Posted on 09/08/2020 9:27:12 AM PDT by ConservativeMind
New atrial fibrillation drugs possess significant advantages over warfarin for reducing the risk of embolic events such as a stroke or peripheral embolism.
Patients with AFib have an especially high risk of blood clots that can lead to stroke. Warfarin (Coumadin) has been the gold standard for stroke prevention in patients with AFib for the past 50 years. But to be effective, warfarin requires careful monitoring.
Within the last several years, the FDA has approved several new anticoagulants as alternatives to warfarin: dabigatran (Pradaxa), a direct thrombin inhibitor; rivaroxaban (Xarelto), a factor Xa inhibitor; and apixaban (Eliquis), also a factor Xa inhibitor.
In testing these drugs’ efficacy against warfarin’s performance, the newer drugs showed some significant advantages. All were studied in large clinical trials of between 14,000 and 19,000 subjects—and all showed that these drugs were equal to warfarin or superior in reducing the risk of embolic events such as a stroke or peripheral embolism.
“By a significant percentage—30% to 40%—there was a reduction in stroke or systemic embolism,” Sheikh says. “And all of these drugs did it with at least equivalent safety or, in some cases, even greater safety.”
Additionally, there are dietary restrictions associated with warfarin that aren’t necessary with the new anticoagulants. Warfarin works against vitamin K, which the liver uses to make blood-clotting proteins, reducing the liver’s ability to use vitamin K to produce these proteins. So if a patient on warfarin eats too many foods with high levels of vitamin K, such as leafy greens or liver, it can affect warfarin’s metabolism. “It could either get very high or very low and increase the risk of bleeding or stroke,” Sheikh says. “But with these new drugs you don’t have to worry about these types of food interactions. People can eat what they want.”
(Excerpt) Read more at todaysgeriatricmedicine.com ...
Cryo would work...if they could find the right spot...so far no luck even with Zio monitors and episode have not had long duration.
Have excellent cardio team capable of cryo.
Nah...several echo-cardiagrams continue to show structurally sound healthy heart with no scarring, never had even a ‘silent heart atrack’.
Must be genetic..................
neurological....seems kind like a loose battery cable that gets bumped...sez my tick-tock doc. We’ll find it eventually..have my three score andcten plus bonus years, and 8 year cancer survivor, so I can’t kick.
Does Plavix have the same food interactions as Warfarin?
Had a stent put in back in early 2003 after a very mild heart attack that only did negligible damage, if any. My cardiologist put me on that stuff until the stent had time to settle in. . . about 6 months. He gave me the option to stay on it and I refused, so he put me on Plavix instead.
After about 15 years, I had to have quadruple bypass at the end of 2017. After surgery, there was no thinner at all aside from aspirin until about 6 months ago. Now I am back on Plavix.
I try not to be reckless, but I also try to live a full life. So far, the strategy has worked well. I know there will come a time when I need to dial it back a bit. Right now, I feel great. I work out hard with weights. I went snow skiing in Utah in March 2018. Did not go skiing this year because I re-married in January, but planning to go next March. I have a kayak/ fishing trip planned for this weekend with an old friend and my oldest son. Life is pretty good right now, and I will be 64 in November.
Good for you! I am glad you are enjoying life
With Trumps new, lower drug prices he may be able to afford to buy Xarelto himself.
One of my wife’s medications went from $500 to $88 already, and I’m not sure the new regulations are even officially here. Another from $2200 per year to $640 per year.
Hi, I too have afib and am 74. Doctors have tried ablation and minimize procedures to reset my heart rhythm but the result has been a return to afib and now the afib is there all the time.
I reacted poorly with Plavix, (one of the new anti-coagulation drugs, It led to a brain bleed and a brain operation to drain the excess blood and I would presume close the leaking vessels. They used heparin in the procedure and this may have interacted with the Plavix and aspirin I was taking The end result is that I finally tried a procedure that attempted to stop the afib from the outside of the heart. This worked a little, so I have less afib but did not work all the way. But I had a small clamp placed on the LAA to stop the major source of clots leading to strokes. Here is a link to understand this:
https://en.wikipedia.org/wiki/Left_atrial_appendage_occlusion
The result is that I have lived with afib for several years now and get monitored for the concern once a year by the cardiologist. I also have a new heart rate monitor called kardia. This checks the heart rate more accurately than most heart monitors. Here is a link about this device too:
https://www.alivecor.com/kardiamobile/
I had these things about 9 years ago. Almost all covered by insurance (Medicare plus Humana) Also had a brain bleed on warfarin and a subsequent brain surgery. Now I don’t ever use blood thinners or even aspirin.
Lots of ups and downs in the afib world, but I was surprised to see how many risks there were. Now I live with it and it seems to be only one of the things that happen as we age. Take Care. KC
Anyone have any experience or information on that Watchman device that gets implanted?
My cardiologist sez I’m a ‘lucky man’! Most guys don’t know they even need quad by-pass surgery until after the autopsy!........
Real fun guy that doc is....................
I pray that you're blessed with many more years!
Thanks.
LOL !
I’m sure its true...no doubt this Texas Dr. was just having a bit’o’humor
unless there’s structural heart issues like a bad valve, artificial valve or heart damage, almost all afib is a triggered by the pulmonary veins right before they enter the left atrium ... ablation attempts to isolate the veins from the heart tissue in the left atrium by killing the heart tissue that surrounds each of the four pulmonary vein openings, with subsequent scaring of the dead tissue being non-conductive ... to work, the tissue has to be killed the full depth of the atrial wall and the full circle of tissue killed, otherwise unwanted electrical activity of the pulmonary veins will find it’s way though ... radio-wave ablation is not very successful in creating complete isolation, which tries to burn a series of connected points around the openings while the heart beats against the burner tip ... in fact, i’ve personally known several people who’ve undergone the radio-wave procedure and it didn’t work for any of them ... some went back as many as three times
cryo, on the other hand freezes the full circle of tissue with a super-cooled balloon that sticks to each pulmonary opening like a tongue stuck to a frozen flag pole, and will freeze the tissue all at once ...
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