Is hormone therapy safe for women with atrial fibrillation?

Hello,

Welcome to icliniq.com.

I can understand your concern.

The need for anticoagulation (blood thinners) is determined after assessing risk of thromboembolic events and bleeding. A final decision is made based on the risk-versus-benefit ratio. Healthcare providers will use different scores to calculate the risk. If the CHA2DS2-VASc score is 3, then, as per the latest international guidelines, the risk of developing blood clots and eventually having a stroke is very high. Her physician must have also calculated your bleeding risk.

One of the scores used to calculate bleeding risk is the HAS-BLED (hypertension, abnormal renal or liver function, stroke, bleeding history or predisposition, labile INR, elderly, and drugs or alcohol) score. If this score is high, physicians typically have a detailed discussion with the patient. If the risk of bleeding is low, anticoagulation is considered a safe option.

If your mother was advised to take blood thinners after careful calculation of all the risks and benefits, then she should continue taking them. If there is spontaneous bleeding with the use of Warfarin, or she is unable to maintain her INR (International normalized ratio) or perform blood tests, then I would suggest switching to a group of blood thinners called DOACs (direct anticoagulants). This should be discussed with her primary cardiologist, as DOACs are relatively safer in terms of bleeding complications and do not require frequent lab monitoring.

Preferred agents are Rivaroxaban 20 mg once daily or Apixaban 5 mg twice daily. Beta-blockers such as metoprolol should make her symptoms better. Suppose she is experiencing symptoms such as dizziness, fatigue, palpitations, and shortness of breath even on beta-blockers. In that case, it suggests that her heart rate is still uncontrolled and needs to be maintained within the desired range, preferably below 100 beats per minute. There is no direct relationship between atrial fibrillation and hormonal changes around the perimenopause period.

There is no direct relationship between the worsening of atrial fibrillation and HRT, and yes, it is safe to take HRT with atrial fibrillation. Please remember that atrial fibrillation often has a secondary cause, including hypertension, ischemia, structural heart diseases, and electrolyte imbalances.

Therefore, it is crucial to identify and address the underlying cause to prevent and effectively manage atrial fibrillation. The main pillars of treatment include heart rate control, rhythm control, anticoagulation as needed, treating the underlying cause, and, if necessary, intervention such as ablation.

Rhythm is first reverted to normal sinus rhythm with the help of anti-arrhythmic medications. If unsuccessful or if you are unstable, a shock can be delivered. In this procedure, the patient is sedated, paddles are placed over the chest, and a small shock is delivered. This is a very safe procedure if proper precautions are taken beforehand. Surgeons sometimes perform a maze procedure to treat atrial fibrillation. Additionally, an electrophysiologist can conduct an electrophysiology study by placing different electrodes inside your heart through your peripheral vein, locating the foci of atrial fibrillation, and ablating them.

These procedures are also being used very successfully now. Mild secondary MR (mild regurgitation) does not cause any health issues and does not require treatment. It would have been helpful if you could have shared her echocardiogram with me. Her blood pressure is certainly elevated, and it is one of the causes of atrial fibrillation.

Her blood pressure should be optimized. If you can share a blood pressure chart of a few days along with her blood pressure medication name and dose, I will help optimize the medication. Her total cholesterol is elevated, and she should follow lifestyle changes to fight hyperlipidemia. If you could share her fasting lipid profile report, I can propose a treatment for that.

I hope this information is helpful.

Thanks.