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 hes taking has reduced over the years.

Age at interview 47

Gender Male

Age at diagnosis 41

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He was taken off warfarin because of side effects.

Age at interview 81

Gender Male

Age at diagnosis 79

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

Age at interview 68

Gender Female

Age at diagnosis 48

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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.

Age at interview 59

Gender Male

Age at diagnosis 40

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Mahendra explained the monitoring that followed his surgery to put him back on warfarin.

Age at interview 59

Gender Male

Age at diagnosis 40

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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.

Age at interview 59

Gender Male

Age at diagnosis 58

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

Age at interview 53

Gender Female

Age at diagnosis 49

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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 medicine (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.

Age at interview 54

Gender Male

Age at diagnosis 49

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See our resources for publications which explain heart failure medications in more detail.