Dr. Roach: Atrial fibrillation discovered during routine colonoscopy
Dear Dr. Roach: I recently had a colonoscopy and was told I was in atrial fibrillation. I’m 71 years old and have never had this before. I was told to see a cardiologist ASAP. I called my doctor, who put me on Eliquis without seeing me because it was going to be a month before the heart doctor was available. When I saw him, I was fine and had no atrial fibrillation, but he said I should stay on Eliquis. It sounds like I’m stuck taking this very expensive medicine for the rest of my life. What would you recommend?
Dear J.W.: Atrial fibrillation is a common abnormal heart rhythm that is of major concern because it increases the risk of a blood clot forming in the heart and going to the brain, causing a stroke. When AFib comes and goes, it is called “paroxysmal atrial fibrillation”; however, it is still dangerous and nearly as likely to cause strokes as AFib that is there all the time. I suspect that you have been in and out of atrial fibrillation for a long time, and they only caught it during the colonoscopy because they were monitoring you with the EKG during the procedure.
There is a risk score for stroke in people with AFib, called the CHA2DS2-VASc score, and you have at least two points due to your age and sex. People with a score of two or higher are generally recommended for anticoagulation treatment. Apixaban (Eliquis) is a common anticoagulant used for AFib, and although it is expensive, it has the benefit of not requiring blood testing. Warfarin (Coumadin) is much less expensive but requires periodic blood testing and a careful diet to be as safe and effective as possible.
Everyone who’s prescribed anticoagulation should receive a thorough review of the costs and benefits.
Dear Dr. Roach: It was with some sadness that I read your letter from M.K. regarding her husband who won’t take his mobile oxygen tank when he leaves the house. Ten years ago on Christmas Eve, this same sort of vanity killed my wonderful mother-in-law. Too vain and stubborn to listen to those around her, she left the house on a cold day to do some shopping. No one was there to see it happen, but she evidently collapsed in her car because she did not bring her oxygen into the store with her. She was revived a couple of times, but died almost at the stroke of midnight Christmas Eve. It was a loss that impacted all those who loved her, particularly her husband. She suffered from emphysema from years of smoking. Though she had quit quite a few years before the incident, the damage was done.
This was a tragedy that did not have to happen. I hope your encouragement to M.K.’s husband will be sufficient to make him accept that he is putting himself at great risk if he leaves his oxygen behind. It is definitely not a risk worth taking.
Dear J.E.: Thank you for writing. I am very sorry for your mother-in-law. While there is no guarantee the oxygen would have prevented her passing, oxygen does help people with COPD, like emphysema, live longer and with a better quality of life.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.