Atrial Fibrillation and the Use of Blood Thinners

Patient Expert

Last time we were discussing atrial fibrillation, we looked at blood thinners and why they are so important, not only for those persistently or permanently in afib, but those who go in and out of it (paroxysmal afib). Afib is an irregular heartbeat that can raise chance of stroke by five times normal. It's a serious concern to keep blood from forming clots.

The most common drug used to lower the risk of stroke by keeping blood moving smoothly is Coumadin (generic name: warfarin.)   But, in the last few years, some newer drugs which do not require regular monitoring and may offer less possibility of internal bleeds have joined the group - namely Xarelto, Pradaxa, and Elequis.               .

There are other more potent, "big gun"  blood thinners that those with afib should know about, particularly if they are hospitalized. They are heparin and lovenox.

In my two episodes of hospitalization for heart-related issues, I have had experience with each of these blood thinners.

When I had my open heart surgery to repair a leaking/regurgitating mitral valve, everyone took a lot of care to make sure everything went as smoothly as possible. In the OR, I spent an hour and a half awake and talking to the anesthesiologist while I was prepped with tubes and cannulas going in and out of my groin, my neck, and my wrist. These port entries were necessary for the heart-lung pump that would filter my blood and keep me alive while my heart was stopped.

In addition, the ports were used for the tiny instruments the surgeon employed while using the Da Vinci robot, a less invasive way to accomplish open heart surgery.

You can imagine all of the drugs that were used to keep my blood from clotting during and after this major surgery. But, despite all the care, a beta blocker that I took regularly was omitted from my post-op meds and I went into atrial fibrillation on the second day after surgery.

It was scary, uncomfortable and disappointing to go into afib after such a big surgery, and the addition of heparin to my regimen made everything more difficult. For one thing, heparin could not be administered directly, but had to be dripped into me through an incredibly complicated system that included a very large rolling device, as tall as I was and bigger all around, which I then had to drag along with me when I took my mandatory recovery walks down the hall.

Heparin sodium can be administered in shots, as well as intravenously. It's a powerful blood thinner and  a life-saving drug. However, like all blood thinners and, perhaps even more so, it can be a dangerous one. It requires careful management.   The dosage must be carefully prescribed and regulated. It can cause bleeding episodes that can be fatal along with allergic reactions.

Lovenox is another blood thinner used often in emergency or hospital situations. It is actually derived from heparin, but it has been altered and has a lower molecular weight. What this means is that Lovenox can last much longer than heparin - sometimes as long as 24 hours. Given by injection rather than intravenously, Lovenox can be effective and more convenient  in some situations than heparin.

My second experience with blood thinners was when I first experienced cardiomyopathy, during which I was taken to the hospital because the doctors were not sure whether or not I was having a heart attack. (It turned out that I was not.)   I was given an aspirin to chew immediately and another upon reaching the ER, and later, an injection of Lovenox to thin my blood. Lovenox shots are administered to the abdomen. The thought of an abdominal injection is a little off-putting, to say the least However, this shot did not hurt - the only thing I noticed was the sting.

Heparin can be used over long periods of time when a patient is at risk for forming a blood clot. Lovenox tends to be used when there are concerns about clotting from a heart attack or surgery and can only be used for 17 days, so it is a short term blood thinner.   Lovenox requires far less monitoring than Heparin, but both drugs can be life saving and are an important part of the blood thinner arsenal.