Article on anticoagulation in today's Daily Telegraph

The article (for which I can't give a link) has some interesting statistics.

3.4% of AF patients are on NOACs - NICE expected it to be 20% by now. This is believed to be due to doctors not discussing this option with patients.

25% of AF patients admitted to hospital after a stroke are on no medication at all

38% of AF patients admitted to hospital after a stroke are on aspirin

Aspirin reduces stroke risk by 19% and warfarin reduces stroke risk by 64%

There are 7100 preventable AF related strokes each year in the UK

These figures are from a report made to Parliament 2 weeks ago and quotes a Professor Cowie of Imperial College. The report also says that many doctors are more wary of the side effects of anticoagulants than of the risk of stroke. It will be interesting to see whether the imminent NICE report has the same figures.

33 Replies

  • Yes these are things AFA have been saying for years and hope the new NICE guidelines will address.. Personally I doubt the 7100 number and feel that the figures are much higher than that. I also doubt the reality of the estimations of people with undiagnosed AF which again I feel are much higher.

    Prof Greg Lip in a talk some four years ago commented that if a GP had one patient with a serious bleed he was ten times less likely to prescribe warfarin yet have a patient with an AF related stroke and he was not more likely to use warfarin.


  • Two of the figures took me by surprise:

    The low take-up of NOACs, which reinforces my belief that the vast majority of doctors habitually withhold information from patients. Even allowing for the cost element and fears about lack of antidote, this seems really low given that 50% of people who responded to the latest poll now say that they would opt for NOACs given the chance.

    That aspirin reduces stroke risk by 19% and warfarin by 64%. From views expressed by some on this forum, I had expected the respective figures to be nearly 0 and close to 100.

  • 64 is an awful lot closer to a 100 than 19! The point is that one is three times better than the other, a simple observation which should be reason enough for most of us.....

  • This, along with other recent posts about studies, seems to underline the old maxim: there are lies, damned lies and statistics!

  • Well, I did ask my doctor about NOACs and he said no, but we are talking about NHS Wales here, and I don't think Wales uses the NOACs unless you have serious problems with warfarin. So we just have to get on with it! Glad my INR seems to be stable and I haven't had any major problems with it, is all I can say.


  • What were the other 37 percent on?

  • Presumably an unspecified anticoagulant, which would be warfarin in the vast majority of cases. The article didn't say.

    The campaign to get all AF sufferers onto anticoagulation should be run in tandem with a push for more information and choices about alternatives to warfarin. It would be interesting to know why the figures for no anticoagulation and aspirin are so high. Would there be more people on anticoagulants if there were more choices? Fifty percent of people in the AFA poll said that they would take NOACs.

  • Hi Mrspat

    Only one comment, there are quite a few of us out there having been offered NOAC's prefer to stay on warfarin. But whether more people would be anti coagulated if there was more choice, who knows. It is always difficult to get new expensive drugs into general circulation but it does happen eventually, like all things it takes time , and education, and it's early days yet for NOAC's.


  • At age 69 I was offered no anti coagulation at all except aspirin which I did not take because of the side effects. I was about to ask my doctor to put me on warfarin which I found very difficult to cope with on previous occasions, when I was admitted to hospital with angina and fast AF. After an angiogram the consultant said he was prescribing one of the NOACs and I could choose which one would suit me best! I promptly said 'You choose' so now I'm on Riveroxaban. I could have cried with relief which I'm sure some other posters will appreciate.

  • Choice is the key word for me and I guess there are some who will choose to stay on warfarin even when antidotes for NOACs become available. I do find it disappointing that that AFA are pretty much silent on the choice issue, which just colludes with the warfarinise everybody point of view. I now have experience of warfarin, aspirin and Xarelto. Warfarin would be third choice on my personal list.

  • AFA do not collude with the warfarin isle everyone. They provide the information so that you can exercise your right to choose. As many health authorities are unwilling to prescribe the new anticoagulants, although hopefully this will change


  • Hi all another interesting conversation with of course those dreaded statistics again, and thank you for your contributions MrSpat I still have yet to quite get to the bottom of why you appear so anti warfarin (it would be your 3rd choice AFTER aspirin?) but perhaps another thread one day.

    Going back to thje stats quoted.

    You need to remember that it's all very well talking about 19% reduction for aspirin, and 64% of warfarin, but 19% and 64% of what?.

    OK so let's take a base risk for any one person right now to be 1

    With no other factors whatsoever, family history, smoking, etc etc, JUST with AF, that risk is now at least 5.

    You are 5 times more likely to have a stroke if you suffer from AF, so OUR baseline, is not 1 but 5. (some say 6 but let's stick with the lower 5)

    Now take those stats, with aspirin a 19% reduction from 5 takes you to 4.05, you are still 4.05 times more like to have a stroke.

    With warfarin you get a 64% reduction, on your base of 5 which makes you 1.8 times more likely to have a stroke.

    So let's talk about real stats now

    If you suffer from AF and take aspirin as an anti-coagulant you are 4.05 times more like to have a stroke.

    If you suffer from AF and take warfarin as an anti-coagulant you are 1.8 times more likely to have a stroke.

    All of course based on the Daily Telegraph stats as published above, etc etc usual provisos.

    For me? No contest

    Be well


  • Can I throw another stat in? Using the stroke risk assessment tool (which I know some people think is controversial in itself) my personal annual risk of stroke is 2.2%. That may be a lot higher than somebody without AF but doesn't it also mean that I have a 97.8% likelihood of not having a stroke?

    On the subject of warfarin itself, my views can summarised as concern about interactions with other drugs (which I have experienced), frequency of testing (my INR was never really stable, partly due to changes in medication), dietary concerns (restricting green vegetables and/or having to keep intake of various foods balanced - I've always eaten healthily. Chucking in bigger doses to counteract this seems dangerous to me). Physical concerns (hair loss, dry and itchy skin).

    I appreciate that there are a number of people on this forum, who have been on warfarin for years and swear by it. However, we don't always get a balanced view and a somewhat idealised picture involving stable INR and side effects dismissed as minimal is often painted. I have even heard the view expressed that the drugs companies have deliberately created a demand for NOACs that isn't really there. Taking away the cost and lack of antidote issues which will be resolved, why do people not welcome the NOACs and want to stick to warfarin like a comfort blanket?

  • Hi Mrspat

    OK thanks for the info, and actually I do welcome the NOACs and in 18 months or so when the antidotes are in I will probably switch to them if I can persuade my GP.

    Couple of things, the stroke risk calculator is cumulative I understand, cumulative compounded so with AF and as you get older the risk of NOT getting a stroke gets smaller and smaller.

    I appreciate the interaction with other drugs problems, but isn't that also true of NOACs?

    There are no dietary restrictions with warfarin except cranberry juice, you do not have limit the intake of green veggies simply not binge on them (or anything) so your "healthy diet" is exactly the same on warfarin.

    Lastly actually I do not agree with you about higher doses being dangerous, in fact I think it's safer. if you for example eat the equivalent of 4mg warfarin of green veggies a day and then have to take say 6mg a day to get in range, for me that is safer, and more practical than being on 2mg a day, There is someone on here who explains this much better than me, but it's about safety margins, and the dosage of warfarin really is irrelevant, any not used goes straight through the body.

    I don't think stable INR is that common, many of us fight more than a bit to remain stable, but I do think the risk of side effects is really really small, we get almost none on a board of over 1400 members most of who are on warfarin.

    As always appreciate your comments Mrspat, none of us are perfect and we can all learn things from others views.

    Be well


  • Hi Mrspat, I'll add another to your concerns - having to get doctor's surgery (weekly in my case) via infrequent bus service plus walk, alternative 30 minute walk or taxi.

  • I think the risk of getting AF and/or stroke increases with age anyway. The interactions that I see listed for Xarelto are mostly over the counter products, products containing aspirin or other anticoagulants. There are no interactions with any other drug that I am on nor any that I have been on.

    Have to disagree on the bigger dose issue as it must impact on kidneys, stomach and liver.

    I forgot to add to the lost of things I dislike about Warfarin - the infringement on quality of life. Yes, I can hear people saying, you'd have no quality of life if you had a bad stroke. I find it intolerable to go to the doctors every few weeks. Although I accept some but not all of the NHS's test offerings, I don't consider going to the doctor every few weeks for the rest of my life an acceptable state of affairs. Self testing also just emphasises that things aren't right.

  • I will put my 2 cents in here. I agree with you Mrspat that I would have a 97% chance of NOT having a stroke. To me, that is a big chance of never having a stroke. That being said, I am taking Xarelto. Been taking it for 3 weeks far so good. I refused to take warfrin. For me, the stress of having to be tested every week or two and worrying about "numbers", and always wondering if I am eating the right food (Although I do eat healthy) would be worse for my heart than not taking anything. I am glad I have a doctor who gave me choices.

  • I agree about the stress and feel warfarin has severely impacted on my quality of life. I still take it and feel I have no good way forward.

  • I totally think that we should all have the right to choose . I am very happy with warfarin and love self testing as I can be confident that I am in range all the time.when I get older and maybe less able t be in contol of diet etc one of the new drugs maybe more appropriate howrver. I have always been on a hihh dose of watfarin to stay in range but the reason for this is that my kidneys get rid of it at a fast rate thrtefore it is not in my body for sd long s someone on a low dose. If it is not in your body it cant be doing you any more harm than anyone else. All drugs have some negative effect it is just a question of weighing up advantages and risks. Warfarin seems to evoke an emotional response in some people prehaps because it is used as rat poison. X

  • I have to say I wasn't keen to introduce another drug into my life, but when I found out the full impact of warfarin I was horrified - the card to carry at all times, the yellow book ( with 'for life' written in) the instruction never again to eat cranberries or grapefruit (two favorites) the visits to the surgery, the need to watch greens ... And the prospect of bruises and bleeding being of significance. And for me, all for a problem that hardly ever occurred and did not have much impact when it did. People always in AF, tedious though it must be, have a more tangible situation than those who rarely have AF and who are almost normal but not quite but who know they might be struck down without warning. I've found it very difficult and frequently had to give my treadmill a hard time to wear off the incandescence.

  • I can relate to all of this. Part of the problem for me was the almost casual way I was started on Warfarin after I had a return of AF post-operatively. Nobody explained that they intended it to be for life and all of the literature that I was given explained that people who had had my operation were usually on it for about 6 months. I was willing to accept that, especially as I was scored as low risk for stroke. Even my GP didn't know they intended it for life and I didn't know until I asked the cardiologist the direct question. I find this deceitful and with previous bad experiences of a different cardiologist, trust comes very hard. I had to find out everything about NOACs myself and the cardiologist was surprised how much I knew. Nor have I ever been told much about AF itself - most that I have learned came courtesy of this forum.

    Incandescent describes me at times too and I don't need to be told that I will be happier if I just accept it all.

  • My cardiologist decided warfarin was for me and there was no explanation of the benefits. I did nothing for a few weeks and then my surgery rang and called me in. After getting the yellow pack, I refused to comply on the grounds that I am too accident prone but I was eventually persuaded by my family. My son (whose other half is a doctor) told me to deal with my situation and as you say, mrspat, accept it and not moan. I find it difficult in the middle of the night with weird feet that feel they are made of half set concrete, courtesy of flecainide, and am convinced, probably wrongly, that warfarin has some sting in the tail as well, like hair loss. But it's better to bleed to death than to sit in a wheelchair and dribble day after day.

  • That is very true. I think it is always easier to accept things when there is no alternative. For example those in persistent A.F. with no symptoms must find it hard also. When your heart flip flops nearly all the time it is difficult to ignore what could happen without the meds.x

  • Oh please. What a lot of whining about warfarin. You'd think the European Court should get involved the way our human rights are being snatched away from us by deceitful doctors daring to prescribe this wicked drug. Let's get real. We have AF. Most of us are of an age where it could more likely be cancer, motor neurone disease, Parkinson's, dementia or a thousand other real nasties. If AF is the worst thing we get then we should consider ourselves rather lucky. Not moaning about clinic visits, having to give up cranberries and well, the outrage of having to carry a yellow book..... it's not a yellow star!

    Now, of course we hope that NOACs bed down and prove to be very effective alternatives to the tried and tested warfarin that, yes, does have its drawbacks. But until the price comes down, many folk not willing or not able to bang on their GPs desk, simply won't be prescribed it. The antidote thing is a bit of a red herring anyway - there are ways of dealing with that in the ER - but it provides yet another lever enabling medics to encourage patients to stay on the cheap stuff. Like Ian, I'm sure NOACs represent the way forward but personally, I will miss the reassurance of an INR in therapeutic range and a little wary that, at the moment, no one on an NOAC for AF has lived longer than 5 years........But I'm sure many will!

    No one is being force-fed warfarin. We can always say no. If you're feeling really brave, burn your yellow book and wash down your daily aspirin with a nice glass of cranberry juice. Why not take up smoking cigarettes again too...?

  • This is a forum where we can chat about anything AF related. Do you want members to be careful about what they say in case you respond with your belittling comments? That's not the way it is on here, we offer kind, considerate and supportive comments at all times to everyone.

  • Dear Anti-coagulate now

    Thank you for your contribution, and I often appreciate your comments and support in the discussions on this forum, but may I please ask that you consider that others do have their views, nothing is as black and white as sometimes we would like it to be, and that is especially true of AF which is so different in so many different people.

    I don't know who said it but it's true.

    "A person persuaded against their will is of the same opinion still"

    I 100% support your thrust to anti-coagulate now, I actually 100% agree with most of your points, BUT and it's a big but if I may, please recognise that warfarin can be an emotionally difficult drug for some people, and failing to recognise that, will not convert anyone who thinks differently.

    Influence is not about battering people with facts, but understanding their perspective and then allaying fears, gently coaxing at times, and being their for support when they need it.

    I value your contributions, and your arguments, but please consider your wording at times, this post is not up to the standard that I know you can contribute.

    Of course I am neither the administrator nor the arbiter on this forum, merely a fairly prolific poster, who is asking a fellow excellent poster to just take care at times please.


  • Sorry that you feel the need to express yourself in this negative and intolerant way AntiCoagulateNow. I thought we were having a reasonable discussion. I don't actually like cranberry juice and I've never smoked. What I do know is that although I enjoy an argument, stress and bullying sometimes brings on AF, so you'll have your way and no more comments from me in this thread.

  • Hi Mrspat - Please ignore AnticoagulateNows comment. This forum is here for all members to talk about anything AF related. I'm sure he/she doesn't mean to come across as they have. Please don't feel that you have to leave this discussion. We are all here to support each other in any way we can, for as long as we want. Lets all feel we can discuss ANYTHING without being 'put down by others comments'. I think the saying is "If you can't speak nice, don't speak at all"

  • I'm glad I didn't idly pick up my ipad while I was in the middle of cooking, or we might have had a very frazzled meal!

    I stand by my comments about being moved into a world that didn't seem at all inviting. Yes, it is a bit pathetic to feel having a yellow book is an imposition, and that 's part of the trouble: it appears to be a huge thing, out of all proportion. When I was diagnosed with cancer, when my children were 7 and 6, I recall being quite dynamic and determined to make the most of the short amount of time I thought might be ahead. Wrong, of course, as I have survived, thanks to surgery. We never know what is ahead. I know I'm lucky, very lucky, to be where I am now. I've just passed the point in my life where I am twenty years older than my sister was when she died. If I were to expire tomorrow, I would not feel short changed. But I don't enjoy being on warfarin.

  • Can I please point out that if you are on any form of anticoagulant it is a good idea to carry something that identifies this fact. If you have an accident you are still at risk of bleeding. So maybe not a yellow book, but something.

    Also with the new ones you should still see your dr for the monitoring of possible side effects, although not as often as INR testing.

    All drugs have side effects although obviously not everyone has them. That's my two penny worth,


  • Thanks for that. Good idea. I haven't ordered a medical bracelet yet as I am not sure what my GP wants to do long term about anticoagulation. I have a little card in my purse that gives details re warfarin, hospital numbers and contact details and so on. I find annual blood tests quite comforting as sometimes things can be picked up early as a result.

  • I posted a little while ago about medical alert bracelets as I discussed it with my GP. If you don't already know your blood group, the NHS may charge you for finding it out, even if you are having blood drawn for another purpose. Luckily I found mine out through old maternity notes.

    Thanks for the reminder that even NOACs are not test free. As I have a slightly reduced kidney function at times due to only having one, GP has requested 3 monthly blood tests initially until we are sure that there are no side effects.

  • My sincere apologies if I have upset anyone with my post - which clearly I have. But (he dares to have a but?), I totally reject any suggestion that aspirin is superior to warfarin for stroke protection in AF and, whenever and wherever such an assertion is made, it should always be robustly challenged. Intolerant? I am when I read 'dangerous' comments that may influence the uninformed.

    I'm truly sorry if on this occasion I was overly robust for some in the way I made my point. However, I make no apology whatsoever for the fact that the point was made.

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