that I have a mildly low platelet count. That makes taking blood thinners difficult; however, I did have to use Eliquis and I must admit I was extremely fearful. Still, I had no choice as my events were A-flutter for the most part and long lasting. Most of the time, I required Electrocardioversion and often that didn't last. I was scheduled for a second ablation 11 years after the first one, so I knew I'd need an anticoag - regardless. I was in my late 70's.

I, too, worried about the risk of bleeding if injured and fortunately, was spared of anything major. Bruising was common but I expected that. Small cuts didn't cause much that was abnormal and I always carried a "kit" of a powder that I could apply quickly if I had a trauma away from home. Fortunately, it's still unused.

There were side effects as I also have multiple chemical sensitivities but I learned to cope. I did have to cut back significantly or eliminate totally, some of the natural substances I typically used to keep my blood thin and not sticky... and because of that, I noticed some aches and pains reappearing that were managed successfully with the natural antiinflammatories. Other than that, it was uneventful. And all improved when I was able to lower the dosage by half.

Your stomach issues are another aspect. The Nexium type products block production of stomach acid... which is important to break down food so it can be utilized. It's not uncommon to have complications when you don't have enough natural stomach acid. That's a whole other topic and I can direct you to various reports on those issues as well if you like.

The bottom line is, your afib events at 8 hours are relatively long and could cause clot formation especially if other factors that contribute to thick, sticky blood are present.

Start with this post on the NOAC Topic... and my response given the link to the Thick, Sticky Blood report.
[www.afibbers.org]

If you use this link [www.afibbers.org] you can read through 4 pages of related links to the "thick, sticky blood" topic.

Hope this helps. Let me know if I can clarify or elaborate more.

Best to you,
Jackie

Thanks for the reply Jackie. I find I bleed a bit from cuts and nicks if I'm gardening or using tools like saws etc. I don't get too concerned about them.My big worry is GI bleeding as I feel the Eliquis is causing ulceration.Right now I'm between a rock & a hard place trying to balance my medication and have some relief from this pain.
I'm a vegetarian so my diet is good and I I've always had fairly thin blood and tiny cuts could bleed for ages. I don't eat junk foods apart from some chocolate now and then. I will read the articles you mentioned and also try some natural supplements. Any information or references to articles is helpful and appreciated.

Regards

Joyg

Joyg - consider using a high-count probiotic to ensure that the integrity of your GI tract is healthy. An imbalance between 'good and bad' gut bacteria can be a negative influence on overall health and obviously, that of the fragility of the intestinal mucosal membrane, itself.

Reliable, effective probiotic brands are many...and include the product line by Garden of Life specifically that designated RAW Probiotics, and also Ultimate Flora with 30 or 50 billion cultures. A variety of probiotic species in one dose is important because so many act in different ways to ensure a healthy bacterial colony. The ultimate probiotic, VSL#3, is very pricey but highly effective when taken in the recommended doses.

When I went on Eliquis, I had already been using high-count probiotics for many years and fortunately, I didn't notice any GI changes.... although as I noted in another post on Eliquis side effects, I did notice many other undesirable effects, unfortunately. [www.afibbers.org] I just learned to cope and eventually, the half-dose eliminated some of those issues.

It's also known that vegetarians typically tend to be deficient in vitamin B12 and that iron and zinc are more difficult to absorb from plant sources so be aware you may need to supplement those. On the B 12, it's important to choose the form of methylcobalamin and in higher milligram doses rather than microgram doses. Zinc chelate products are also more readily absorbed. Just FYI.

Jackie

Hi Jackie

I do take a probiotic but I will try one of the ones you have listed. My B12 Iron and Zinc are all good as I supplement as well as combine foods that provide those Vitamins and Minerals. In fact as a vegetarian I have quite 'thin' blood and in the past alway bled freely when I cut myself. Which is why I was surprised when I suffered a PE whilst on Xarelto, as were the Drs who kept insisting I must have missed a dose or even stopped taking it all together which was very annoying.

I'm not happy taking blood thinners because I believe they change the composition of my blood as well as the awful side effects they cause, However because of the constant talk about strokes from my Drs I have become a bit cautious. For me that's a big decision as I've always managed my AF very successfully in the past and still do. As I also have Parkinsons Disease I am forever trying to balance what's best for my body.

Thanks for the information. I have read some of the articles about sticky blood which are all very interesting, and I am also trying the organic Apple Cider for my reflux.

I firmly believe my AF is Vagal as I can bring it on if I eat quickly or too much or have spicy food or even sodas. Wine will do it sometimes as will beer, but heck one has to enjoy life a bit now and then,

Kind Regards

Joy

Jackie,

My events last between 3-8 hours (often closest to 5). I had often heard that episodes > 24-48 hours are considered the "warning" benchmarks for when clots may form. Is it commonly accepted that clots can form in < 12 hours? This would radically affect my approach to how long I'd wait for an ablation if so.

Thanks!

-Eric

Eric - Much depends on the blood's typical viscosity status... or thickness. There are many influences that cause blood to be overly thick and sticky...and which make it a definite risk for clot formation with dire consequences... even without arrhythmia. Add in, arrhythmia and the risk factor increases... so the arrhythmia time factor depends on viscosity.

You can scan through this previous post on thick, sticky blood and the influences that cause it. And also note Shannon's response on the newer viscosity test from Meridian Valley Labs for monitoring. [www.afibbers.org]

When I began my afib saga 21 years ago, it was common to routinely put patients on warfarin/coumadin for blood thinning protection. Now we have more options. Back then, and because I didn't tolerate warfarin, I did a lot of research on natural blood thinners and eventually stopped the Rx anticoagulant. I waited 8 years before my first ablation which then lasted 11 years.

I settled on a combination of the fibrinolytic enzyme, Nattokinase 3 times a day, Omega 3 fish oil, magnesium which is anti-platelet aggregation, and several herbals known to reduce inflammation that causes sticky blood. Among those were pycnogenol or Maritime pine bark - which tested well in a study for preventing blood clots in legs on long-haul flights, ginger, ginkgo baloba, vitamin K in the MK2 form, curcumin and a few others. Mainly, nattokinase is the major protective supplement. The others are added insurance.

You can read more about Nattokinase in Conference Room Sessions 39 and 40 that resulted after my research with Ralph Holsworth, DO, who is the Nattokinase expert in the US. His guidance was and is... invaluable.
[www.afibbers.org]
[www.afibbers.org]

I had a large number of AF events over the years both before and after ablations, the Nattokinase definitely kept me safe from adverse clotting... and the higher dosing of Omega 3's was also at the top of the importance list.

If you can have the Meridian Valley test, that would be ideal.

Hope this helps. Let me know if I can elaborate more.

Jackie

Eric,

The recognized beginning window of not just when a clot can start to form, but the earliest time frame accepted now for beginning of actual stroke/TIA risk is 5 hours after onset of AFIB.

The 24-48 previous window was a rough average time frame as obviously not everyone is going to have a stroke after 5 hours of unprotected AFIB... Thank goodness.

But the 5 hour time frame is important as people can and have stroked in that time frame marked from beginning of AFIB episode.

Also, I would not use waiting for 24-48 hour long episodes as the metric from which to then pony up for an ablation. While some folks start out in persistent AFIB, most experience a gradual progression over time during which gradually accelerating rates of structural remodeling start to set in and for most such more typical AFIB progression stories, by the time you get to clocking regular 24-48 hour episodes you have very likely insured yourself a much more extensive ablation process to secure long term freedom from the beast as well.

The better rule of thumb is, at the beginning of AFIB,or at least as soon as you find this website and/or discover kind of experieced well-seasoned advice, make a 6 month to 1 year dedicated effort to essentially end your episodes, or at least come very close, via all the life style risk factor/ weight loss if needed, address 'metabolic syndrome diabesity' issue and OSA sleep apnea, and adopt good diet and Strategy repletion. If you are not almost totally successful ( as in George's case as a guideline example, who though he still will have a very occasional but pretty rare eoidode from overdoing exercise mostly, he is able to quickly end the episodes often in under an hour and he is not having a dozen episodes a year or there abouts either.

If you are having even a big reduction in episodes that is super, but if that reduction is still in the roughly one episode a month or more range and those episodes last a few hours up to more than a day ... And if this is your new normal even after having adopted all of the above self-health protocols, ... then do not procrastinate in also adding I. An expert ablation process any longer and hook up with the best ablationist you can.

I don't agree that so called 'well-managed' AFIB includes having AFIB a dozen or more times a year. It may be a big improvement over having three a day, to be sure, and a big step in the right direction. But don't get complacent just because things are a good deal better. When you are still triggering AF at a rate of one a month level, the odds are very high you are continually laying down more structural remodeling/scarring etc such that at a certain point the odds are you will suddenly increase frequency again over a matter of months until you become 24/7 persistent and thus will almost certainly have made a tougher road for yourself.

Don't do like I did and drag it out 16 years before making sure you do everything possible to put this genie back in the bottle for the long haul ... Instead, do what we strongly suggest and do not accept AFIB as even a monthly visitor in your life. Especially if you are in your 60s and younger and enjoy a relatively active life. That is not at all 'well-managed' AFIB in my book, it is mostly just drawing out the inevitable at that point and increasing the odds for even more ablation and more areas of both atrias needing to be addressed while increasing the odds of steadily increasingly silent cerebral ischemia (SCI) which are tiny white spots accumulating in your brain over time that are individually asymptomatic but accumulate overtime with on-going modest or greater AFIB burden, leading to a significant increased risk of early onset dementia.

But I also know that most people will postpone adding in an expert ablation long past when it might be best for them to do so and will hold out until the AFIB just gets so intolerable that they are basically willing to sell there home and mother both to get back to NSR before they finally make that decision. I fully understand and did the exact same thing, even though I was never overweight or out of decent shape and ate well since my teens and mostly was health conscious most of my life since then as well. Even was able to buy about 5 years of near total freedom from AFIB via a close Strategy-like protocols etc. but still I procrastinated and rationalized up a storm to convince myself I had this all under control until I finally flipped into 24/7 aggressive persistent AF that no amount of supplements, dietary changes of redoubling RFM efforts would alter the reality that I had waited a good deal too longer than was in my own best interest.

My AFIB story has turned out very nicely in any event, but in the process due to my lng prior 16 year history before connecting with Dr Natale (and to be fair most if that 16 years was either before AF ablations even existed or they were still in the dark ages), but nevertheless I had to go through just about every EP procedure known to man and some of them many times with 16 ECVs and 14 TEEs, two ablations, a LARIAT and LARIAT leak plugging device ( not to mention a pacemaker now half way through generation two) etc. to win back the blessings of constant unbroken NSR I've enjoyed for years now.

If only a handful of afibbers really digest the message to first adopt aggressive self-health as a life time commitment but then also remaining open and willing to partner with the very best most experienced EP they possibly can, when and only If, all the Self Health measures fail to deliver truly outstanding degree of freedom from all arrhythmia. The content focus on emphasizing this balanced truly integrative path your ads reclaiming a quite heart as soon as is practical
will have been well worth the effort.

Shannon



Edited 1 time(s). Last edit at 07/17/2016 12:20PM by Shannon.

-edit- I should add I am 38. -edit-

Thanks Jackie, I will try and see if my PCP can authorize the Meridian Valley test.

Thanks Shannon, I took your advice back in 2013 when I was first diagnosed with afib. I went from weekly episodes in 2013 to having had 4 episodes this year (two recently), I was doing extremely well until I had a rough patch of indigestion. I made all the changes you'd expect. Supplement magnesium && potassium. Eat healthy, meditate, yoga, and reduce sugar, bad foods / alcohol, etc.

Since I've only ever had afib episodes as a result of indigestion over the past 18 months, I am keen on trying to solve these indigestion issues, and hopefully reduce afib episodes even further.

> If you are having even a big reduction in episodes that is super, but if that reduction is still in the roughly one episode a month or more range and those > episodes last a few hours up to more than a day ... And if this is your new normal even after having adopted all of the above self-health protocols,

I am on pace for 6 or 7 afibs this year. With episode average around 4:30 hours. (6 max).

My current EP is Dr. Mittal here in NYC. He suggested we should just see how things proceed and once I cross a threshold, we'll just ablate. I was thinking of also talking to Dr. DiBiase as well, as when it is time to ablate ,I think I would choose Dr. Natale.

This is frustrating, because my episode average is flirting with 5 hours, but I am only getting events every few months, and only when I am having indigestion issues at night. It seems like a hard call at the moment.

Thanks,

-Eric



Edited 1 time(s). Last edit at 07/17/2016 05:16PM by erich.

Sounds good Erich!! I wouldn't worry about the strike risk at you age and infrequency of AFIB with durations still so short.

Take Cardiokinase as we have noted before while you are still not official qualifying for NOACs but would like to add a bit of extra pretty harmless insurance on that front.

Cheers!
Shannon

Shannon and Jackie

I read your comments with with great interest and gratitude )along with just a twinge of fear we all want to live for as long as we can and be in as good health as is possible, and given my years I'm not doing so bad. I do contend with a number of chronic conditions that are sometimes hard to manage, but by far the one that causes me the most stress and heartache (pun intended) is AF.

I have always believed one must be responsible for their own health as well as considering all of the advice, some good and some bad, that the medical community has to offer, but with this condition the only advice from my Cardio and GP has been "take your medication" Well I have done that and it doesn't really work for me. I still get episodes of AF every couple of weeks and sometimes more than that.

I have followed a lot of the advice and read many articles on this site and if it hasn't stopped my AF it has given food for thought and calmed my anxiety on many occasions. In fact if I'm having a particularly bad episode in the middle of the night I can be found on this site reading and re reading comments and articles...works better than any meds I take.

I am health conscious and eat well and use supplements. I was on Xarelto but I had a PE whilst on it so I was switched to Eliquis. However I have found taking Eliquis also has been a problem and has many side effects including heartburn/reflux, headaches, joint pain etc. I'm trying to work out a way to come off it but that's another story

I was concerned to read about the window of 5 hours > as a risk for stroke as I've always followed the old line of 24 to 48 hours. And my Cardio reiterates that every time I broach the subject with him, so as well as keeping me calm you also give me solid information and this is important. I am aware this window does not mean any more than an approximate as we are all different in how AF effects us but it's a timely warning to not take anything for granted and to keep abreast of the current dialogues.

I have spoken to my Cardio about ablation but he just brushes it off and says you don't want to go there?? Am I too old at 74? Or is it because I have Parkinson's. He doesn't elaborate at all and I get the feeling maybe I've been seeing him for too long.

Are you aware of any good Drs and Electrophysiology in Melbourne that are involved in the treatment of AF.

Thanks Again