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Q.

By how much does Warfarin reduce the risk of blood clots in atrial fibrillation vs no Coumadin? Is it significant?

From the reading I've done, it seems that Coumadin/Warfarin does not eliminate the risk of blood clots, only reduce the risk somewhat.  I'm trying to figure out by how much and if I might not just be better off exploring other strategies..  I had a close call yesterday with bleeding...I didn't realize that I was continuing to bleed for several hours.  Does anyone know what the odds are with and without it?  Thanks.

 

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General Medicine
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A.
Warfarin (Coumadin) is, indeed, important in reducing the risk of blood clot due to atrial fibrillation (A-fib). And, on the other hand, there's a significant risk of bleeding too much while using warfarin, as you just found out.

I'd suggest a couple of things. First, you should be getting your clotting factor checked by blood test every week while on warfarin therapy. Make sure you're doing that so that your blood doesn't get thinned too much.

Second, I'd suggest you call your cardiologist as soon as possible to report this bleeding episode and discuss whether or not warfarin is still the right treatment for you. In the past couple of years, new drugs have come on the market that also treat the risk of blood clot due to A-fib. Perhaps your cardiologist would be willing to investigate using one of these new drugs in your case. It never hurts to ask.

Meanwhile, I would not recommend you stop taking your warfarin. It's impossible to tell you the exact risk of blood clots should you discontinue the medication, but the risk is significant. In the future, if you experience a serious bleeding episode, do not hesitate to call 911 or otherwise seek immediate medical attention.

Hope this helps!

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A.
Thanks for you reply.  I think I have actually found my answer here:
http://heartdisease.about.com/library/weekly/aa080601a.htm
It refers to the CHADS model.  I am a 2, which means I have a 4% risk of stroke without Coumadin.

It also seems that brief bouts of afib are not a major concern, but long bouts lasting 24 hours or more can start to throw clots.


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My husband was on Coumadin for 6 months due to a blood clot between his lung and rib. The least little thing caused him to bleed and it was bad, we told the Dr and they just pretty much have to change dosage around and check PT levels, his case was the medicine was thinning too much and that could be the case with you. Talk with your Dr about your dosage and how much you take it, it really helped him when they flip flopped it around. Hope this helps.

 

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Thanks for the advice :)

Actually, I decided to take myself off the Coumadin against the doctor's recommendations.  So far, so good.  From what I've read, this increases my chance of a stroke from 2% to 4%. 

The main thing is to get myself out of afib.  This would solve everything.  But from what my doctor says, they could shock my heart.  But, this would only last for 2 or 3 months.  Then, they would have to shock it again.

The problem is that my right atrium is about 2.5 times as large as it should be.  So of course, the rhythm will suffer.

I am now researching to see if there is a way to naturally or otherwise reduce the size of the upper right atrium.  I will probably be back here eventually start a new thread :)

Thanks again!

Much appreciated :)

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