DEAR DR. ROACH: I am a 76 year old active male. I became aware of an increase in my resting heart rate in April 2021, from a resting rate of 48 to 74 beats per minute over a six-day period. It’s persistent. This led me to a cardiologist who diagnosed me with atrial fibrillation three weeks ago. I bruise and bleed easily and don’t want to take more blood thinners. I had a CHA2DS2-VASc score of 2. My cardiologist and my electrophysiologist both confirmed that there was a 2.2% to 2.5% chance of stroke due to nonvalvular AFib with a probability 1% stroke even though I was on blood thinners. Both immediately recommended Xarelto, Eliquis or at least one aspirin per day. My calculations tell me that taking blood thinners offers a 1.2-1.5% benefit in preventing stroke. Do you agree with this assessment? Isn’t that a low risk number for the negative side effects that blood thinners are producing in me?
Currently I am taking metoprolol. My resting heart went from 74 bpm to 67.
I don’t want to take blood thinners. I bend over to have a WATCHMAN device implanted and try Tikosyn to see if it can bring me back to sinus rhythm. – JT
RESPONNSE: Atrial fibrillation is a common problem in which the heart’s natural rhythm is disturbed. Heart rate often increases and people are at a higher risk of stroke. Treatment is designed to bring the heart rate back to near normal and to reduce the risk of stroke. Metoprolol completed the first part. Dofetilide (Tikosyn) is an antiarrhythmic drug.
The CHA2DS2-VASc score is one way to classify stroke risk. The numbers you quote come directly from the study, but it’s important to recognize that these are the risks of stroke every year. Over the next 10 years, it’s something like a 22% to 25% risk of stroke without medication versus a 10% risk with an anticoagulant medication. If you’ve ever seen someone with a serious stroke, I think you wouldn’t be so quick to rule out the risk. There is a risk associated with taking the medicine: your bleeding and easy bruising will get worse. For people who do not wish to take an anticoagulant, the WATCHMAN device is a reasonable alternative.
The WATCHMAN device (or the next generation WATCHMAN FLX device) is designed to block the part of the heart from which most blood clots originate, called the left atrial appendage. The most recent data suggest that the benefit of the WATCHMAN device in preventing stroke is similar to that of anticoagulation. However, a study that was just published in October suggested that lower-dose anticoagulation, even after starting WATCHMAN, reduced the risk of side effects, including stroke, bleeding, and coagulation in the device.
DEAR DR. ROACH: A recent column on urinary tract infections did not mention cranberry juice. I had this painful problem, but not anymore. What cured me was replacing my daily orange juice with cranberry juice. Hope this can help other people with this problem. – JR
RESPONNSE: Some studies have shown a benefit in reducing UTIs by drinking cranberry juice or taking cranberry capsules. Cranberries contain a substance that prevents bacteria from sticking to the lining of the bladder. However, systemic reviews of all available studies have concluded that there is not enough strong evidence to recommend cranberry juice for the prevention of UTIs. Even so, I have had patients like you who have been relieved. The only downside is that most cranberry juice contains a fair amount of sugar; otherwise, cranberry juice is safe.
– Dr Roach regrets not being able to respond to individual letters, but will include them in the column whenever possible. Readers can send questions by email to [email protected] or by mail to 628 Virginia Dr., Orlando, FL 32803.