Heart failure
Warfarin, digoxin, asprin and statins
In addition to the triple combination of diuretics, ACE inhibitors and beta-blockers (see 'Beta-blockers, ACE inhibitors, diuretics and aldosterone antagonists') several drugs are commonly prescribed to help relieve symptoms of heart failure. Among people we talked to these included daily aspirin; a cholesterol-lowering drug (statin); warfarin (which prevents blood clots forming); digoxin (which can control heart rhythm and slightly increases the force of the heartbeat). Most people said that their drugs had to be carefully balanced. A woman who had been taking warfarin and digoxin for 44 years, said that coping with the 'whole rigmarole' of drugs had become second nature to her.
Aspirin reduces the ability of blood clots to form thereby reducing the risk of having a heart attack. Sometimes people are given a drug called clopidogrel instead of or as well as aspirin. This combination treatment is usually given for a limited time but Tim says he was put back on it for life after having another heart attack after stopping clopidogrel.
Several people who had had heart failure for many years talked about how drugs had changed; one said that was the only advance that he had noticed in the treatment of heart failure. Warfarin was widely thought of as an 'older' drug that thinned the blood, and was known to have the same active ingredient as rat poison. People recognised that warfarin needed to be carefully monitored and that it could cause bleeding; two people had bled into their urine as a result of taking warfarin. One woman said that she was careful to check whether warfarin would be affected by other medicines such as antibiotics. She also found that the herbal remedy valerian interfered with warfarin. It is not unusual for herbal remedies to interact with prescribed medicines, so people should always talk to their doctor if they are considering taking them.
The number of heart failure drugs he's taking has reduced over the years.
The number of heart failure drugs he's taking has reduced over the years.
He was taken off warfarin because of side effects.
He was taken off warfarin because of side effects.
She is cautious about taking any other drug that might affect her warfarin levels.
She is cautious about taking any other drug that might affect her warfarin levels.
Not really, I've not really noticed any side-effects other than those. But I do, if I go to the chemist for anything, then I always tell them what drugs I'm on and they're pretty good. You know, they sort of look it up in a book. And I won't take anything unless, if it interferes with warfarin, then I don't take it, you know, I've had a period of not being able to sleep and I thought I'd try Valerian, the complementary medicine, and I found that that interfered with warfarin. It's a bit of a balance actually, the whole rigmarole of the drugs, but you know, as I say, it's just second nature to me, I just take them. In fact my husband brings my coffee up in the morning and before I even lift it I've got my pills out, you know.
Mahendra had to stay in hospital before and after his ICD was fitted where his warfarin was replaced by heparin before having surgery.
Mahendra had to stay in hospital before and after his ICD was fitted where his warfarin was replaced by heparin before having surgery.
Yes.
And they changed your warfarin for heparin.
They had to put me on heparin.
Can we talk about it because that is a very specific case. So how long before did you go into hospital?
They called me a week before that, you know. And they told me that, ‘Ok we’ll take you on certain days but we’ve got to make sure that your’. They put me on heparin to make sure that the levels dropped before they can insert this defibrillator, you see.
Yeah because they have to
Yeah they’ve got to make a cut to put it in.
And it’s always a danger of haemorrhage and
Yeah
When you are on warfarin
Warfarin yeah
Yeah. And then you had to stay. A week before the ICD was fitted
Yeah
And a week after it was fitted?
Roughly nearly a week but it was as soon as the INR was up again back to normal they just told me, ‘Ok you’ll be alright now.’
Mahendra explained the monitoring that followed his surgery to put him back on warfarin.
Mahendra explained the monitoring that followed his surgery to put him back on warfarin.
They had to put me slowly back to warfarin because soon as the operation was done from next day they had to check the INR and according to what levels my INR then they had to give me that much warfarin, you know, those levels, like 5mg or 6mg to go back to normal, you know, what my targets are, you know 3.0 to 3.5. So soon as it was up to 3.0 they just told me, ‘You are aright now and just carry on with this’, you know, warfarin until everything comes back to normal. And you just have your INR checked at [muffled name of hospital] hospital, you know, where every. Soon as they check my INR and they tell me after how long do I have to come back again and have my INR checked.
Ok roughly how often do they check the warfarin?
Well I have to sometimes go, it depends you know, if my INR goes down when I have an INR checked and they say the levels have dropped down then they say, ‘Right come after a fortnight’. And after fortnightly they check it and see if the INR is gone back to normal then they say, ‘Ok come after 4 weeks now’.
He takes warfarin, digoxin, frusemide, spironolactone, atorvastatin, bisoprolol and aspirin.
He takes warfarin, digoxin, frusemide, spironolactone, atorvastatin, bisoprolol and aspirin.
She describes digoxin as a 'poison' that improves her heart beat.
She describes digoxin as a 'poison' that improves her heart beat.
It's like you see on the telly and it's quite scary, where they shock you back alive again! [laughs]. And I was a bit scared but I had that done and it did, it made my heart go back to normal, and touch wood I haven't had no problems. I'm also on another drug and that makes me laugh because it's made out of foxgloves, but it's a poison but it makes your heart beat better! [smiles]. My consultant said he couldn't understand why I needed to take that because the electric shock treatment should have done it, but it seems to work with me so I'm pleased.
Simvastatin - a medicine that reduces cholesterol in the blood - was mentioned by many people and several wondered whether they would have avoided heart failure if it had been prescribed at an earlier stage. A man who couldn't tolerate simvastatin said that another medicisne (cholestyramine) was able to reduce some of the kinds of fat in body (see 'Other side effects of heart failure medication').
He wonders if he should have been prescribed statins after his first heart attack.
He wonders if he should have been prescribed statins after his first heart attack.
Last reviewed April 2016.
Last updated April 2016.
Copyright © 2024 University of Oxford. All rights reserved.