Atrial Fibrilation – Blood Thinner Problem.?
My wife has a heart condition but the docs can’t find a remedy.
She has an implanted defibrillator. Normally it would “shock” her heart into correct rhythm.
The Medtronic 3-wire ICD was recently replaced with a St Jude 3-wire model. Apparently St Jude is superior.
Unfortunately it’s programmed NOT to shock under most conditions. As a result, she went into afib (out of rhythm) about a week ago and is in the hospital. She’s very weak.
The docs say they can’t shock her now because she might have blood clots. They have to give her blood thinner for awhile. BUT they can’t give her blood thinner because the last time she went to the hospital her gums started bleeding.
Apparently her blood is TOO thin already. I think they are going to release her soon, still with afib and still with blood that is too thin but also still risking that the next shock from the ICD will release blood clots.
My argument is they handle this while she is still at the hospital. Otherwise, it will happen at some random time in the future when she is not at the hospital.
My second argument is there must be blood thickeners that could be used before they use coumadin, which also should be administered while she is at the hospital.
It’s a puzzle. The St Jude ICD could be triggered and her heart could be stabilized. If not, she might be too weak to go for dialysis, leading to worse problems.
Suggestions?
Related posts:
- Will Cpr Restart A Stopped Heart, Or Does It Keep Circulation Going Until Defibrillator Is Used?
- Needing Information On A Defibrillator That Is Installed Above The Heart. What Are The Reasons Why It Is Done.
- Does Endotracheal Intubation Cause Bleeding?
- Why Would A Defibrillator Tell You Not To Shock Someone Who Is Unconscious?
- If I Get A Implantable Heart Defibrillator Will I Still Be Able To Drive ?
November 26, 2009 @ 6:46 am
The paramedic is wrong.
The reason they don’t want to shock her heart is that she’s likely been in AF and built up clots. Shocking (or chemically) converting such a patient is like asking for a stroke.
The ICD is designed to shock vfib, not afib. It would be rare for any device to be set to shock AF. If the device fires, it might kick a clot, but if it didn’t fire, she wouldn’t survive.
The problem with blood “thickeners” is that they directly counteract coumadin. It’s virtually impossibly to perfectly reverse someone.
You need to sit down with her cardiologist, lay out your concerns, and get answers.
Good luck.
November 26, 2009 @ 7:21 am
Well, I am not an expert as far as the defibrillator. However, the matter of her coumadin level (blood test – PT), yes there is a way to make her blood “thick” that would be vitamin K. But, they will only use that if her PT results are extremely abnormal and I’m not sure that would be a wise idea because of the risk of blood clots. My mother was on chemo and it caused her coumadin to go completely off the charts. They gave her two units of fresh frozen plasma and within 24 hours her level was back in therapeutic range. Ultimately, I guess I really don’t have any suggestions, none that would make more sense then what her cardiologist has already tried. You could always ask for a second opinion. Your wife is a lucky lady to have you (and I am sure you feel equally blessed). Take care.
November 26, 2009 @ 10:15 am
I’m not sure why they won’t do an elective cardioversion for her Afib. The only contraindication that I know of for cardioversion due to Afib is if the tachycardia is either from poison or a drug OD. The reason they took her off the blood thinners is because if your gums are starting to bleed, then you risk internal bleeding in another part of the body, possibly the brain, which could cause a hemorrhagic stroke. The blood clots are caused because the blood is being churned up in her heart because her top chambers (atria) are almost quivering. I would definitely get a second opinion. You can have another cardiologist come and evaluate her in the hospital. If you do not feel comfortable with her leaving the hospital, then you need to say so. You can ask to speak to a patient representative or some type of family liaison to tell them your concerns.
November 26, 2009 @ 2:41 pm
I also suggest you ask for them to explain your wifes situation again as it doesnt really make sense. I am thinking you may have misunderstood some of the things happening and the reasons why.
If your wifes INR is too high she may get a bleed…usually for this to happen it would need to be way over the recommended range of around 2.5-3.5 possibly something closer to 8-10 for bleeding to occur and if it were that high they would treat it and get her back in-range. If it is too low she is in danger of throwing a clot and having a stroke which is much worse. You can replace blood but you cant replace brain cells.
November 26, 2009 @ 5:52 pm
Something doesn’t add up here. The risk of blood clots is life-threatening, but bleeding gums are just an annoyance – it doesn’t make any sense that you would put someone’s life at risk to avoid bleeding gums.
To sort this out, recognize that blood thinners do not actually make blood thinner – they reduce the ability of the blood to clot. The very last thing you want when a person has atrial fibrillation is to have blood start to clot inside the heart, so the blood has to remain “thinned.” Under these circumstances, having blood that is too thin is exactly what you want to have – that means she doesn’t need any medicine to prevent clotting. What doesn’t make any sense is why the docs would say on one hand that the blood is too thin, while at the same time saying that they can’t apply electrical shocks due to blood clot risk. These two conditions are mutually exclusive unless she has some type of blood disorder.
My advice is to ask the docs to explain this all to you again, and if you don’t get a satisfactory answer, take her to a different cardiologist ASAP.