A-Z

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.

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Age at interview: 47
Sex: Male
Age at diagnosis: 41
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Well I'm actually taking less tablets now than I did when I first started because a lot of those drugs have been changed over the years and that's the only advancement I've seen. [Pause] About 10 a day, I take. 10 tablets a day, some are to be aggressive, I mean I take huge amounts of diuretics. My father-in-law brags about taking 25 or is he taking 10mg of frusemide, I said I take 500mg and frusemide and lansoprazole, that's for acid stomachs and to suppress any acids in your stomach or something like that. And then you've got the metolazone which is a mild form of diuretic, you've got spironolactone, another diuretic which isn't so harsh on losing potassium.
 

He was taken off warfarin because of side effects.

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Age at interview: 81
Sex: Male
Age at diagnosis: 79
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I've been very fortunate that the tablets that I've had I got on very well with the Aspirin, but then I was changed over to Warfarin, but Warfarin unfortunately was not good for me and caused me to bleed which was produced through my urine and eventually they said that I had to have x-rays and I was taken off Warfarin but during these x-rays they found that I had stones, so in January of 2003 I went in for stone removal and scraping of the prostate, but having said that, this present time having got my weight back to about 10st I have an excellent appetite and am enjoying life pretty well apart from the fact that the moment I start doing anything physical or doing anything too quick, I feel the effects of angina or something, but that's to be measured with the state of my heart which is very weak and the fact that I am 81 years of age.
 

She is cautious about taking any other drug that might affect her warfarin levels.

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Age at interview: 68
Sex: Female
Age at diagnosis: 48
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I take digoxin, amiodarone, frusemide, isosorbide mononitrate, spironolactone, lisinopril and warfarin. And iron because of the warfarin and because I'm still bleeding in the gut somewhere, in the colon, and they can't do anything about it. I'm on a very high dose of iron to keep my haemoglobin up.

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. 

People on warfarin who need surgery have their warfarin treatment stopped and replaced by heparin until after the procedure to avoid the danger of excessive bleeding. After surgery people are put back on warfarin under careful monitoring.  
 

Mahendra had to stay in hospital before and after his ICD was fitted where his warfarin was replaced by heparin before having surgery.

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Age at interview: 59
Sex: Male
Age at diagnosis: 40
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So you went into hospital before the ICD was fitted?

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.

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Age at interview: 59
Sex: Male
Age at diagnosis: 40
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Do you remember how soon after the ICD was fitted you went back on to 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’.
Many of those who took digoxin knew it was derived from foxgloves and that it slowed the heartbeat. One woman referred to digoxin as a poison that did her good. Some people said they decided not to take it, against doctors advice. Others said that they were taking a lower dose now than they used to.
 

He takes warfarin, digoxin, frusemide, spironolactone, atorvastatin, bisoprolol and aspirin.

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Age at interview: 59
Sex: Male
Age at diagnosis: 58
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Frusemide and spironolactone [pause] and that rids me of fluid in the mornings. I'm on a beta-blocker, bisoprolol.  I'm on atorvastatin to reduce my lipids which were high and part of the reason for it happening I suppose. I'm on digoxin, the old foxglove treatment, to keep my heart rate down. I'm on anti-coagulants, warfarin, to keep my blood thin to prevent a further clot developing in my heart and another embolus happening. I'm on aspirin... and I'm on treatment for gout, Allopurinol, and  I'm on an Ace inhibitor... which [smiles]... it's silly isn't it!

 

She describes digoxin as a 'poison' that improves her heart beat.

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Age at interview: 53
Sex: Female
Age at diagnosis: 49
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That was 3 or 4 years ago now and I'm now on 36 mg of beta-blockers a day, plus the blood pressure tablets, only two water tablets, and I'm feeling a lot better. I have had one or two scares where my heart went out of rhythm and I had to have a special treatment. 

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.

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Age at interview: 54
Sex: Male
Age at diagnosis: 49
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I think one of the things is very interesting but I think, I'm not sure if I'm right or wrong [laughs], after the heart attack, the first heart attack or just before I had a heart attack the first time, I should have been on the cholesterol tablets. I was very, it was very high, I was told it was very high, but nobody prescribed them to me, and I don't know why. And when, you know when I learned a lot about my experiences, how the cholesterol and everything, I was wondering why I didn't get cholesterol tablets rather than they advise.. well they advised me to lose weight, this is a normal thing to lose weight, the diet, the food and all this, but I wasn't really keeping to it, you know what I mean. I mean to say that's one thing which I think, I should have been on cholesterol tablets a long time ago... otherwise you know they, I think they do their best to control the, the heart and you know to protect from another from heart attack.
 
See our resources for publications which explain heart failure medications in more detail.

 

Last reviewed April 2016.
Last updated April 2016.

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