Tuesday, March 21, 2017

Which people with atrial fib should be on blood thinners?

Just another day for someone with afib.
First--this is not medical advice. Second--I don't want to get too far into the weeds here.

But over a decade ago, a doctor discovered I had irregular heartbeat--known as atrial fibrillation. One in five Americans have it--my brother does, also a maternal aunt. For once, this is not related to being fat!

Basically, this is when a clump of regulating cells near the heart go off  track somehow and cause the heart to beat funny. One doctor kept referring to mine as my "hippety-hoppety heart."

This funny beat, in turn, can cause blood in the upper chamber of the heart to get sort of churned up into a clot that can travel to other parts--and cause a stroke. People with afib, as they call it, have a greater chance of a stroke as those with "normal sinus rhythm."

Some people get a fluttery feeling and are "in" afib for a time, then revert to normal. Others--like me--are always in afib. My pulse is sort of  like BEAT BEAT...Slidy slurry BEAT...PAUSE...BEAT....

At first, they put me on a med called amiodarone to regulate the beat. This drug made me so sick I ended up ion the hospital and later they said they didn't know if I was coming out alive. I did!

Then they put me on blood thinners--a blood thinner--warfarin. Every month, I had to go to a lab and get a blood test...they would call and say eat a spinach salad--vitamin K in spinach affects your blood thinness. It was wacky...then my intestine bled, leading to a terrible hospitalization for a colonoscopy. Can't have that with thinners on board, so they tried to counteract the thinner with blood plasma. The colonoscopy could not be completed.

I stayed on thinners. They said to.  Eventually, I experienced another bleed--in my right eye, leading to terrible clots, a fully detached retina, four surgeries, and now a blind eye.

I quit warfarin. Now I am on an aspirin only and have been for 10 yrs.

There are two other approaches to afib--ablation (try to kill the rogue cells with radio waves or heat) or the "paddles"--shock you into proper rhythm. I refused both

Long story longer, research from the Intermountain Medical Center Heart Institute in Salt Lake City now says there is an effective way to tell if someone needs thinners. First, you do a questionnaire called the CHA2DS2-VASc (see what I mean by "weeds"?) and then a second scoring--the Intermountain Mortality Risk Score.

The first is not predictive of outcomes, but has been used for years anyway. It is oversinmplified, the researchers say--a woman over 65 would automatically get a thinner, even though this is not a comprehensive way to tell is she needs one.

The new Intermountain score adds more variables.

Well, fine and dandy...I am seeing my ninth cardiologist next week--to see if I can withstand hernia surgery.  Wonder if he will recommend this.

As I peer into the screen with my one remaining eye--I have no idea.

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