Replying to the aspirin debate

[Brian101]

I read the 70 odd posts with interest.

It was mostly a good debate.

But.

This is how my heart surgeon explained it to me.

The aorta has a sac - its like a little bag hanging down somewhere just after the valve from the heart. When we are in sinus (normal) rythym with every heart beat this valve fills and empties with blood.

When we are in AF the sac doesn't completely empty - thats when clots can form - they sit in the bottom of the sac and when we go back to normal rythym the sac empties and we are playing russian roulete .

It happened to me , I was was lucky the clot landed in my arm.

At the time I was on aspirin.

Thats why Im now on warfarin.

Brian

[Rellim296]

Thanks for this. I have just added to the lengthy debate, but the comment is better added here.

It is guesswork and, as you say Brian, a gamble.. The CHADS scale is something that can be employed usefully instead of a intuitive - and possibly erroneous - decision. Doctors' opinions have to be coloured by what has happened to their other patients. We have to choose to follow advice which may be unpalatable or to plough our own furrow which may be misguided.

If it all goes slightly wrong, AFibbers have to live with the consequences, be it a small stroke, ulcer or a haemorrhage.. or hopefully nothing too untoward and a clearer picture. If it goes very wrong, we ourselves are less at the helm, and it is our nearest and dearest who have to come to terms with the person they are left with - or without. I am now inclined not to follow my own gut feeling but to go along (somewhat unwillingly) with what my husband and children favour.

I have two friends who live life without family and for them the choice is their own.

[BobD Volunteer]

One of the problems in getting impartial advice is that many GPs are terrified of warfarin or fear gastro intestinal bleeds. It has been shown by statistical analysis that if a GP has one patient with GI bleed he is ten times less likely to prescribe warfarin in the next six months than before yet he could have ten patients with stroke and do nothing about it.

Human nature I guess but not helpful to those without the knowledge we do.

Bob

[Offcut]

I was on warfarin and had a heart attack because of the blood vortex in my heart chamber starved it of oxygen while I was in a severe AF. I peaked at 218 bpm in hospital which made the machines beep a bit!

[RobertELee]

Brian, as you probably know, the 'sac' you refer to is called the left atrial appendage. I read a statistic somewhere - I think it was on the AFA website - that 95% of all strokes suffered by those with AF are caused by clots that originate in this appendage. There is a catheter procedure available to close or 'occlude' this appendage with a mesh, with the result that while blood may still pass into it, clots, if formed, cannot escape into the blood stream. Now, as a layman, that sounded to me like a no-brainer. Close up my appendage, keep taking the warfarin for the odd 5% of clots that might come from elsewhere and job done; stroke free for the rest of my long life! But my cardiologist tells me it is only available to those who cannot take anticoagulants. I didn't labour the point with him on this occasion but I'd be interested to know if anyone else on this forum has knowledge of this. Why isn't it used more? It just seems to me that it would be a thoroughly effective method to hugely reduce the risk of stroke that comes with our condition, involving a procedure which apparently is no more surgically complicated than an ablation. But what do I know???

[Brian101 in reply to RobertELee]

Yes Leelec you are correct - it can be corrected by catheter but here in Sydney they had a failure with sad results so that is not an option. Open heart no problem . Big call

Brian

[seasider18 in reply to RobertELee]

Surgeons doing bypass or valve replacement surgery could remove the appendage at the same time but few do. When I told my EP that I am thinking of having it done privately he checked my operation notes to see it had already been done. Sadly it had not.

[BobD Volunteer]

Leelec I know that there is a surgical key hole procedure done my one doctor down near Southampton where they lasso the appendage from outside via a small cut and burn it off.with a hot wire.(very simplified). Just a second option.

I guess all these things are about cost but at the end of the day warfarin alone is pretty good!

Bob

[iris1205]

Good article, read through to the end!

heart.bmj.com/content/82/5/...

Hope this helps.