AF Association
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Should I be on a anti-coagulant?

I keep reading on here everyone is on a walfarin or similar. No doc has mentioned me going on one. Should I be? I'm 35 non smoker with no family history of stroke etc. I've been referred by my local cardiologist for a ablation at st Thomas London, not sure how long I'll be waiting.

Should I be asking about going on one?

23 Replies
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Hi BattyMumma

There can be a lot of confusion about this, but generally I suspect most doctors would say that with no other contra indications, then at your age probably no anti-coagulant. And this comes down to a CHADS2VACS score which will probably be 1 for you being female and under 65.

However some say why risk it?, stroke is still the big risk for us all, and most of us have no or almost no problems with warfarin, so why not take it? It's not a straighforward decision and there is some new guidelines coming out from NICE in June on this very subject and we are hoping they say "In AF? anti-coagulate" but maybe we are hoping too much for such clear guidance.

Oh and we don't usually call them blood thinners, mainly because they don't (thin the blood that is) and because using that terminology tends to add to the fear factor around them which is unwarranted and unnecessary as they are really easy drugs to take for most of us.

Be well

Ian

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Thank you for the fast reply. I am still getting use to the terminology and spelling coagulant was beyond me at this time of the morning LOL.

Think I'll have to make myself a terminology list.

I guessed because I'm 'low risk' is why it's not been mentioned. Think I'll discuss it at my next appointment.

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I agree with Ian BUT guidelines change all the time so you need to keep abreast of the situation.

Bob

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hi Battymumma

since being diagnosed with afib just over a year ago. one thing i have learnt is afib is far from straight forward. it seem every cardiologist as a different rule book for treatments.which is not really what we want to hear as it always throws a big shadow of doubt of whether or not we are on the right road for treatment. my best advice would be to keep asking questions and dont worry about being more forceful in getting the answers. i have learnt this from being to easy going in the past i was taken off warfarin last september and put on aspirin. which i am led to believe from reading on this site is non effective for afib ?? i sometimes feel like i am walking a tightrope without a safety net. i will certainly be more prepared on my next visit to the cardio dept. still at least you have a plan of action and are going forward with a up and coming ablation, keep your chin up :)

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Aspirin is still used for other conditions, but it doesn't prevent strokes in af. But I would query it with your drs, as it is also a stomach irritant and can cause bleeds, so if you don't need anti coagulants why take aspirin?

Eileen

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True but sadly there are still cardiologists who think it is the holy grail. This whole question of anti-coagulant or not is quite strange as many people here think it is vital based on advice we have had at recent conferences etc but some of the decision makers still feel that we need to be protected from ourselves for some reason. There still seems to be a great worry about having major bleeds (not like my finger when I caught it on some wire in the garden, I mean REAL bleeds.) WE here tend not to consider the bleed risk too much whereas medics use the HasBled chart as well as ChadsVasc and as I said in a different post there does come a point of age where bleed risk exceeds stroke risk.so it really isn't cut and dried. Personally with a ChadsVasc of 2 and a HasBled of 1 I ma happy on my warfarin..

By the way BattyMumma you will probably have to go on warfarin for a few months before your ablation anyway so don't worry too much right now.

Bob

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All too frequent medical opinion is that you should wait until you've had a stroke before you ask for anti-coagulation. It puts your CHADS score up you see. If you think that makes sense, do nothing. If you value your life, get angry and get anti-coagulated now!

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I was first put on Warfarin when I was 36 and been on it ever since.

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I had ablation in St thomas ' and found them really good. Are you seeing Dr o Neill? I waited about 3 months so not bad. You probably should ask about going on warfarin as it can take a while to get to the target range and they won't do the ablation unless you are within range, normally 2 to 3. Best of luck

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Don't know who I'll be under yet. I'm going to book an appointment with my GP next week to discuss all this. They'll likely be useless and tell me I don't have a heart condition (happened previously with my lung condition even after proof) but maybe they'll surprise me. Thank you for the reassurance about st Thomas'.

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I was diagnosed a year ago with AF and put on warfarin and Cartia XT. My Cardiologist and EP both say at 68 I will remain it warfarin. Recently, I went on Flecainide as we'll which has finally taken the frequent episodes away. I hate to be on such a strong drug, but aside from Ablation, don't have a choice. Are most of you on both Flecainide and Cartia?

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I have just been diagnosed with AF a month ago. They want me to go on Warfarin for the rest of my life, I haven't been given any other choices. Will life as I know it be over?

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There are nearly always treatment choices. It is just that the medical profession can be absolutely useless when it comes to explaining them. Some of them just want to you to do what they say without telling you why or giving alternatives. We aren't qualified to give medical opinions. Different things suit different people. Do your own research, ask people on here about their experience of different treatments and don't be afraid to ask doctors to justify their recommendations.

When I was put on Warfarin, which I am not on now, I was bounced into it after having a major operation. I was sent home with a load of literature, some basic counselling, in a very vulnerable condition mentally and no indication that it was supposed to be for ever. Had I felt stronger I would have asked many more questions and I had to work out a lot of things for myself.

No, life is not over. Don't wait for something to be offered if you think something better needs to be discussed.

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Hi Tupelo

No is the simple answer, within months you will wonder what all the fuss about warfarin is about and just pop the pills and offer the arm for a blood test like nearly all of us. No drama, no fuss, no diet change, all a bit of nothing really.

Be well

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Actually, there are other choices of blood thinners out now and they are available on the NHS. A cardio I saw recommended to my GP., that because of my age (65), she recommends that I be put on Warfarin in the not too distant future. I told her that I wasn't going to take Warfarin and that I knew there were new alternative drugs available. She told me that as they were new treatments they didn't know the long term effects and she said they maybe could cause cancer long term. What sort of a statement is that from a so called doctor. If the truth were known, it is probably cheaper for Warfarin than these new drugs, which incidentally are available on the NHS, so I'm just on Aspirin 75mg., one a day at the moment and the last cardio I saw told me that the UK., is the only country in the EU., that recognises Aspirin as a viable blood thinner now, so I told the cardio, who I'm seeing prior to ablation that if I have to have another blood thinner prior to ablation, I will take one of the newer drugs please.

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Hi Jowett

There certainly are alternatives, ther's 3 of them generally grouped and referred to here as NOACS (New oral anti-coagulants) you're also right there is a very big price difference even with the costs of blood testing warfarin is a lot cheaper, but also you need to understand the other challenges. summed up here.

Warfarin:- tried and proven long term, very small diet changes and blood tests needed can be difficult to stay in range, but readily able to be reversed with Vitamin K injections, cheap.

NOACs:- New not yet proven, some say cause less bleeds, but there is also a group which alleges they cause more bleeds, no blood testing, no diet changes, expensive and at present not able to be reversed, although reversal agents under testing in the US, and they have a relatively short half life around 12 hours but not sure how that helps in a trauma situation.

Fully agree about aspirin, and your doctor's statement was outrageous. However none of them are blood thinners, not only do they not thin the blood the use of the term seems to scare people unecessarily.

Interested why you appear to be against warfarin, for most of us it's a non event, only pfaffing around is the blood tests.

Be well

Ian

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As I have mention it seems every cardiologist as a different rule book for treatments. I have cut my dosage of aspirin from 150 mg a day down to 75 mg a day, this is solely my decision, based on information have read ,as I am not prepared to wait a year every time to voice my concerns with the cardiologist. I am also now booked in to see Dr Peter o’ Callaghan next Thursday to see if I am an eligible candidate for an ablation. Onwards and upwards fingers x

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I'm 37 and was diagnosed with afib last September. Have never smoked and no heart conditions within the family. I was put on bisoprolol and asprin 75mg. Like most people on here I knew nothing about afib or that us put you at a higher risk of stroke. I am a single. Mum of 3 kids and am worried for the future. I have been to see 2 drs, 2 cardiologists and an ep and none will put me on warfarin. They say I'm a low risk but at the end of the day a risk is a risk.

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Wow millie123 it must be quite something going through all this as a single mum. I hope you have a good family behind you helping you cope.

My family is pretty useless but I am blessed with a miracle and have an amazing husband. My kiddies are 4, 3 and 12 weeks, how old are yours?

If you ever need anyone to chat to feel free to pm me.

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Thank you all.

I thought I'd just wait now until I have my letter about my ablation but think I'll ask for a cardiologist appointment to discuss this. I don't want to have any delays in having th opp. My lung consultant wants to test how my lungs and heart work while doing stuff but can only do it after my ablation.

None of these conditions are straight forward are they?

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Dear BattyMumma, my CHAD was only 1, but my consultant put me on Rivoroxaban because of anatomical changes to my heart plus irregular rhythm. He seemed to suggest that although there are guidelines about the use of anticoagulants you also have to look at each individual persons risk factors. I am more than wiling to take the medication if it reduces my risk of a stroke.

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For me walfarin has a stigma attached. When i think of it I see injections into belly (even thou in pregnancy I had them in my thigh) and PAIN! Goodness those injections hurt. Also major bleeding and loads of check ups.

I think I'll be researching NOAC's.

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It's heparin that's injected into your belly, not warfarin. Having been the recipient of these injections after heart surgery, before they could start warfarin, I never wanted to have them again. It was one of the reasons I wanted to come off warfarin and on to aspirin and did: I had a fairly minor op scheduled and they wanted bridging anti-coagulation - injecting myself with heparin for several days before the operation. Luckily I didn't need the op. If I need an op in the future, I will probably have to fight that battle all over again even with the NOAC.

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