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2017-10-11 / South Texas Living

A fib increases risk of blood clots, stroke

DEAR DR. ROACH: I have been taking warfarin (Coumadin) for two years now. I started taking it after a knee-replacement surgery, when they discovered I had atrial fibrillation. I have high blood pressure and high cholesterol that are controlled with medication, and diabetes controlled with diet. Do you think I need to be on warfarin if my blood pressure and cholesterol are well-controlled? Before the surgery I was on two 81-mg tablets of aspirin. Could I safely go back? -- J.K.

ANSWER: Doctors recommend warfarin or other anticoagulant medication for people with atrial fibrillation -- a chaotic condition of the electrical system of the heart -- if they have more than minimal risk for blood clots and stroke. Older age, female sex, high blood pressure and diabetes (even if controlled), congestive heart failure and history of stroke or vascular disease all increase risk for stroke in people with atrial fibrillation, also known as A fib.

Although I don’t know how old you are, just being female and having high blood pressure and diabetes puts you in a risk category where you would normally be recommended to stay on anticoagulation. Never stop warfarin (or similar medication) without first discussing it with your physician.

READERS: Atrial fibrillation affects some 2 million Americans and becomes more common as we age. To learn more about A fib, order the booklet on Heartbeat Irregularities by writing: Dr. Roach -- No. 107W, 628 Virginia Drive, Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. ROACH: I am a post-menopausal woman (12 years since my last cycle). Last month, I had a light period that lasted over a week. I have seen my OB/GYN, who sent me for a pelvic ultrasound and a transvaginal ultrasound. The only thing it showed was a thickening of the lining. I then had a biopsy, and the results came back showing normal cells. He seems stumped, and said that if it happens again, he’d suggest a D and C. But, as he acknowledged, a 66-year-old woman isn’t supposed to be having periods. Obviously, he and I both know something isn’t right but just don’t know what it might be. Any thoughts? -- D.H.

ANSWER: Any bleeding after menopause needs to be evaluated, since it can represent uterine cancer about 10 percent of the time. Fortunately, that is very unlikely with a normal biopsy. Since you did have a thickened endometrium, it is possible that you have endometrial hyperplasia, though this should have shown up on the biopsy. An ultrasound should have picked up a polyp.

If it does happen again, you should certainly have further evaluation. Even though a negative biopsy is very good evidence that there isn’t a cancer, no test is perfect. About 20 percent of women with persistent bleeding after a normal biopsy had cancer or a precancerous lesion. This occasionally happens when the uterine cancer is in one focal place, rather than present throughout the lining of the uterus.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. To view and order health pamphlets, visit www.rbmamall.com, or write to Good Health, 628 Virginia Drive, Orlando, FL 32803. © 2017 North America Synd., Inc. All Rights Reserved

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