I have been prescribed Dabigatran as I have a Chad vasc score of 3.

[Dulcimer]

I have been researching taking anticoagulants and there seems to be a high risk of severe bleeding. Also two friends have recently lost friends due to brain bleeds after taking Warfarin long term. Does anyone have statistics about the pros and cons of anticoagulants?

[Beancounter Volunteer]

Hi Dulcimer

Whilst I acknowledge that there is a risk with any anti-coagulant, and yes there was some report about brain haemorrhage a few years ago, surely the statistic which is more important, is what is the risk of ischemic stroke, with a Chadvasc of 3?

All our treatments are about balancing risk to some extent, as the condition that is A Fib usually has to be treated in some way, and none of the treatments are risk free.

My personal view is that I am much more afraid of a stroke than a bleed, and again my personal view is that the stroke is a great deal more likely than the bleed.

Having been on warfarin for 9 months now, I have had no problems whatsoever, and possible more importantly, on this board we hear from very few people who have any problems with warfarin, and they can generally switch to one of the other anti-coagulants, such as Dabigatran which has been suggested to you. Seriouse side effects would appear to be quite rare.

I am not sure where you get the information that there is a "high risk of severe bleeding" I am not aware of this.

Best of luck and be well

Ian

[Dulcimer in reply to Beancounter]

Thanks for your reply. Attached is the link to the report that has given me concern. It is worth reading the whole report, dated 2013.

drugwatch.com/pradaxa/

[Beancounter Volunteer in reply to Dulcimer]

Hi Dulcimer

Yes I have read that before, and I understand your concern.

I would still go back to my original question to you and ask which carries more risk? taking an anti-coagulant, or with CHADVACS score of 3 suffering an ischemic stroke.

My personal decision (with a lower score than you) is to stay on warfarin, and reduce my risk of stroke, you have to make your own decision of course, however Pradaxa is not the only anti-coagulant on the market, there are others.

Did you discuss the alternatives with your cardio and have you expressed your fears to him/her about Pradaxa, and did you discuss the others?

I'm not medically qualified, and would not even try and give you medical advice, but I would repeat what I said in the earlier message. We all have been diagnosed with AF, our treatment or lack of treatment in now a question of balancing the risks, and making an informed decision based on the best evidence available. And I applaud you for taking to time to try and find out what those risks are and what others think about them, it's a great move on your part.

However what neither you nor I enjoy is the luxury of doing nothing, unless you make that choice with the full knowledge of the risks of doing that compared to the other risk decisions and their factors.

I really do wish you well,

Ian

[Dulcimer in reply to Beancounter]

Thanks for your good wishes.

[Dulcimer]

Thanks for your reply. Attached is the link to the report that has given me concern. It is worth reading the whole report, dated 2013.

drugwatch.com/pradaxa/

[Offcut]

I have been on warfarin since 1992 with a very small gap of no warfarin in that time. I would love to say it is a nice steady reading but of late I am anything from 1.8 to 3.8 INR but I have seen and lost people close to me with strokes. I would prefer to keep to my warfarin even though I have never been offered an alternative. I am allergic to iodine/trace which was not used on my last ablation. I am also resistant to anasthetic (woke up in theatre twice) and to top it off morphine does not have the desired effect on me. It is clear from this forum we are all very different and with my many tablet changes will continue to be so.

[AFAssociation1]

Thank you for your informed response Ian.

Dulcimer - you ask a good question which concerns a lot of our members. It is unfortunate that you know two people who had a bleed to the brain because this is relatively uncommon.

As Ian mentions, people with AF are at an increased risk of AF-related stroke; a five-fold increased risk. Therefore, oral anticoagulation is essential to curb this risk. Although anticoagulants cannot prevent a bleed to the brain, they significantly reduce the risk of AF stroke.

A recent study compares warfarin to new oral anticoagulants (dabigatran, rivoroxaban and apixaban), which shows the newer medications have a much lower bleed rate than warfarin:

ARISTOTLE (looks at apixaban versus warfarin) nejm.org/doi/full/10.1056/N...

Dabigatran has been clinically approved and is prescribed by leading heart rhythm specialists.

Raj

[Dulcimer in reply to AFAssociation1]

Thank you for your reply to my question. Is the stroke risk still five fold greater with paroxysmal AF. I have had 3 episodes in 4 years with the longest being 6 to 8 hours.

[joeat in reply to Dulcimer]

Hi, I'm no expert (just joined), but there are various web sites that help assess the relevant risks (what I'm trying to do now), such as preventaf-strokecrisis.org/...