Have Sinus Rhythm After ECV. Poor Appetite After Taking Warfarin. Do I Need Anticoagulation?

Posted on Wed, 9 Jan 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Wed, 9 Jan 2013 Answered on

Fri, 1 Feb 2013 Last reviewed on

Question : I am still in sinus rythym 6weeks after an ECV for A-Fib. As I am 68 and female I have a score of 2 on newest scale of risk for warfarin. I have no other risk factors. My cardiologist is actually giving me the choice of whether to stay on warfarin or not. I have been weighing up the pros and cons and cannot decide. My IRN has not been very stable and my diet has been very poor since starting warfarin but no other side effects. However my sister died of a massive brain bleed at 54 and just knowing that makes me worry about a bleed more than a stroke. I also have stomach problems and have had ulcers in the past If I am in sinus rythym do I need anti coagulation?
Any thoughts on this? Thanks May

Answered by Dr. Anantharamakrishnan (2 hours later)

Hi friend,
Welcome to Health Care Magic

It is a question of risks versus benefits / the benefit is in Atrial fibrillation

     If normal sinus rhythm is being maintained for more than a month after the cardioversion, Warfarin may be withheld.
     If the size of the atrium, atrial appendage is normal / and there is no thrombus (detectable by ECHO), Warfarin can be withheld.
     Especially in case of poor diet, history of ulcer, unstable INR, low CHADS2 score, Warfarin may be withheld.

In summary, I feel, you need not take it, as of now.
You may need it if the fibrillation recurs / An electro-physiologist can help in the investigation and prevention - but the procedure is invasive.

Take care
Wishing speedy recovery
God bless
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar