Can I Ever Go Off Coumadin?

Dear Dr. Sinatra,

I’m taking Coumadin. Do I need to stay on it for the rest of my life?


Dr. Sinatra says…


It seems like “Can I stop taking Coumadin?” is the one question I get asked everywhere I go.

My answer is always the same. If you have a prosthetic heart valve or atrial fibrillation with a leaky valve or enlarged left atrium, you must continue taking Coumadin (warfarin). There is no adequate blood-thinning substitute if you have those conditions.

Atrial fibrillation, or A-fib, is the main reason Coumadin is prescribed. In patients with a normal heart rhythm, the upper chambers of the heart contract in unison in response to a signal from the sinus node. In patients with A-fib, however, this response is overpowered by electrical signals scattered throughout the atria, and instead of contracting, the heart vibrates rapidly. Millions of people are affected by the condition, which raises risk of blood clots and, therefore, requires Coumadin.

The only exceptions to that rule are patients who have “lone” A-fib. That means you have atrial fibrillation but with normal valve function and heart size. Because these patients are at lower risk for a blood clot, they are good candidates for natural blood thinners such as fish oil (2 g daily) and nattokinase (100 mg daily).

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