prn blood thinner helps against stroke how soon?

Hi,

Sorry to ask such a basic question and probably already been answered but forgotten.

If one is doing well for months and has been given the okay not to do blood thinners every day, but only start one if an episode of atrial flutter feeling occurs for more than 4-6 hr, how much protection how soon does this give against a possible stroke? I will be taking Eliquis if that happens, so I wonder why my local EP would be fearful of me having a stroke & wants me to take Eliquis every day instead.

Just looking for reassurance.

Thanks.

I asked an EP I highly respect that exact same question once. His answer was, "Why wait? Just take it as soon as an episode begins."

He's right. There's no consensus on how long it takes for clots to form during an AF episode, and at least one study has shown it can be as fast as 6 minutes. Following some randomly chosen period of time to wait accomplishes nothing, and might incur risk.

Quote
Carey
I asked an EP I highly respect that exact same question once. His answer was, "Why wait? Just take it as soon as an episode begins."

He's right. There's no consensus on how long it takes for clots to form during an AF episode, and at least one study has shown it can be as fast as 6 minutes. Following some randomly chosen period of time to wait accomplishes nothing, and might incur risk.

Thanks Carey. Shannon said the same thing once, i.e., why wait the 4-6 h, why not take it as soon as I felt an arrhythmia. It was Dr. Natale's NP who said after 4-6 hr of feeling arrhythmia, take the Eliquis & that I could send her my Kardia to tell me what she sees on it.

I have no problem taking the Eliquis right away, but even then I was wondering if that was enough to keep me from risking stroke. Can one dose of Eliquis after flutter onset actually be enough to avert a clot getting formed or through? So, when one study says clots can form as quick as 6 minutes, that means I better be very aware of any arrhythmia, take my Kardia, take an Eliquis, send my EKG to Kim, Dr. Natale's assistant, for Dx of flutter.

I was organizing some papers tonight & ran across medical notes on one of my sisters who first got early Alzheimer's & she had diagnosed atrial fibrillation, which I had not remembered. So I bet she was having the TIAs because of either untreated or not properly & fully treated afib. They first thought it was multi-infarct dementia. Throughout several office notes, she was having episodes that her Dr said s/l afib after her tennis games. Other than eventual Coumadin (after everything had already been happening), she continued to have more TIAs I believe, or at least damage & I read nothing about her being put on antiarrhythmics, just a small mention one time of being on a beta blocker. Like me, she was trim, athletic, otherwise healthy & a very active individual.

I think I have been saved bec of this group & the awareness you have given me to look into things more & be more vigilant in following up what is going on with me the past 3 yrs or so.

I had one more sister after the older one who also developed early Alzheimer's, but I don't really have her medical notes to understand what happened to her. Like all of us (6 females) she was trim & healthy & active. Perhaps afib does run in my family & it was not all due to my thyroid medicine. (I had a total thyroidectomy in 2005 & have been on replacement therapy of natural dessicated thyroid since about 2007, synthetic replacement at first). I do feel some of my afib was due in part to overtreatment of my thyroid, but not completely. It has taken time, but I have altered my medicines & that has helped. I am so glad that I did get the ablation too. I still have fears of return of flutter or even afib at some point, but for the most part am so much more aware of taking care of myself if I feel odd (tight chest, palpitations, shortness of breath).

I cannot believe I did not have time to go back into my sisters' hx sooner & connect the dots & see that possibly the only reason they developed early Alzheimer's was because of untreated afib & strokes - that is possible & would relieve her 2 children to know they might not inherit the gene for Alzheimer's. It is also sobering to realize how close I have come to the same fate they had. I told every single doctor about my 2 sisters with the odd "early Alz dx" & all wondering exactly what caused it for them. But ultimately it was up to me to make the connection & see that I might have been experiencing some of the same things as they did, but I started getting help in the correct way sooner.

Sorry, I just went off.............after going through these old notes - you can imagine after 10-11 yrs of each sister consecutively going through this disease before dying & wanting to put it behind me. But maybe I was headed the same place & I hope I am doing the right stuff now.

Thanks so much for all your help.

Carey:

i think your 6 min. time line for a clot to form after going into AF is not in line with most thinking.


“How long do I have to be in A-Fib before I develop a clot and have a stroke?”

When blood is stagnant and not being pumped out of the left atrium, a clot can form. When the left atrium starts beating again, this clot can be pushed downstream into the left ventricle which then pumps this clot into the legs, lungs, brain or other organs causing an ischemic stroke.

But these clots aren’t formed instantly. It takes a while for stagnant blood to pool and clot. For example, if you have a ten minute attack of A-Fib, conventional wisdom says it’s unlikely a clot will develop.

The American College of Chest Physicians recommends that anticoagulation therapy be started after two days. But not everyone is in agreement that it takes at least two days of being in A-Fib for a clot to form. Dr. Antonio Gotto in Bottom Line Health says it takes one day for a clot to form, “There’s an increased risk for stroke if the irregular heartbeat continues for more than 24 hours.” (Some doctors are of the opinion that it takes as little as 5 1/2 hours of A-Fib for a clot to develop.)

Quote
Elizabeth
i think your 6 min. time line for a clot to form after going into AF is not in line with most thinking.

No, probably not, but those are the findings from a study done just a few years ago. The results raised eyebrows, but nobody yet has refuted them so far. I doubt it's that short a time period except perhaps with very ill people and people with sky high CHADS scores, but the trouble is we don't know what the real numbers are. For many years 48 hours was the accepted criteria, but that began falling apart a few years ago when evidence of much shorter times became apparent. So now it's all over the map. Some hospitals and doctors use 24 hours as a guideline, others use 8 hours -- there's currently no standard.

So whatever the real number is, it makes no sense for Madeline to wait at all. All of the NOACs become effective within about 20-30 minutes, so if you take one right away when an episode starts, your at risk time is really minimal.

While having afib and using blood thinners is a no brainer, having afib does not mean you will have a stroke if not on blood thinners. I had afib for 5 years with over a 100 episodes and didn't know it was afib. I was misdiagnosed with "occasional irregular heart rhythm because of mitral valve prolapse". Finally caught the afib on an ECG and I didn't have mitral valve prolapse as it turns out. Then six years on meds with 200 episodes and finally an ablation. This all started 25 years ago.

Is your EF while in afib involved with blood clotting ?

Madeline,

Do some research on Nattokinase.
I take nattokinase for blood thinning.
This is one link to get you started. [www.ncbi.nlm.nih.gov]

You know I think there could be a link between thyroid problems and afib. The heart and thyroid are both able to produce calcitonin only if stimulated by vitamin k2. Calcitonin controls calcium in your arteries and directs it into your bones where it belongs.
There is not a lot of vitamin k2 in the western diet and you may also do some research on Natto which is fermented soybean from Japan and is high in vitamin k2 and nattokinase. It's a miracle food.

[draxe.com]
[www.nyrture.com]

Natto and vitamin D has cured my monthly afib.



Edited 1 time(s). Last edit at 12/06/2020 01:45PM by colindo.

Colindo,

I have no idea what my ejection fraction is, nor do i know what it would mean! But I should’ve clarified to everyone that I had my ablation 8/2/19 and I am clear of the A-Fib for quite a while but it’s the flutter that has come back a time or two. Dr. Natale is fine with me being off the blood thinner and only using it if I have another episode and then for sure eventually following up with the “touch up “ablation. I am OK with that until I have to see the local cardiologist or EP here for routine followup (& then they want to put the fear of God in me that I am going to have another episode and possible stroke & need to be at least on a blood thinner if not on an anti-arrhythmic. The EP was ok with me just being on a blood thinner daily, but I am following Natale with the prn Eliquis.

Am I the only one who has run into some conflict with their local doctor by seeing them for care but mostly following the advice of my out of town electrophysiologist Dr. Natale. It has been a challenge to balance following each doctor as much as possible. The local doctor has helped me a lot too when things have gone awry here, so I have tried to comply just enough for them to not kick me out for not following all their advice.

I should have made my last reply to Pompon, not Colindo - re the EF. Sorry.

Thank you, Colindo. I have definitely heard good things about nattokinase. Appreciate your input.

Madeline,

I am encouraged to read that Dr. Natale recommends PRN Eliquis for you. I see a great electrocardiologist at Duke (Dr. Bahnson) who did two Afib and 1 flutter ablation for my husband and saved his life as he had an AVM that burst and a hemorragic stroke that would have killed him if he had been on a blood thinner. My brother had afib for 20 years as his not so hot doctor told him he should not get an ablation because it was too new (it wasn't). He was brilliant and started to deteriorate cognitively on COUMADIN (really stupid) a few years before he died at age 79 and also had "Alzheimer's" supposedly which I don't believe. He had many tiny strokes (like 40 towards the end) at some point. He was very athletic and had one stroke at 77 after trying to swim under water for the length of the pool. He died walking around his neighborhood with his friend from a more massive stroke. His thought processes were like Swiss cheese. He could correct his aphasia sometimes by using other words. He also had an aortic valve replacement (he swam a half mile the month before which is crazy) several years before he died which was successful but can't have helped.

This is all to say I am not excited about getting on Eliquis full time, which my doctor recommends (I am 68 and a woman, which he believes is a significant risk factor). I have a new puppy and given the bleeding that occurred when I started the Eliquis and simultaneously got the puppy, he agreed I could delay until biting was no longer an issue! I have had four incidents of Afib this year--3 in September due to stress, one in March. None last longer than 1-6 hours. I convert with liquid magnesium thank heavens so far.

My question for the group. How long would one take Eliquis PRN after an Afib incident? A week?

Karin

Quote
karin
My question for the group. How long would one take Eliquis PRN after an Afib incident? A week?

That was the advice to me.

But there aren't established guidelines for using anticoagulants prn in the first place, so there isn't really a right or wrong answer.

Speaking from experience - a STROKE is way worse than any AFIB event. You want to avoid a stroke more than a heart attack, more than cancer, more than picking fights with Harley gangs. Knowing the variability of OTC supplements I would not trust avoiding a stroke to anything less that the best NOACs that exist today. To me - eliquis is a life and death matter to take on time, without fail and as far as I am concerned I'm OK with it for the rest of my life. Stroke is a bitch. Even minor stroke, even TIA stroke. YOU DON'T WANT IT.

Hay NLAMA,

Is eliquis 100% guaranteed in preventing a stroke.

Colindo

Of course not, there have been people that have written on this site that have said they were taking a blood thinner and had a stroke. I am not saying that you shouldn't take Eliquis or Xarelto etc. especially if you are in AF permanently which I am now. My mother was on Coumadin for about 8 years and had to quit because she was bleeding internally. All drugs have side effects but sometimes I guess you have to accept it. The thing is if AF can be cured, that would solve all of our problems, but I am sure we probably won't see that happening for a very long time.

I have to take a thyroid med. because I had Graves disease about 30 years ago and had my thyroid nuked, so I have been on a thyroid med. since. I was paraoximal AF for about 20 years and did not take any blood thinners during that time, i never took Natto because it is made from soybeans which is a no no for my thyroid, i realize it is fermented which could make a difference, I have also discovered that soybean oil causes migraines in me, so i am leery of it. I also believe I went into permanent AF almost a year ago because my thyroid went hyper (I took the same amount of thyroid meds for years without any problem). So, yes, I believe our thyroids and AF march together.

Quote
colindo
Is eliquis 100% guaranteed in preventing a stroke.

That's a straw man question.

There's no 100% guarantee of anything in medicine, but Eliquis does provide a predictable, reliable, proven level of risk reduction. So do all the other FDA-approved anticoagulants. I don't know of anything else that can make that claim.

Quote
Carey

Is eliquis 100% guaranteed in preventing a stroke.

That's a straw man question.

There's no 100% guarantee of anything in medicine, but Eliquis does provide a predictable, reliable, proven level of risk reduction. So do all the other FDA-approved anticoagulants. I don't know of anything else that can make that claim.

I know it's not 100% guaranteed in preventing a stroke but NLAMA seemed to infer that.
We've had this discussion before and I won't carry it on.

Quote
NotLyingAboutMyAfib
Speaking from experience - a STROKE is way worse than any AFIB event. You want to avoid a stroke more than a heart attack, more than cancer, more than picking fights with Harley gangs. Knowing the variability of OTC supplements I would not trust avoiding a stroke to anything less that the best NOACs that exist today. To me - eliquis is a life and death matter to take on time, without fail and as far as I am concerned I'm OK with it for the rest of my life. Stroke is a bitch. Even minor stroke, even TIA stroke. YOU DON'T WANT IT.

Also speaking from experience, after seeing my father—once a physically active ex professional baseball player in his prime — the decay of having over a dozen strokes changing him to a vegetable with tears of dismay and frustration in his eyes after each stroke,

I couldn’t agree with NLAMA more—except you don’t prefer a stroke more than cancer. After his first major stroke he lost complete use of his side of his body- arm and leg. With sweat and determination he conquered his disability with intensive relentless painful PT and he was able to take the first dance with me as a bride at my wedding three months later. He taught me to be tough.

Aggressive cancer is worst. Chemo sucks. Cancer in final stages is painful. It’s hard to tough that ailment out knowing you will be missing loved ones and knowingly acknowledge that your future potential is lost. You can’t get PT rehab for cancer to patch you back together.



Edited 1 time(s). Last edit at 12/10/2020 10:18AM by susan.d.