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Does Intake Of Aspirin Help In Curing Constant Atrial Fibrillation?
Question: I would like your opinion on whether to put my 95 yr old mother on aspirin therapy instead of warfarin to treat atrial fibrillation. She has been on warfarin therapy and closely monitored (INR regularly) for about 15 years with no side effects. Her cardiologist is concerned about falls at her advanced age, although she has never had one and is very XXXXXXX He has suggested that she take amiodarone to correct the AFib, and then discontinue warfarin. She has never experienced bruising, or bleeding of any kind. When she has blood drawn, there is never any blood on the bandage applied. Her PCP also has reservations regarding amiodarone and suggests that she try aspirin therapy. I also have reservations about amiodarone. She does have a pacemaker since 2010. In a visit to the cardio last week, the test revealed that she had had only four episodes of Afib in the last year which had a very short duration. She also has a diagnosis of congestive heart failure, but has no shortness of breath, swelling, or chest pains. I would appreciate your feedback.I can give you her list of RX medications if you wish. It is a short list for one her age. E.Ford
Brief Answer:
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I read carefully your question and would explain that oral anticoagulants are not counterindicated at your mothers age.
If her atrial fibrillation were constant, she would have a calculated CHA2DS2-VASc Score of 4, which means that anticoagulation would be needed.
Warfarin is a traditional oral anticoagulant, which should be used with caution, with a close monitoring of INR, to adjust the doses. It has also many interactions with other drugs, which imposes a high risk of bleeding. From the other hand, taking into consideration her age and her physical performance, there is a higher possibility of falling (incidental), which can lead to bleeding while on warfarin therapy.
I would prefer new oral anticoagulants like rivaroxaban or apixaban in this case. They do not need to be monitored with repeated INR, and impose a lower riks of bleeding, compared to warfarin.
Aspirin would also be another treatment option, which does not impose a higher risk of hemorrhage, but is not as effective as anticoagulants in preventing any possible ischemic events.
I would recommend you choose between new oral anticoagulants and aspirin.
Regarding amiodarone, I would not recommend starting it, before having a careful examination of her cardiac function.
Could you please upload her performed cardiac tests reports for me to review and give another professional opinion?
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
I would recommend as follows:
Detailed Answer:
Hello!
Welcome and thank you for asking on HCM!
I read carefully your question and would explain that oral anticoagulants are not counterindicated at your mothers age.
If her atrial fibrillation were constant, she would have a calculated CHA2DS2-VASc Score of 4, which means that anticoagulation would be needed.
Warfarin is a traditional oral anticoagulant, which should be used with caution, with a close monitoring of INR, to adjust the doses. It has also many interactions with other drugs, which imposes a high risk of bleeding. From the other hand, taking into consideration her age and her physical performance, there is a higher possibility of falling (incidental), which can lead to bleeding while on warfarin therapy.
I would prefer new oral anticoagulants like rivaroxaban or apixaban in this case. They do not need to be monitored with repeated INR, and impose a lower riks of bleeding, compared to warfarin.
Aspirin would also be another treatment option, which does not impose a higher risk of hemorrhage, but is not as effective as anticoagulants in preventing any possible ischemic events.
I would recommend you choose between new oral anticoagulants and aspirin.
Regarding amiodarone, I would not recommend starting it, before having a careful examination of her cardiac function.
Could you please upload her performed cardiac tests reports for me to review and give another professional opinion?
Hope you will find this answer helpful!
Kind regards,
Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Neither the cardiologist nor the PCP even mentioned the option of the new anticoagulants that you mentioned, and i didn't think to ask. I'm sorry that I don't have access to all cardiac tests performed over the last year or years. I do have have the test report from an ECG done on XXXXXXX 6, the day that we saw the cardio.It is called an ECG 12-LEAD Results are as follows:
Ventricular rate 69 bpm
Atrial rate 14 bpm
QRS duration 86 ms
Q-T interval 346 ms
QTCINT 370 ms
P Axis Blank
R Axis -34 degrees
T Axis 133 degrees
Diagnosis: Sx:148.0 paroxysmal atrial fibrillation…….Poor data quality, interpretation may be adversely affected. AV sequential or dual chamber pacemaker.
I'm wondering if there was poor data quality, what caused that or why wasn't it repeated? Too, do you have any statistics regarding the number of elderly who are on coumadin therapy who actually hemorrhage to death following a fall? I'm still a bit conflicted about abandoning the coumadin therapy since she has done so well on it and gets her INR done regularly. In addition, her count is almost always in range without any adjustment made to the dosage. Thank you again.
XXXXXXX Ford
Ventricular rate 69 bpm
Atrial rate 14 bpm
QRS duration 86 ms
Q-T interval 346 ms
QTCINT 370 ms
P Axis Blank
R Axis -34 degrees
T Axis 133 degrees
Diagnosis: Sx:148.0 paroxysmal atrial fibrillation…….Poor data quality, interpretation may be adversely affected. AV sequential or dual chamber pacemaker.
I'm wondering if there was poor data quality, what caused that or why wasn't it repeated? Too, do you have any statistics regarding the number of elderly who are on coumadin therapy who actually hemorrhage to death following a fall? I'm still a bit conflicted about abandoning the coumadin therapy since she has done so well on it and gets her INR done regularly. In addition, her count is almost always in range without any adjustment made to the dosage. Thank you again.
XXXXXXX Ford
Brief Answer:
My opinion:
Detailed Answer:
Dear XXXXXXX
The uploaded ECG parameters seem in general to be OK, for an individual holding a pacemaker.
There is nothing to worry about.
Poor data quality means that certain artifacts (such as body movement, respiration, not optimal electrode contacts, tremor which is frequently seen in the elderly, etc.) may have interfered while registering the ECG.
ECG machines make interpretations based on rigid algorithms and frequently do not come to the right selection.
Nevertheless, the obtained information is sufficient to give a conclusion by an expert eye.
That’s why probably the ECG isn’t repeated again.
Regarding traumatic injuries in the elderly, I could explain that falls are the leading cause of fractures (more than 85%) and death due to injury.
Hip fractures and cranial injuries are among the most dangerous complications.
In conclusion, I could explain that when considering anticoagulant (coumadin) continuation, it is important to bear in mind that the risks should not outweigh the benefits.
In your mother’s case, the risks for hemorrhagic complications are high, and those short episodes of paroxysmal atrial fibrillation probably are not sufficient to justify coumadin continuation (even if INR is optimally controlled).
Hope this opinion will be helpful when discussing with her attending doctor.
Best wishes,
Dr. Iliri
My opinion:
Detailed Answer:
Dear XXXXXXX
The uploaded ECG parameters seem in general to be OK, for an individual holding a pacemaker.
There is nothing to worry about.
Poor data quality means that certain artifacts (such as body movement, respiration, not optimal electrode contacts, tremor which is frequently seen in the elderly, etc.) may have interfered while registering the ECG.
ECG machines make interpretations based on rigid algorithms and frequently do not come to the right selection.
Nevertheless, the obtained information is sufficient to give a conclusion by an expert eye.
That’s why probably the ECG isn’t repeated again.
Regarding traumatic injuries in the elderly, I could explain that falls are the leading cause of fractures (more than 85%) and death due to injury.
Hip fractures and cranial injuries are among the most dangerous complications.
In conclusion, I could explain that when considering anticoagulant (coumadin) continuation, it is important to bear in mind that the risks should not outweigh the benefits.
In your mother’s case, the risks for hemorrhagic complications are high, and those short episodes of paroxysmal atrial fibrillation probably are not sufficient to justify coumadin continuation (even if INR is optimally controlled).
Hope this opinion will be helpful when discussing with her attending doctor.
Best wishes,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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