Anyone on blood thinners?

[paulsask1]

Hi Everyone,

I am a 53 year old C4-5 male quadriplegic 27 years post injury. In 2014 I discovered my AFib and have been using Warfarin (10ml daily) as a blood thinner until I had a Cryo-ablation procedure done at the end of November last year. So far the ablation has reduced any AFib symptoms about 90%.
My cardiologist now has me on low dose aspirin daily (81mg).
What I have been wondering has anyone used both of these as blood thinners and if so their opinions?
When I was using Warfarin my INR was always around 2.5 and I monitored this monthly.
I can not find any studies regarding paralyzed people and what dosage of aspirin would be as effective as my 10mg daily of Warfarin?
I would think immobile people would require thinner blood than able bodied people to be safe against blood clots/stroke.
I realize both medications work differently but some experienced opinions would be helpful.

Thanks, Paul

[SCI-Nurse]

The Warfarin is for you heart and is the recommended treatment for Afib- to prevent strokes. Unless you have a history of DVT/PE? which would be related to your SCI and puts you at high risk for reoccurrence.
If you are truly out of A fib- i.e. the ablation worked permanently, then you should do what your cardiologist told you.
Do NOT take Aspirin and Warfarin unless the cardiologist tells you to do so.
CWO

[funklab]

Aspirin is not a blood thinner per say. It works in a very different way from warfarin and is not comparable, nor substitutable in most cases. (Cardiologists and PCPs generally start almost everyone on a low dose aspirin, which is what you are taking, when their risk of heart attack is high). You are on warfarin because you had (and based on what you say still have from time to time) an irregular heart beat which can cause blood to get "stuck" in your heart and clot because it's not moving like it should.

No one would prescribe warfarin just because your cardiac risk is high (the most common reason for low dose aspirin).
No one would start aspirin for Afib (the reason you are taking warfarin).

I haven't looked at the data in a while, but wheelchair users (can't remember if the study was SCI specific) are at higher risk of clots for a brief period of time after initial injury, but that risk becomes more or less the same as an AB persons risk after a few months. Last I heard no one is sure quite why this is the case, but the evidence does not suggest that we are at higher risk for clots in the long term, despite there being very "common sense" reasons why that should be the case.

Adding aspirin to warfarin is a reasonable thing to do according to this article in certain cases, but it's worth asking your cardiologist if you need to be on both. And of course to make sure the person prescribing the aspirin to you knows you are on warfarin and vice versa (if it's not the same person) https://www.clevelandclinicmeded.com/medicalpubs/ccjm/March2008/madhwal.htm


Obviously the best person to give you actual medical advice in this particular circumstance is your cardiologist.

[nonoise]

Hi Paul,
Just checking, it sounds like you still have 10% of your Afib since the ablation, but have stopped the warfaran.
So the deal is that there is a small heart chamber that blood can pool and clot in during Afib bouts. It is called if my memory serves me, the left atrial addendum. Unless thinking has changed since mine was removed, I would think your doctor would want you on Warfaran or one of the newer anticoagulants.

[parashooter]

I've taken warfarin and aspirin since 1998. Had blood clot in my leg that went to lungs. I take 7.5mg warfarin and 325mg aspirin.

[Brad09]

I've been taking Xarelto since my PE and never have to have my blood checked like you do on warfarin. Only costs me $10 a month with their discount card (private insurance).

[hlh]

As someone else asked, are you ONLY taking Aspirin now? Your doctor stopped the Coumadin?

Why did he tell you to start taking the Aspirin? No dose of Aspirin is equivalent to or better than Coumadin for treating Afib.

And what do you mean that your Afib symptoms are 90% gone? Have you had a long term holter monitor study showing that you still have some episodes of Afib?

If you still have some Afib, you are still at risk for having a stroke and you should be on Coumadin or one of the injectable blood thinners long term. Aspirin is not the proven treatment for this.

Could you clarify?

It is actually a bit dangerous to be on BOTH coumadin and Aspirin at the same time, as your risk for bleeding becomes quite high. But I don't think that is what you mean....

There isn't a proven "best" dose for aspirin for treatment of Afib, and people with spinal cord injury are not put on Aspirin or blood thinners routinely because of their immobility.

My father had a blood clot in his leg right after his accident, while he was in the ICU. They placed an IVC filter to decrease the chance of blood clots from his legs flying through the blood stream up to his lungs and causing a Pulmonary Embolism (PE). He was put on Coumadin. He developed a lot of edema in his legs, likely due to a combination of the old blood clots, slowing of his circulation in his legs due to the IVC filter, and his immobility. He wears compression stockings every day because of this.

Over the years, his doctors had many discussions about whether he should be on coumadin long term or stop it. There actually are not firm guidelines for someone like him. There are arguments that if you have an IVC filter in your body that slows down blood circulation in your legs, with a history of a prior blood clot, that alone means you should be on Coumadin for life. It is true that having a SCI injury and being relatively immobile probably increases your chance as well. He had doctors recommend everything from Coumadin for life to a "baby dose" of Coumadin every day to trying the injectables to just aspirin. After careful discussions with an expert in blood thinners and his hematologist, he will be on Coumadin for the rest of his life, but keeping his INR low... around 2... to decrease the risk of bleeding. He falls, so blood thinners are quite dangerous for him. He checks his INR at home, by himself, every week with a simple machine paid for by Medicare. This is now the best standard of care, to make sure his INR is stable. He likes knowing exactly how "thin" his blood is. It is a bit of a pain though.

[paulsask1]

Thanks for everyones input.
My cardiologist prescribed me low dose Aspirin. I am no longer taking Warfarin. As for the A-fib I still feel some minor, irregular heartbeats but not near as strong or as often as before. I never had trouble with a racing heartbeat, just irregular beats.
Every time I've worn the holter monitor (48 hours) nothing showed.

Thanks,
Paul

[SCI-Nurse]

Thanks for everyones input.
My cardiologist prescribed me low dose Aspirin. I am no longer taking Warfarin. As for the A-fib I still feel some minor, irregular heartbeats but not near as strong or as often as before. I never had trouble with a racing heartbeat, just irregular beats.
Every time I've worn the holter monitor (48 hours) nothing showed.

Thanks,
Paul

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(KLD)

[hlh]

So, your doctor is trying to do his best at recommending treatment, when he has no clear evidence you are still having events of Afib, but he wants to "hedge his bets" and give you something in case you still have some rare episodes. So he told you to take an aspirin.

If you are uncomfortable with his treatment plan, see him again and talk about the pros/cons. Be sure to alert him immediately if you start to have more symptoms, although Afib is not always symptomatic. You could also ask him about wearing a holter monitor for longer periods of time. Sometimes people are monitored as long as a month.

[SCI-Nurse]

Aspirin is an antiplatelet- which means it should prevent clotting.
Most doctors recommend one baby aspirin a day - to prevent heart attacks and strokes- for all persons especially those over 40 or with strong family history. It does serve some purpose. Unless you have hx of GI or other recent bleeding etc.. which would be helpful in preventing strokes which is the main problem with Afib.
Also, most doctors recommend aspirin when SCI person is going to fly in an airplane ( I personally take 325 mg two hours before flight and 2 hours after I am flying and will take the following day also- many people get DVTs in flight or within 2-4 weeks of flying and subsequent PE. SCI GUIDELINES- not all agree, but we do a risk stratification and follow the guidelines but for inpatient who are admitted, we start Lovenox or continue Warfarin, or Xarelto etc... And every time the leg(s) swell, we do a doppler to rule out DVT.
You can also get DVT's in your arms.
No filters. If someone gets a filter it is supposed to be removed after several months.
CWO