Are blood thinners needed after the Cox-maze procedure for atrial fibrillation?

Hello,

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I read your query and understood your concern. I would like to gather additional details about your case for further discussion and management. Could you please provide the following information: your age, the date when the Cox-maze procedure was performed along with the appendage excision, the indication for the procedure at that time, the presence of any other prosthetic materials (such as a prosthetic heart valve), any contraindications for blood thinners, any recent echo reports, and if you have a documented episode of paroxysmal atrial fibrillation. Once I have these details, I can make a more informed discussion regarding your situation. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. However, to ensure a proper diagnosis of paroxysmal atrial fibrillation, it would be beneficial if you could share the ECGs (electrocardiograms) and mobile device recordings, if available. I suggest you undergo an ECG to assess the size of your left atrium, presence of spontaneous echo contrast (SEC), if any, and overall heart function as per the planned course with your cardiologist. Additionally, provide your kidney function test or serum creatinine report. It is important to know if you have diabetes or hypertension and if there is any history of bleeding in the past, as these factors are significant considering your age. Starting oral anticoagulant medication (blood thinner) can pose a high risk of bleeding unless it is deemed necessary for your specific case. I hope this has helped you. Kindly follow up with the reports and other required information.

Thank you.

Hello,

Welcome back to icliniq.com.

I have reviewed your kidney reports (attachments removed to protect the patient's identity) and they are not recent enough for me to provide an evaluation. If you have reports from this year, please share them. Additionally, please attach your ECGs and echo report for further assessment. This will help us determine whether to initiate or defer the use of blood thinners. While your bleeding risk appears low overall, considering your age, it is important to have clear evidence before starting any medication. Kindly provide the requested ECGs, other recordings, and echo report to guide the decision-making process. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

After reviewing your provided ECGs, which show evidence of atrial fibrillation (AF), and considering your age, medical history, and other reports, I suggest you to be on blood thinners, such as anti-platelets or newer anticoagulants. These medications will help reduce the risk of stroke, although there is a mild to moderate risk of bleeding due to your age. However, a final decision can be made once your echo report is available. Please provide your echo report from your cardiologist once you have it. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

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I read your query and understood your concern. LAA (left atrial appendage) closure can reduce the risk of stroke but does not eliminate it completely. In such cases, other factors such as left atrial size, left ventricle function, presence of structural heart disease, and valvular functions are considered to determine the need for blood thinners. I suggest you to get the risk of bleeding assessed before initiating medication. However, please do not worry as your risk of embolic stroke is not very high, and the bleeding risk is also low. The final decision can be made after reviewing the results of the 2D (two dimensional) echocardiography. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

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I have reviewed your attached document (attachments removed to protect the patient's identity). Since you have undergone bypass surgery in addition to the maze procedure, it is necessary for you to be on blood thinners (anti-platelets) for the coronary artery bypass graft surgery (CABG). The question remains whether to prescribe stronger blood thinners such as newer oral anticoagulants, which will be determined after reviewing your Echo report. Along with the Echo report, please provide a list of your current medications, particularly the dosage of Aspirin you are taking. I hope this has helped you. Kindly follow up with the required information and reports.

Thank you.

Hello,

Welcome back to icliniq.com.

The correct dose of Aspirin for you is 75 mg, as previously mentioned. The summary you provided in the previous attachment showed a higher dose of 325 mg, which would be excessive. Please confirm the dose of Aspirin again. In the meantime, continue taking Aspirin 75 mg once a day, along with your other medications, until you undergo your echo. Additionally, I suggest you undergo a 24-hour Holter monitor test, lipid profile, and serum creatinine if they have not been recently completed. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

Please provide the Holter report along with the other completed reports. I noticed that you shared a list of lab tests, but I kindly request the actual reports themselves. Additionally, if available, please include the Holter report that should contain a series of ECG recordings.

Ok. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I have reviewed your Echo report (attachment reviewed to protect the patient's identity). The findings indicate that you were in atrial fibrillation (AF) during the study, with biatrial dilatation. However, your left ventricle (LV) systolic function is good, and there is no evidence of clots or spontaneous echo contrast (SEC) in the atrium. Although there is no specific comment on the left atrial appendage (LAA) recess, it suggests that the LAA is possibly completely closed. Additionally, there are some minor valvular issues, such as mild aortic stenosis (AS) and mild aortic regurgitation (AR), which are likely due to age-related degenerative changes. These findings are not a cause for concern at this time. Overall, your Echo report indicates satisfactory and positive results. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I have reviewed your Echo report (attachment reviewed to protect the patient's identity). The attached Echo report appears to be completely normal with no issues identified. Your left ventricle (LV) function is within the normal range. Please continue with the same treatment as before. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I have reviewed your electrocardiogram (EKG) report (attachment reviewed to protect the patient's identity).Based on your current EKG, it indicates atrial fibrillation with a controlled ventricular rate, and there are no other abnormalities observed. Your heart rate is also reasonably well-controlled. To further analyze and manage your total iron report, I need to review your complete blood count (CBC), comprehensive iron profile, and liver function tests (LFT). Please provide all your recent lab reports, including the serum iron report. I hope this has helped you. Kindly follow up with requested reports.

Thank you.

Hello,

Welcome back to icliniq.com.

I have not receive any of your laboratory reports. Kindly reattach them. Thank you.

Hello,

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I read your query and understood your concern. I Have received two files attachments (attachment removed to protect patient's identity) that are your electrocardiogram recordings. Both the EKG reports are indicative of atrial fibrillation with a controlled ventricular rate, which has been consistently present for you. There are no new changes observed, so I suggest you continue with the same treatment. However, I have not received any additional lab reports apart from the EKGs. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I have reviewed your lab reports (attachment removed to protect patient's identity). Your serum iron levels are elevated, but they are not in the toxic range. All other reports indicate normal values. Have you been taking any oral iron supplements or received injectable iron therapy recently? I suggest you avoid iron supplements, as well as vitamin C supplements. Additionally, reduce the consumption of food with high iron content. Do you currently experience increased fatigue and weakness? Are there any joint pains or stiffness? I also suggest you limit your alcohol intake. For now, I suggest you manage your elevated serum iron levels conservatively through dietary control. I suggest you repeat the serum Iron profile after one month, which includes serum iron levels, serum ferritin, transferrin saturation levels, and a peripheral smear. I will review the results with the reports, and suggest if any treatment for high serum iron levels is necessary. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I would like to inform you that clams provide both iron and vitamin C as a nutritional supplement. Therefore, it is advisable to avoid consuming clams and other foods that contain iron and vitamin C until your serum iron levels return to the normal range. However, the rest of the foods you mentioned in your message should be fine to consume. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I would like to gather some additional details regarding her condition. When was her pacemaker implanted? Has it been interrogated recently? If so, please provide the latest report. And also share the reports from her 7-day and 30-day Holter monitoring, as well as any recent ECGs taken after the fainting episode. What type of lymphoma does she have, and is it currently stable? How is her blood pressure? Furthermore, please provide a list of her current medications. Please provide the above-mentioned details so that we can proceed with further management. Kindly follow up with requested information.

Thank you.

Hello sir,

Welcome back to icliniq.com.

I have read through your reply and you have provided enough information. However, I also need to know that has she experienced any fainting episodes after the insertion of the permanent pacemaker? Does her heart rate vary frequently, or does it primarily fluctuate according to her activity levels? Actually, variation in heart rate in response to her activity is a natural physiological response. For example, during sleep, the heart rate is low, while during wakefulness or physical activity, such as walking or exertion, the heart rate increases. If that is the case, then there is no need to worry. I suggest you get her pacemaker interrogated once at a nearby hospital so that we can obtain a clear picture of her heart rate and rhythm. Additionally, I suggest she undergo an ECG also. I suggest you try to find out her previous discharge summary from the pacemaker implantation so that we can understand the reason for her pacemaker. I hope this has helped you. Kindly follow up with requested information.

Thank you.

Hello,

Welcome back to icliniq.com.

I have reviewed your recent laboratory reports (attachments removed to protect the patient's identity), and all of your reports are well within the normal range. There is no cause for concern. Your serum iron levels, which were previously high at 210 mcg/dL, have now returned to the normal range at 162 mcg/dL. Therefore, there is no need to worry about your serum iron levels. For the time being, I suggest you avoid consuming foods that are high in iron and vitamin C. Apart from that, everything else is fine. I suggest you continue taking all of your previous medications as prescribed. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. Based on the information you provided, hemochromatosis could potentially explain the previously elevated serum iron levels, but at present, they are within the normal range. Therefore, there is no cause for concern regarding that issue. Regarding your blood pressure, I suggest you initiate treatment with Amlodipine 5 mg tablet once daily in the morning after breakfast. After 15 days, I suggest you monitor your blood pressure and schedule a follow-up to determine if any adjustments to the dosage are necessary. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

Firstly, I need to clarify whose ECG recordings are being referred to. Are they your own or your wife's? The mobile device report indicates a normal sinus rhythm. However, there are a few baseline artifacts present, and the rhythm appears to be consistently regular, but it still appears to be atrial fibrillation with a controlled ventricular rate. To confirm these findings, additional ECG strips or prolonged recordings would be necessary. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Hello,

Welcome back to icliniq.com.

Based on the ECG report you attached (attachment removed to protect patient's identity), it appears that you are in atrial fibrillation with a controlled ventricular rate. There is no need to worry, this is a persistent atrial fibrillation that has been ongoing for some time. I suggest you continue taking the same anticoagulant medication as before. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.