Question: My husband had quadruple bypass surgery three months ago. At the two month checkup the EKG indicated he had an atrial flutter. His doctor put him on 5mg Coumadin. I know of the adverse effects this medication can have, and I am looking for a non-drug alternative. What natural/alternative treatments can be used to replace Coumadin?

Dr. Hibberd's Answer:

Recurrent atrial flutter is a rhythm disturbance that places you at increased stroke risk and usually precipitates reduced cardiac output and even acute congestive heart failure. It is not usually well-tolerated and is often associated with chronic atrial fibrillation, another rhythm that without carefully measured Coumadin medication also has a high stroke risk. Correcting atrial flutter requires control using drugs or synchronised cardioversion depending upon its gravity. Failure to maintain conversion or recurrence often generates a visit to the EP (electrophysiology) lab for ablation consideration.

Coumadin will reduce the chances of embolic stroke occurring from the upper chambers of the heart (atria) that will occasionally harbor micro-thrombi (small clots) that are subject to being dislodged when atrial fibrillation/flutter recurs. The risk of embolic stroke from frequent or prolonged atrial fibillation or atrial flutter is high, especially for those not on Coumadin. Coumadin therapy is mandatory for adequate stroke protection, and your PT with INR (a Coumadin blood test) must be meticulously maintained at 2.0 to 3.0, with improved protection noted at the 3.0 INR level. This requires weekly monitoring initially, followed by monthly levels indefinitely.

There is no alternative that will give you the stroke protection provided by Coumadin, and certainly no over the counter supplements. Alternative oral "thinners" are all inferior to Coumadin with respect to stroke risk.

I understand the nuisance Coumadin therapy and its monitoring can cause, but Coumadin will reduce the chances your brain will have an embolic stroke. There is no intervention or clot buster for embolic stroke, so your best bet is to stick with your doctor’s recommendations and maintain close communication with your husband’s doctor with respect to the targeted doses of his medications.