Hi everyone I just thought I would create a post supporting my given choice of medication. I often discuss with my GP and Cardiologist what I read in respect of Antiplatelets Vs Anticoagulants. I am told (and trust the advice) that, If the only condition suffered is Afib and there are 'no' other conditions or complications and having an otherwise healthy heart, the best 'and only' medication required for a person under 60 is a low dose blood thinner, ie, Asprin, this will be sufficient as a blood thinner therefore preventing clot formation.
Just thought I'd strike up the debate.?
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steve60
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I think if you are male, under 60, and have no other coronary contra-indications then aspirin is adequate, not optimal, but adequate, because your CHADS2VACS will be zero.
But of course most people here will have a CHADS2VACS of at least 1 and possibly 2 or higher, then I think your argument is much weaker, in fact over 2 I could not agree at all.
Hi Steve up until last autumn I did exactly what you have chosen to do, then I went to the AFA patients day and having spoken to EPs there, who were in agreement, the type of stroke you risk with AF is so different to say a deep vein thrombosis because the clot forms in the atria and you therefor need a drug to prevent a clot forming, not just an antiplatelet which is useful in preventing stroke in the general population, but not for us AFibbers.
Sorry but I am now convinced, based on the latest research and literature. I also have a PFO with also elevates my risk of stroke.
I think the word 'risk' is what needs to be the determining factor, I feel I do not have any greater risk with my lone Afib than the general population (except when I over exercise or over drink alcohol), which can increase risk in non Afib sufferers as well. Therefore I don't want to start on the route on life changing/altering drugs until told unless you do this you 'will' suffer a stroke. Only my opinion but to many people rush panicking straight to the end game before thinking of what it will do to them. A chads score of 0 says no risk, therefore why head straight for the Warafin when there is no medical need to.?
I agree with you about risk, but not about two of your statements if I may
1) "life changing/altering drugs" from my personal viewpoint and in my opinion, warfarin is no different a drug to aspirin which you are already taking, so I am struggling to see you point here, warfarin is a very easy drug to take with minimal side effects.
2) Risk, I regret you do have a greater chance of stroke than the general population about 3 times that of the general population of the same age and sex. Even with a CHADS2VACS score of zero warfarin reduces stroke risk by 45% and aspirin by only 22% so less than half the reduction.
However you are correct the stroke risk for a male under 60 is much lower, but NOT zero, and with AF depending on the severity and regularity it is roughly 3 times higher, so I don't understand.
Let's suppose for the general population at your age the stroke risk is say 1%, with AF that is immediately at least 3%, aspirin reduces that by 22% or less than one and warfarin by 45% or nearly 1.5.
In my personal view, I know what I would choose.
In your last sentence you say "no medical need to" and I agree current medical thinking is that aspirin is sufficient. However AF has increased your risk of stroke, just by a "medically acceptable" amount, and aspirin provably does not reduce that risk as much as warfarin. Both drugs are easy to take, and with minimal side effects.
This is my thinking anyway, and why I take warfarin with a CHADS2VACS of zero.
Don't know Steve I have taken warfarin for 9 years but have never taken rat poison! No they haven't used it for that in many a year. Quite frankly Steve everybody is entitled to their opinion, but based on medical research and facts I know where I stand on this subject. You wanted a debate and I think you know that most on here will disagree with you but as they say I will defend your right to be wrong! LOL
Medical research is paid for by drug companies and they will have a product to promote and sell. I just think it is to strong a drug to be given out so widely. Especially to some people who probably don't need it. And remember once on itnenever off it. Just wish I had some shares in that company lol
PLEASE DON'T believe this advice. I am well under 60 .I was diagnosed with lone AF but otherwise very healthy and fairly fit. I don't drink and I have never smoked. I was prescribed aspirin ,also told I was not at risk of stroke .Only about 8 weeks after diagnosis I had a T.I.A. Followed a week later by a stroke.I was then given Warfarin which I've been taking for the last year without any further problems. Thank goodness for Warfarin or the new anti-coags .Please seriously consider.
No. I have not nor ever have had any heart condition or any other medical condition prior to AF. The stroke was the direct result of AF .At the time I didn't know that you are at high risk of stroke if you have AF nor did I know that anti-coagulation is a vital medication .I now am very keen to spread the word that in my case aspirin was as useful as a chocolate teapot .Fi
It means your risk is "medically acceptable" which is 1.9 % usually for anyone under 60 with A Fib, and that's near as damn in 1 in 50. That's a long way off "no risk".
That risk is 3 times higher than an equivalent person without A Fib, and even worse of course the strokes that people with A Fib who are not anti-coagulated are the very worst kind in that they are not usually TIAs.
I'm sorry Steve, if you choose to stay on aspirin, then that's fine and your choice, but other readers need to be aware of medical facts here please.
You are quite right and I can't emphasis enough that the statement -chads2 score of 0 means "no" risk - It DOESN'T it just means that the risk is lower than a higher score but you are still at risk if you have AF. Fi
Me too.I was 50, otherwise as fit as a fiddle. Blood pressure wieght cholesterol family history all fine. It didn't stop me having 3 T.I.A.s. I was then put on warfarin and have been fine ever since. Previous to this I was on aspirin which obviously didn't work. X
I was told that the danger of stomach bleeding through continual absorption of asprin can occur within a year. I take warfarin and have not had to change my diet, other than avoiding cranberries which is certainly no hardship. I really do not consider a six weekly blood test to be either inconvenient or life changing, more of a comfort to know that my stroke risk is being closely monitored and substantially reduced.
I am sorry but I have to disagree with you on that. Medical opinion is based on scientific research, knowledge of subject matter together with years of experience. Having said that I am happy that both you and your father have been trouble free on asprin for so long, and very much hope that will continue.
What I think is warfarin has been around a long time and yes it has its disadvantages but two post AF I am alive Praise the lord
I don't think the CHADS system works with arrhythmias. My EP put me on Warfarin years ago even though I had, and still have a score of zero, so it isn't just my opinion. It's best to act first rather than wait till you have a stroke. That's what's wrong with CHADS I think; it looks at what has already happened, not what may happen in the future.
I'm feeling I'm in a no win situation. I don't get on with Warfarin. If I move to Apixaban (or whatever new anticoagulant may be the most appropriate) there are several nasties to consider. Expensive, no antidote, not much long term data regarding side effects, risk of haemorrhage and so on. I'm good at cuts, bruises and fractures. I don't feel Asprin is my best way forward. Not taking an anticoagulant at all may be a bad choice - everyone tells me that it would be - but a stroke is not a certainty. There are no dietary implications, no side effects, no interaction with other medication, no monitoring, no surgery visits. Seems very attractive to me and very cheap - but admittedly very risky, Probably difficult to get insurance. I've been given Heparin a couple of times but this doesn't seem to be an option. I'm left to choose the least worst of the alternatives and frankly, I don't know what it is. I have the impression that whichever way I turn, I will regret the choice.
I understand your frustrations, but let me try and at least go through the options.
1) No anti-coagulation, well depends on your CHADS2VACS score but I'd be willing to bet you are 2 or more, so for me that's not a risk I could consider. As many people have said here, better to take a pill than end up drooling in the corner.
2) Aspirin, maybe OK if your CHADS2VACS is zero, but not for me too much risk of gastro bleeds and certainly less effective than an anti-coagulant.
Which leaves you with.
3) Warfarin, my choice, no change to diet whatsoever with the exception of taking out cranberries (and please don't listen to your practice nurse here, or look at tables which show Vit K content, just EAT. Pros are simple easily reversable, Cons are blood tests and tiny dietary restrictions.
4) NOACs such as Apixiban etc, now quite well researched, Pros probably lower risk of bleeds than warfarin, no blood tests. Cons not immediately reversible, but short half life usually 12 hours, and some GPs will not prescribe due to price.
I have to say I think you will regret having a stroke much more than either 3 or 4 above, and give warfarin another chance why not?
Thank you, Ian, for the clarity of the above. My CHADS2VACS score is 3. I will see how I am getting on with warfarin on Thursday. Last test my INR had dropped from 3.4 to 2.2 in a week, but there were reasons - my dose was lowered, I ate more liberally and I was walking more by the day. I am now back to walking the usual amount and the dose has been static for the last two weeks, so we will see. I have spent so little time near the middle of the therapeutic range (6 weeks in 9 months) that I haven't been able to gauge just what effect eating greens has. One thing we haven't mentioned is the reaction of medications with warfarin. I was unable in the summer to take oral antihistamine for hayfever because it doesn't mix with warfarin. When I was stung by a wasp a couple of years ago, I had a bad reaction and was prescribed quite a hefty dose of antihistamine, so that is a concern.
I've been having weekly blood tests virtually all this year and the way the INR has wandered hasn't given me much feeling of security at all. However, I do have cold feet about swapping to apixaban, which I had thought would be the best way forward.
My doc prescribes antihistamine as I have year round allergy & asthma problems, also been on oral steroids whilst on warfarin.
They just had my blood tests increased in frequency whilst on those meds.
I never noticed any probs.
ps as an ex front row forward my nose is subject to regular nose bleeds, however I strangely have less of a problem with warfarin than when on aspirin !!!!
Thanks for that. Interesting. When I first started with warfarin I had a sudden rash on my arms - could have been something to do with gardening - and they suggested topical treatment only.
Hi Rellim, if you were in contact with conifers, especially Junipers, that would give you a rash, even if you just brush past them with bare skin. Usually doesn't last long.
Thanks for that. I'd been tidying overgrown weeds in the 'garden'. No idea what caused the reaction, but it may also have been linked to sunshine.
Hi everyone... Well, all I can say is that my male cousin had a series of TIAs at 57, he too has lone AF, it runs in the family. And I don't think the nasty pharma companies are pushing warfarin, it's as cheap as chips, just saying
Don't feel that we are the flat earth society, most of us spend a lot of time on the internet researching the latest on our condition and believe me, as a journalist, if there was a conspiracy out there to push one drug in favour of a good equivalent I'd have found it by now. Take care and be well.
Along those lines, I have often thought what a bright bunch we are on here and certainly bear no resemblance to the flat earth society. Mostly willing and able to debate all kinds of issues. Considering that there are many emotional aspects to A.F. I think we do well to keep a lid on things sometimes. It does no harm to have a lively debate as long no one is badly affected and we try to keep our sense of humour! X
I haven't changed my diet apart from no cranberry and a finger prick every 6 weeks is hardly life changing. A stroke on the other hand IS life changing.
I am 59 & have had AF since 2006 & up till now was only given 100mg Asprin daily as well as my AF meds . On the 26/01 whilst in the middle of a very savage bout of AF I had a TIA which resulted in them putting me on Xarelto & last Sat I had another AF lasting 14 hrs & on Mon night I had another TIA ? today I had to have another MRI to confirm this - I would hate to think what would have happened if I wasn't on a anticoagulant . My PVI Ablation date is 13/05 & it can't come soon enough , even though I am a little bit nervous about it !!
I am pretty fit I do Aqua Aerobics 3 times a week , eat a very healthy diet & weigh 62 kgs & this is pretty scary - I can't do much more than I am doing . I think their is a place for both Aspirin & anticoagulants but if you are having lots of AF despite meds then I believe you should be on anticoagulants
Oh Steve you really do need some serious authoritative advice from professionals. The ones currently giving you information are letting you down very badly. You've made two dreadfully erroneous statements and if these have genuinely come from doctors, they should be struck off the medical register! Firstly "a CHADS score of zero means there is no risk". What utter nonsense! The very reason you are even looking at a CHADS matrix is because you have AF which, on its own, exposes you to a very high risk of stroke. Secondly, "I don't have any greater risk than the general population". That would be laughable, it is wasn't so serious. Do you have dependents Steve?
Perhaps this is a post designed to be controversial, to stir things up. Well done, you have succeeded. But just in case you really believe the nonsense you are passing off - think of those dependents Steve, think how their lives will continue without you. Or perhaps worse still, how they will have to care for you morning, noon and night, attending to your every physical and mental needs no matter how unpleasant or degrading that would be for all parties. Neither are attractive options Steve so for them, if not for yourself, get onto a proper anti-coagulant as quickly as possible. You sure as hell are not on one at the moment.
My only intention in starting this post was to state how asprin can be used in the management of AF. It did make me think on reading all your replies that all the medical advice I have been given these last 4 years was wrong, however, the most recent article which states 'A CHA2DS2VASC score of 0 in a person under 65 is classed as 'truly low risk', then treatment is with Asprin or 'nothing' and can be considered for 'no antithrombotic treatment'.
I know if we trawl the internet for long enough we will find an answer we are happy with and will dismiss all others, but my intention was not to be dismissive of others views but merely to state that in somes cases Asprin is the appropriate treatment for AF.
All the medical advice says that it is (in low risk AF sufferers). Did you know also that if you are admitted to hospital having suffered a stroke, the first medication you are given is Asprin
Believe what you will Steve but the propagation of such appalling misinformation is very dangerous. What risks you take with your own life are entirely up to you but I hope that the strong rebuttal your post has received will convince other readers that you are talking utter nonsense and they should not be led down that scary path. Good luck for the future Steve - though why you would want to rely simply on luck astounds me......
I've found life on warfarin life changing. Years ago, flexitime was introduced at work. Everyone else they would be sticking to their usual routine, they said, and I said I would be doing something different every day. It goes against the grain to be consistent.
It would seem that for me maintaing a stable INR goes further than eating, and exercise plays a significant part.
I stuck to a very stable diet for a few weeks - if my INR dropped below 2, my ablation would get postponed - and INR wandered from 2.0 to 2.2, which sounds OK, but as I was having weekly tests I know it went down to 1.8 and up to 3.5 in between.
Happily I did get five weeks consistently over 2 and had an ablation 3weeks ago.
You don't have to change your diet, with one exception cranberry juice. I never liked cranberries so no diet change for me. For peace of mind I self test (Coaguchek machine cost £299 now available on 12 x monthly instalments.) Now my INR has stabilised I test about every month, although can test whenever I want.
I used to be on 300mgs aspirin per day but am glad I've reduced my chances of getting a stroke by being on Warfarin.
Thanks Thomas. I love cranberries, though I find the juice on its own is very tart. I note you say 'now my INR has stablised'. Do we adjust to warfarin, or do we find a level that seems to suit our lifestyle and gives apparently consistent results?
If I were to stick to warfarin, I would certainly get a machine and self test. Have taken up far too much time at the surgery.
I think that you will find that the new NICE guidelines for the treatment of af do not recommend aspirin at all. But if you have other heart conditions it is still prescribed. These guidelines are due out in June.
Current NICE guidance R27 states 'No drug treatment required', an asprin is standard for anyone over 50 as a blood thinner which helps prevent clotting.
I am just like you got PAF last September 2013 and got put on Bisoprolol and clopidogel (like asprin with out anti inflammatory ) and have been fine as I have no other problems. But I have my own problem now as I need a holiday back to Florida as had to cancel last year due to this AF. Which has left me frightened of flying. Hopefully I will be ok once I book the flights. Wish me luck oh and good health. Hope you are ok like me and thanks for starting this debated again. I gave up in the end as you can see loads of people are different on this forum. And yes not all but some with high risks do have to be on warfarin. I do wish everyone well as I have come to terms with my PAF and getting on with my life. I have been discharged from the Cardio Clinic in February cause all is well no other problems. Except THE MENAPAUSE!!! Which the cardiologist said could have been the palpertations that set my AF of in the first place last September. But all the best to everyone on this forum.. And thank you all for your help and support you all gave me. all the best Steave 60
Thanks and good holidaying, why are you concerned about flying, I went to New York last year and spent the whole flight in Afib. People please what we all have (agreed at different levels) is a condition, not a life stopper, yes there is a risk, just like bad diet or smoking or drinking, My afib comes on if I drink to much alcohol, if I don't drink to much I don't get Afib, I don't need to be on an anticoagulant for the rest of my life I just need to cut down on my alcohol, its about life style change and management not drug taking.
You're right, AF is most certainly not a life stopper - at least it isn't for those properly anti-coagulated. Sadly, for thousands of others...it can be.
Ok Steve but were you ok, cause that is what I am frightened of being in AF when on a long flight. Touch wood I have not been in AF since I have been on my meds. So that's a hole 6 months now.
I think you've had a hard time by the respondents to your post. After reading them all I read this morning's Telegraph. The Dr James le Fanu column highlights the fact that following the fashion to give out anti-coagulants such as warfarin surgeons are facing a growing number of cases of sub-dural haematoma caused by use of such anticoagulants. Furthermore there is a risk of 'hidden' haematomas causing personality changes. Read the article.
It certainly isn't true that the decision to take warfarin is a simple risk free decision and I think you were right to raise the discussion.
Fair enough, Steve - but having started the debate, you inferred that those that didn't agree with you were like members of the flat earth society. I found that insulting.
Apologies insults were not intended. It wasn't the not seeing my point it was most folks refusal to accept that anti coags are not alwa required in the treatment of afib.
Oh dear, more misinformation! The risk of sub-dural haematoma through the use of anti-coagulation is very low. (less than 0.002 percent per year). That risk is not confined to warfarin. It is equally evident in those taking anti-platelets such as aspirin, but this also remains very low. The chances of an uncoagulated AF patient having a stroke is high (between two and nine percent per year depending on age and other health factors). Going for the 'outsider' on the Grand National is fun. Gambling with these odds on your life is very silly indeed.
well anyone who knows me will know i dont take any medications unless i am fully versed as to why i need it. I then research all the options and decide what i want to do. My EP is brilliant and i am sure he would not recommend anything unless it was needed. I am surprised that an anti platelet drug can do anything like an anticoagulant in terms of clot prevention. I am on anti coagulant and intent to stay on it until anyone convinces me otherwise that my stroke risk has reverted back to that of the population who have never had AF. Incidently i am post cox maze procedure and removal of cardiac mass. Maybe i will not have AF in future but then again didnt know in the beginning i had it anyway so in my case for ME prevention better than stroke
No one said it was a risk free decision, but having seen people with strokes caused by af I decided that my risk of stroke was one I didn't want to take, you will always find pro's and cons for most drugs. I have been on warfarin for 12 years with no adverse effects at all.
Eileen
He'll this has been done to death everyone entitled to do what they think best for them as long as it's an informed choice.
I agree, but its good to debate, for my final post on this I will say that as a 'very low risk' afibber I will continue with my asprin and annual cardio visit, rather than spend a lifetime on a drug that can cause amongst other things; Spontaneous heavy bruising, internal bleeding, cuts which do not stop bleeding, hair loss, etc, and to answer a previous post, it 'is' still used in rat poison !!. Remember there are risks to everything we do in life, its all about how best we manage them, a 0.89 risk of a stroke from Afib for me is less than my chance of having a heart attack from any other reason such as being overweight. I know I can catch a cold at anytime, but I don't drink a lem sip everyday as a risk manager (that last comment was a bit of fun).
I think you could of just stopped at continuing your asprin and annual cardio visit as your final post...... as for the rest.... hair loss, bleeding, rat poison is unnecessary.... you got your point across and people were listening to that but you just seemed hell bent on having a debate that would put backs up and provoke this reaction and like that's fact because you have read the evidence...... its comments like in your last post that makes it hard for people who struggle to come to terms with having to be on warfarin long term... myself being one of them..... after reading your comments it thrills me to think my hairs gonna fall out, that i'm taking rat poison and the other heap of stuff that came dribbling off your key board as it came out of your mind with no regard to peoples feelings reading it..... i'm offended, at first i thought, ok maybe i see your point.... but you lost any respect in your last comment..... i'm glad that its very rare a debate quite goes off the pist as this one..... maybe your in denial..... to be honest i don't give a rats ass now...... you know i'm 34 and recently have had to come to terms with being on warfarin, surgery and understanding the impact physically and emotionally, i think what this debate has brought about for me is how important it is that i carry on taking my medication (and not listen statements like you have made) because on the flip side god forbid, the consequences of a stroke would be awful not just for me but the people left picking up the pieces...so all for just having a finger prick test weekly knocking back a few extra pills so be it...... im glad the aspirin thing is working out for you, and may it continue, i was on aspirin for 6 months and had awful stomach problems.... just saying.... so may you continue staying well and you seem to know what works well for you, but I did read over your old posts and you even stated is it time for something more than aspirin, it was clear from reading up that you've had far more than one episode of af so I don't understand, but each to there own, I wish you well ... all the best...
Can I tell you I was on aspirin and following an AF episode I suffered a mild stroke!
I am healthy, under 60 and other than AF have a healthy heart ! Not a pleasant experience! Anti coagulate properly is my motto and the motto of many I believe.
Sorry to be a pain but I'm interested in reading up on this. I have found what I believe to be the NICE Guidelines for AF, but the only para R27 I can find appears to relate to rhythm control drugs and beta-blockers etc, not anti-coagulants. Am I looking at the right document???
God forbid it happens Steve but when you've had your first TIA and you're then safely on anticoagulants (your risk of stroke goes up once you've had a stroke you see - that's the stupidity of CHADS) I hope you'll have the courage to come back and tell us....
I think Steve has rightly opened the debate here, and whilst many of us disagree, I think he is right in saying that current medical advice is to take aspirin for the under 60s with no other contra-indications, however much some of us would not want that to be the case.
I think he is to be applauded for bringing his views to this forum, and also for his defence of them.
I understand that some feel some phrases could have been better chosen, but I think that would apply to both sides of this debate/argument, and I do not think it detracts from the overall intelligent debate.
However we are very lucky that this unmoderated forum, (posts are very rarely, if at all, censored or deleted) has such a wonderfully helpful and positive vibe, with everyone being very considerate and supportive.
I am sure that we would wish to keep this spirit of harmony and cooperation so please, and I have no authority to ask other than being a long time member, may we consider the wording of our posts occasionally before posting?
I know I shall, and I also know that some of my phrases could have been better chosen. I offer now apologies if anyone felt anything other than supported through any of my posts.
Very true. I was on asprin only until I reached a particular age which meant my risk of stroke was that much higher and warfarin was considered the most appropriate option to lessen the risk. The docs use the CHADS scoring system to determine the medication.
just to remind you this is a forum for AF, while i do appreciate others with more serious conditions are far worse off, this is a place where usually i can come on and talk about how my AF affects me where people understand, i think some people are losing sight of what this forum is intended for? its not to count yourself lucky you only have AF, and other related things you can harm your self doing! this is a space where i can come and ask questions put up posts and enjoy the responses from people who are going through or have been through a similar AF journey, getting a feeling of someone understanding me is very comforting...... and for your information i have been suffering greatly with AF and don't think it should be down played and count your self lucky approach......
sorry in advance if i'm bothering anyone with the content of my reply's tonight..... i came on here to catch up with guys and quite frankly i'm going to log off as feel angry, perhaps i'm being immature and not thinking straight myself, ive been in bed for fours days now debilitated by my AF, but hey i should count my self lucky ive not got anything worse!
I agree! I.m fortunate that I don't "suffer" with my AF but I wish I didn't have it and I don't need to be told that there are far worse things that could have happened to me!
Grrrrr, why are you even on this forum if all you can do is mock the condition? this is a forum for people with AF.... we talk about AF ask questions about AF and support people who have AF not other WORSE conditions, do not underplay what some of us are going through it affects people to different severities.......
Oh dear ! My apologies to those who don't like my positive outlook on life. I have suffered very poorly with AF for 10 years now and been through 2 ablations to no effect. I do not take my condition lightly but I do try to be the master and not the servant. I hope my attitude is of comfort to those who may be relatively new to the condition and can understand that in many cases AF need not be a life changing condition. I refer to those with other conditions only to draw a comparison with how hopeless certain situations can really be. Sometimes one has just to accept their situation in life and make the best they can of it. It's down to the individual, I guess.
I am 11 years with AF and a fan of your positive outlook and feel that it is a great way to support others with AF. I don't think it is unsupportive at all to point out that there are many worse things to have, as that is absolutely true. That said, I certainly don't like having it either and totally give all empathy and support for all those for whom AF is debilitating, but I think all points are welcome on the forum, as the positive approach can be quite uplifting and for many of us, is the only way to cope. Peace to all.
Hey, I'm not knocking your positive outlook in life, sorry if I've come across brash. I am indeed a positive person, I've shared many humorous posts on here and always try to reply to posts if I think I can share any experience or be of help. I guess I should of Sat back and composed myself a little before replying, what I'm also try to say is that some times the reader of the post may be having a particular poorly day, and words are a strong sense of communication and depending on how your feeling you can interpret them differently, so please forgive my rants tonight... and wow see how powerful words are I'm now feeling bad for some think I felt passionate and mad over an hour ago, I don't want to be preceeved as a negative person, that I am not, just struggling and adapting and doing the best I can do! Forgiven? Lol
4charl, no problem. I know just how you feel (I think).
When I was first diagnosed with AF I cried for the first time in many a year. I was absolutely devastated. Why me ? I asked. Over the last 10 years I have lived with this condition and somehow feel I have got to grips with it even though I have days when I am totally knackered and get bad feelings of worry and insecurity. However, most days I am fine and I have a very active physical life involving cycling, walking, badminton and table tennis. The strangest thing is that most people I know must think that AF is a very benign condition because of my attitude to life generally. I remember the many nights when I would lay awake just listening and worrying about my heart beat. Now I just turn off the light and go to sleep.
My earlier reference to others concerned people very close to me suffering from a far greater illness and their suffering and treatment really was something I would never chenge places for.
I sincerely wish you well and hope that things improve for you as soon as possible.
Very true but definitely life changing until you come to terms with it. Now I regard it more as an inconvenience than anything else; though I know it will never get any better and will probably get worse as the years pass. But hey, c'est la vie.
You know Steve that is what I thought, until I sat down to Christmas dinner, 2013. My husband started talking to a lady seated next to him and it came out that I was just recovering from an ablation for AF. Her eyes filled with tears and said that her 26 yr old son had died of heart failure brought on by AF during exercise.
Whilst I am sure this was an exceptional case, he was an ex marine who had been ignoring the symptoms for some time, I would be really careful who you say that to in future.
Mycallc, thank you for taking the time to reply and share that with me. I can tell by reading your post that in the early days you experienced feelings I have now, I hope with time I will be able to get more of agrip on it like you have now.
I do understand also that watching close ones suffer greater is distressing, and I do get where your coming from with that, I really do.
Your well wishes are greatly received, I hope to have some improvement soon, I'm waiting for a pvi ablation but has been postponed due to naughty inr dropping again!
Take care and I also wish you well, I shall take a leaf out of your positive book!
Phew Steve! I Just read through 'The Debate'!! Can you tell me if you are on Meds for AF and are they working? As in do you still get AFibb or are you in Normal Sinus Rhythm all the time? I had a lot of AFibb for a few months last year and was put on Flecinide 100mgs twice a day and also Digoxin once a day. I've had no further episodes of AF since starting on these meds in September! TG! I'm 58 and female. I do lots of Yoga and walk most days for 30-40mins. I take Aspirin daily though my EP wants me on an anti-coagulant. I'm also slow to take meds so I understand how you feel. I would feel pretty nervous and would probebly go on the Anti-C's if I were still getting AFibb. But as I'm doing well on meds I'm holding off on them, I've talked to my GP and she's ok with that too!
Take it gently and continue to be well. I do think we are all so different in how we react to this condition.
Hi Biddy, I've been in and out of AF for the last 4 yrs. up to about 8 months ago I was going in and staying in for up to 5 days and it was'nt nice, since then the pattern has changed and I tend to just get a quick 'flutter' and then its gone. I can and do sympathise with others on here as spending the whole 7 hrs on a flight to New York in AF was not much fun !!. Got my yearly cardio next month so we'll see what he says, generally it goes, 'you know you get your AF from excessive drinking and over exercise, so stop it' !!. I totally agree with an earlier post on here from the person who said that due to circumstances changing they have gone from Asprin to Warfarin, this is what I will do if and when required, but at the moment it is not required. I also agree with the people who commented that they like to be positive and light hearted about our condition, because at the end of the day thats what it is, a quite common condition.
Hi Steve, I think it takes a while to become lighthearted about this condition especially when it's an on-going problem. For myself I have to say it has totally thrown me even though it is said it won't kill me/you ...having my heart jumping all over the place has been a terrifying experience and the exaustion and fragility in the days and sometimes weeks after a bad bout has had a very depressing effect on me at times. But TG I'm in a better place at the moment and I'm beginning to trust my body again. I think walking every day is helping and also getting good sleep with the help of Jan de vries night essence drops has made a big difference to my mood. I've cut out alcohol completely and am on a vegetarian diet again except for a bit of fish once or twice a week. Have also lost some weight and there's more to go!! I am also seeing my EP next month and am hoping I can decrease my Flecinide but we'll see!! It may be a common condition but it effects everyone differently. Good to communicate with you!
Wow, you opened one giant can of worms here, and it is clear that everyone has an opinion. The only thing I missed is whether or not you have had more than one episode of AF or if it is something you contend with on a regular basis. I can see your point if you only had one episode years ago, but if it is a regular feature, popping up at will, then I personally would absolutely positively want to be on anticoagulants. But here is the thing...that is a decision best made by you and your medical team, so wishing you all the best as you choose your own best path.
One comment to all those who have maligned the use of Aspirin. While it is not the choice for AF for stroke prevention, it does play an important role in many diseases and is even thought to be cancer preventative. It can be pregnancy saving for some dire pregnancy situations and truly is a wonder drug when used properly. If you are having a heart attack, chewing an aspirin can be the difference between life and death. That's my 2 cents worth. Be well.
I think you are right, there are a lot of medical professionals out there saying aspirin is an appropriate treatment for AF. However I think if you dig a bit deeper you will find that very few of them are EPs so taking advice from them is like asking the plumber to fix your electrics. Personally I would prefer a qualified electrician.
I have no other health issues but also had 2 TIAs before taking warfarin.
Ok. Since this debate is still going I will add another bit. I have A.F. and had 3 T.I.As. My score is 3 and I take warfarin and flecanide happily. My husband has atrial tachycardia of some sort. It may be flutter or AV. Node 're entry and no way of knowing without E.P. study. Currently completely controlled by bisoprolol. He is neither on aspirin or warfarin and has a score of zero. The E.P. said he was not enough risk for warfarin and that aspirin didn't work for A.F. related clots so better not to take it. We are both under the same E.P. whom we both trust. I would be happier of husband was on warfarin but I believe I would be wrong to influence him because if he then had a significant bleed I would feel I was to blame. We are both intelligent people who have to make their own decisions. In 5 years time when he is 65 he will have a score of 1 and says he will then take warfarin. All I can do is hope our E.P. is right! My point is that we all have our demons and need to work out our own solutions but there is a big need to have access to honest and accurate information so we are properly equipped to make decisions. Even if my score was 1 I would personally want to be on an anticoagulant just to be on the safe side! X
Hi I am 82 female chade 2 had a gastric bleed while on Warferin and another bigger bleed while on Asprin because of bleeds cannot take anticoagulants and hey I am still here I watch what I eat and have no alcohol, and live the fullest life I can with AF.
All this is frightening me (recently diagnosed with PAF. ) doc suggested warfarin but said I did not want it , I have been wondering since if I made correct decision , I take 75 mg aspirin , and frankly after reading all this I am still unsure !!! I am 62yr old woman otherwise no other heart probe or health probe and my risk factor is 1 ( come on throw it at me lol. )
All I can say is that with a score of 1, your GP is right, and you have an enlightened one so stick with him/her many are not.
Aspirin does not reduce the risk for the more serious AF related strokes, warfarin does, and it's easy (and benign) to take, bit of a pfaff with the blood tests but nothing difficult.
My score is zero I take warfarin, but ultimately it's your choice.
You sound bit like me......a worryer! I am far more worried about having a A.F. related stroke than anything else related to A.F. I was nearly hysterical until I got myself onto warfarin. Now I feel like I've protected myself as much as I can and it has taken a lot of the fear away. Of course I was also worried about my I.N.R.( what self respecting worryer wouldn't be!!) I solved that by buying my own testing kit so I could always be in control. I know that is only my take on things. We all have our own particular demons to deal with.x
I never thought I would say I am warming to warfarin but with an INR in range this week, I am hating it less. I still don't know which way to turn. All the alternatives seem like they may prove to have been a bad idea. I am surviving on warfarin, but don't feel at all comfortable with it. I may regret moving to apixaban. I'm good at injuries, so warfarin and apixaban both frighten me. I have probably already taken enough asprin. I think I'd probably regret taking no anticoagulant at all, and there would be nothing worse that having egg on one's face and being unable to wipe it off. Apart from AF I don't tick many likely-to-have-a-stroke boxes (although I am forgetting that being female and over 65 both count) but would I ever get affordable travel insurance?
I'm minded to try some regular but injudicious eating and see what it does to my INR.
I am also on Aspirin in preference to Warfarin but am now reconsidering my options. It's very difficult when medical opinion is divided. I was on Aspirin for 7 years with cardiologist approval but a different cardiologist switched me to Warfarin after heart surgery. I stayed with Warfarin for a year but got fed up with the drug and food interactions but mostly the constant monitoring. My GP agreed to a switch back to Aspirin a year ago as I had a CHADS score of 0. Cardiologist said that CHADS wasn't relevant in my case as my heart isn't structurally normal and wants me back on anticoagulants. Not sure if my GP was aware of this criteria, I certainly wasn't.I have agreed to consider something other than Warfarin but if GP won't fund, I will chose Aspirin. I asked the cardiologist if she could envisage a scenario where I wouldn't be taking an anticoagulant and she couldn't. As I get older, inevitably more things will go wrong - so many other drugs affect INR including antibiotics and other medications that I already need to take. Going to the GP every few weeks for the rest of my life I find an intolerable thought.
There certainly are plenty of drawbacks to warfarin! Constant monitoring is a pain. If there's a gap, how can one be confident about where the INR is going between one test and the next? What's the cost of self monitoring against the cost and inconvenience of travelling to a clinic? Will warfarin become as quaint as the idea of buying a film and popping it into one's camera, taking 12, 24 or 36 photos, winding back and then having to have the prints developed and printed?
Hi Mrspat the new anticoagulants do not work in the same way as Warfarin so you don't need INR testing AND there are no interactions with food and very little interaction with other drugs. I chose to go on new anticoagulants and my GP supported me totally. Aspirin will not protect you from an AF induced TIA or stroke.
Hi cdreamer u seem to be the only other person who has gone on the new anticoag because u didnt want the problems with warfarin I have done the same how are they working and why do u think we dont get more debate about these on the forum
Yes CDreamer, I've read all the arguments and discussions.
Currently my personal choice is likely to be one of the new anticoagulants. My cardiologist is supporting this but has yet to liaise with my GP. My understanding is that the hospital would fund the first 3 months but the GP has to fund thereafter. I believe that my GP has an open mind, however there are others in the practice who do not.
My personal experience of being on warfarin for a year was clouded by drug interactions. Changes to other medication that I was on plus seven courses of antibiotics to fight an infection meant that I had 6 months of going to the GP every couple of weeks. I find the dietary limitations difficult.
When I had my new heart valve, one of the factors in choosing a tissue valve was not needing Warfarin. Nobody told me that I would need permanent anticoagulation because of my history with AF. I had been on Aspirin for 7 years under a different cardiologist.
Still watching from the side lines and been fascinated by this debate
There is a small evidence base for aspirin at 375mg od (the German dose) reduces the AF stroke risk by about 19% (compared with anticoagulants 70%) however at this dose (and actually most of the lesser doses) it carries the same bleeding risk as Warfarin and the non-vitamin K antagonists (NOACs).
For this reason, dramatically less benefit with the same level of risk, it is felt by the clinical community that we should not recommend its use.
The studies showing anticoagulation to be superior to anti-platelet agents goes back over 20 years and was not funded by industry at the outset but the results were the same.
The cost analysis always takes in to account the cost of monitoring the warfarin when looking at non-vitamin k antagonists
With very low risk (CHADSVASc score zero) I would not recommend aspirin as the risk of bleed out weighs benefit. I also have patients at this low risk who have opted for anticoagulants of both monitored and non-monitored varieties. I accept their point that 'low risk is not no risk' and they would wish to actively reduce the risk further
In people with coronary artery disease, circulation issues and previous stroke who opt not to have an anticoagulant then of course we use aspirin, however this is for its prognostic value in their other diseases and I always ensure they realise that the stroke risk from the AF (which in this setting is considerable) is not modified by taking the aspirin.
In people who can't take aspirin or anticoagulants as commented above I work with them to reduce the stroke risk in other ways such as diet and other forms of cardiovascular protection. Unfortunately this does not reduce the specific stroke risk of the AF but reduces their overall cardiovascular risk
Watch NICE on June 10th for the up dated national guideline
Am taking Warfarin(1.5 mg) every day but Doctor wanted me to stop Aspirin which I have taken for 22 years since my 1st MCI, I refused as been OK since triple bypass in 2008, was I wise??? Suffered with AF for 6 months and appears controlled with drugs digoxin and ramiprill, has anyone any thoughts please ?????
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