HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

Suggest Treatment For Atrial Fibrillation While On Aspirin

Posted on Wed, 26 Aug 2015

Question: I was asked to get some voltaren 25mg tablets for my sister's mother in law for her arthritis pain in knee. I know she has atrial fibrillation but she tells me she only takes aspirin for it. My sister says she also takes something else but she says that she doesn't take that all the time. She is pretty independent and doesn't like being told what to do so I am unsure whether she is indeed just on aspirin or other things like warfarin. Is it common for AF patients to just be on aspirin and some other medicine occasionally? She does take Panadol osteo but that doesn't really help. Voltaren she has taken before occasionally when pain is bad. She is pretty stubborn about going to the doctor and she says the doctor is ok with her taking voltaren but I am unsure if this is true.. is she ok to take voltaren?

Answered by Dr. Ilir Sharka (1 hour later)

Brief Answer:
Voltaren should be used with caution while on aspirin or warfarin therapy

Detailed Answer:
Hello!

Thank you for asking on HCM!

I would like to explain that if the risk of cardio-embolic events are quite low such as in the case of CHAD2DS2vasc score< 2 ( a score which calculates stroke risk for patients with atrial fibrillation), it is rational to continue only on aspirin. Otherwise in case of a score> 2, warfarine should be used, because the risk for cardio-embolic events is considerable.

I would like to know precisely what she is taking. There are different interactions between aspirin and voltaren and the same is for warfarin and voltaren.

Aspirin and Voltaren both increase anticoagulation and the serum potassium. Even if you use them both for short periods, it is important to monitor for possible hemorrhages and repeat the blood electrolytes and routine blood tests (including coagulation tests).

While warfarin and voltaren both increase anticoagulation, which can result in a dangerous interaction. If she is taking warfarin too, I would advise to closely monitor her and repeat frequently INR test, in order to adjust the dosage of warfarin.

Hope to have been helpful!

I am at your disposal for further questions whenever you need.

Greetings! Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (20 hours later)

Thanks for the reply. She is also taking metoprolol but not all the time, only if she needs it occasionally.
If voltaren is too strong, then can she take ibuprofen?

Answered by Dr. Ilir Sharka (5 hours later)

Brief Answer:
Ibuprofen is an option, but a careful monitoring is necessary.

Detailed Answer:

Hi again!

The same holds true for ibuprofen. A careful monitoring is necessary. Metoprolol has a slight potential of interaction with NSAIDs (Aspirin, Voltaren, Ibuprofen, etc).

Best regards,

Dr. Iliri

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Ilir Sharka (6 minutes later)

Hi
Ok thanks, i had Google's it in the meantime and google says that ibuprofen can reduce platelet effect of aspirin so it can be not effective for preventing stroke. Is that accurate? Or is it just dr google being unreliable?

Answered by Dr. Ilir Sharka (11 minutes later)

Brief Answer:
You are welcome!

Detailed Answer:

Hi!

I was just saying that NSAIDs (voltaren, Ibuprofen, etc) exert significant interaction in a patiet under anticoagulation.

The primary desirable effects of Warfarin or even Aspirin become unpredictable (that's why a close monitoring is necessary).

Instead of checking those pharmacodynamic interactions, I would recommend you to check if your sister's mother in law is eligible for anticoagulation (Warfarin, etc. by reviewing CHAD2DS2vasc score, as she may be at risk of stroke.

You can use even Google.

Greetings!

Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar