AF Association

Is there any research that equates the length of an episode of PAF with increased risk of stroke?

I'm missing my Warfarin security blanket having had to stop it, hopefully temporarily, and haven't had a major PAF since early April. (42hours) I just have the odd few seconds hiccoughs at the moment. Does an episode need to last for a certain length of time for the chances of a clot forming to be increased? I read something about 48 hours but don't know whether this is proven. Many thanks Liz

4 Replies

It is believed that AF-stroke risk is not linked with the duration of an AF episode because a clot caused through the irregular heart rhythm from AF, can travel away from the left atria during normal sinus rhythm or during an episode. Clinical guidance therefore recommends that everyone with AF and who has been assessed as at higher risk of AF-related stroke (as per the CHA2DS2VASc score) should be anticoagulated unless contraindicated.


Thank you so much admin. team for your prompt response.


Lizzily, there is also a school of thought which suggests that once you have had AF regardless of future outcomes (successful ablation for example) the stroke risk remains. The inner surface of the atria can change during AF and this in itself can result on blood being slowed in some areas and the possibility of clots forming. This is a bit like water pipes clogging up in hard water areas.

Add in the fact that many people have AF without knowing and you can see why we are so keen on anticoagulation for at risk patients rather than simple aspirin which so many doctors still seem to think is a good idea.

The 48hours thing may well have come from something about cardioversion although I would have thought 24 hours more likely. This is the thinking that a cardioversion can only be performed unless in an emergency if the patient has been in AF for less than 24hours. Any longer and proper anticoagulation would be required with an INR of between 2 and 3 to make sure there are no clots about or a TOE performed. (They put an echo device down you throat (under GA ) to look inside the heart to check for any clots which may have formed there.)

Sorry for the late reply I only just found that question.



Thanks Bob for your reply. I'm having to cope without my warfarin until I see the ophthalmologist at RD and E about my retinal bleed on August 21st. I don't like not taking it but I'm stuck at the moment. Have a good time next Wednesday and I hope to join you all next time. Liz


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