DuchessBear
Well-known member
Here's an article that appeared in a local DC newspaper last week. I've marked in red the passage that raised my eyebrows.
The Washington Examiner
Tuesday, September 20, 2005
A.Fib: A case of correlation-causality
Steve Fahey
Ask the Sports Doc
Occasionally I have episodes of atrial fibrillation and am currently taking Sotalol plus one aspirin per day. In the past, I was also taking Coumadin, but my cardiologist discontinued that last year because I do a lot of bicycling. My question: Is there a conflict between Sotalol and aspirin? Can the combination trigger A.fib?
-.Andrew 0., Alexandria
Such an interaction would be very unlikely, Andrew, but first some background for read- ers less knowledgeable on this tricky subject:
In "atrial fibrillation," the two smaller chambers atop the heart begin to twitch ineffectually instead of contracting. This prevents the larger 'chambers, the ventricles, from pumping effectively, and also prevents the heart rate from increasing in response to exercise.
Additionally, because blood can more easily stagnate in a fibrillating atrium, the condition predisposes to the formation of blood clots that, can break loose and travel to the brain to cause a stroke.
If "A.fib" has been present for more than just a couple of hours, cardiologists may choose to "thin the blood" with Coumadin to prevent clotting before taking measures to stop the arrhythmia. They often continue the blood thinner for several months as a preventive measure. Given your active lifestyle it seems wise to have stopped it, as a fall from a bicycle while on Coumadin could easily lead to fatal internal bleeding.
I don't know of any problem with taking both aspirin and Sotalol, a relatively new "beta-blocker" which has additional anti-arrhythmia properties. In fact, the aspirin may be helpful should you go back into atrial fibrillation, as it will partly re place Coumadin's "blood-thinning" effect.
However, Sotalol is a powerful drug in its own right, as I am sure your cardiologist advised you. It is one of the many drugs I discussed last week that need to be avoided in persons with "Long QT Syndrome," and it can cause irregular heartbeats as well as prevent them. Like all "beta-blockers," it also presents problems for patients with diabetes or asthma.
If you have indeed noticed that you go into A.fb more frequently when you take both medicines, you may be dealing with a spurious cause-and-effect relationship. The most important thing I learned in college was that "correlation doesn't prove causality." There is often a hidden variable at play. Is it possible that, you take your aspirin more faithfully, or at a higher dose, when you are going to do something that might, lead to aches and pains, like bicycling? If so, it may be the activity instead of the medicine that leads to the arrhythmia.
I recently fell into a similar correlation-causality trap. Two months after successful knee surgery, my orthopedist gave me some cortisone injections to facilitate getting back into summer sports more quickly. I resumed tennis and surfing during the mid-summer heat wave, and started waking up with painful leg cramps. Assuming it was the heat to which I was unaccustomed, exercise and dehydration causing the cramps, I tried everything from 6 a.m. tennis to salt tablets and Gatorade, and still couldn't get a decent night's sleep.
After two weeks of misery, I went to my own -- very smart -- doctor. He determined that it was not the sports, but the cortisone injections that caused the cramps. As he predicted, the drug would largely be out of my system after a month. I'm now back on the courts -- and sleeping
Dr Steve Fahey is an emergency physician who served for 15 years as a team physician at the University of Maryland Send your questions to [email protected].
The Washington Examiner
Tuesday, September 20, 2005
A.Fib: A case of correlation-causality
Steve Fahey
Ask the Sports Doc
Occasionally I have episodes of atrial fibrillation and am currently taking Sotalol plus one aspirin per day. In the past, I was also taking Coumadin, but my cardiologist discontinued that last year because I do a lot of bicycling. My question: Is there a conflict between Sotalol and aspirin? Can the combination trigger A.fib?
-.Andrew 0., Alexandria
Such an interaction would be very unlikely, Andrew, but first some background for read- ers less knowledgeable on this tricky subject:
In "atrial fibrillation," the two smaller chambers atop the heart begin to twitch ineffectually instead of contracting. This prevents the larger 'chambers, the ventricles, from pumping effectively, and also prevents the heart rate from increasing in response to exercise.
Additionally, because blood can more easily stagnate in a fibrillating atrium, the condition predisposes to the formation of blood clots that, can break loose and travel to the brain to cause a stroke.
If "A.fib" has been present for more than just a couple of hours, cardiologists may choose to "thin the blood" with Coumadin to prevent clotting before taking measures to stop the arrhythmia. They often continue the blood thinner for several months as a preventive measure. Given your active lifestyle it seems wise to have stopped it, as a fall from a bicycle while on Coumadin could easily lead to fatal internal bleeding.
I don't know of any problem with taking both aspirin and Sotalol, a relatively new "beta-blocker" which has additional anti-arrhythmia properties. In fact, the aspirin may be helpful should you go back into atrial fibrillation, as it will partly re place Coumadin's "blood-thinning" effect.
However, Sotalol is a powerful drug in its own right, as I am sure your cardiologist advised you. It is one of the many drugs I discussed last week that need to be avoided in persons with "Long QT Syndrome," and it can cause irregular heartbeats as well as prevent them. Like all "beta-blockers," it also presents problems for patients with diabetes or asthma.
If you have indeed noticed that you go into A.fb more frequently when you take both medicines, you may be dealing with a spurious cause-and-effect relationship. The most important thing I learned in college was that "correlation doesn't prove causality." There is often a hidden variable at play. Is it possible that, you take your aspirin more faithfully, or at a higher dose, when you are going to do something that might, lead to aches and pains, like bicycling? If so, it may be the activity instead of the medicine that leads to the arrhythmia.
I recently fell into a similar correlation-causality trap. Two months after successful knee surgery, my orthopedist gave me some cortisone injections to facilitate getting back into summer sports more quickly. I resumed tennis and surfing during the mid-summer heat wave, and started waking up with painful leg cramps. Assuming it was the heat to which I was unaccustomed, exercise and dehydration causing the cramps, I tried everything from 6 a.m. tennis to salt tablets and Gatorade, and still couldn't get a decent night's sleep.
After two weeks of misery, I went to my own -- very smart -- doctor. He determined that it was not the sports, but the cortisone injections that caused the cramps. As he predicted, the drug would largely be out of my system after a month. I'm now back on the courts -- and sleeping
Dr Steve Fahey is an emergency physician who served for 15 years as a team physician at the University of Maryland Send your questions to [email protected].
