Recently been diagnosed with AF. Consultant advised that I will need to take warfarin when I am 64 (62 at moment) I forgot to ask him why I need to start then and not straight away. It appears on reading posts on here that once diagnosed everyone is on anticoags of some sort. Any advice would be appreciated please
Ally
AF increases your stroke risk by a factor of five regardless of any other conditions you may have. You do the Maths as they say. Go to CAREAF website and down load a pack and read up about it and if you still have any doubts come back and ask again. There are also loads of info sheets on the main AF-A website which you should read up so that YOU become the expert and can discuss such matters fully informed with your doctors.
Bob
Thanks Bob I will take a look
Just taken a look at CAREAF website - very informative thanks. My risk score came up as 1
Hi Ally
Yes that's a somewhat strange comment, all I can think is that he thinks your CHADS2VASC score will tick over to 2 at that point, which is the scoring system used to risk assess for stroke.
All I can really say, is I am 60, my score is zero, I have been taking warfarin for over 2 years now, and if they want me off they will have to drag me off kicking and screaming, it's my best friend.
As Bob says 5 times the usual risk, and to quote him again, you can always stop taking warfarin, you can't undo a stroke.
Be well
Ian
I went through a similar scenario.
I was diagnosed at 64 and warfarin was not mentioned until my next appointment when I was 65, apparently before then having PAF and being otherwise fit and healthy he considered me low risk - being naive ... and more than a little flattered, I had accepted this without question. What a difference a birthday makes!
I was fine up until then and now realise how lucky I was. Don't rely on luck.
At one minute past midnight on the morning of your 64th birthday, when the moon is at its biggest and the stars have never twinkled more brightly, the Tooth Fairy, having run out of coins on the 'slots', will take a short break from collecting discarded infant molars.
She will visit...You. Yes, you Ally. Silently and without you being aware of a thing, she will inject you with a very special magical juice that will help you cope with impending old age. You will be like a new person and so grateful to have been one of the 'Chosen Ones'. Unfortunately one of its horrible side effects is that it increases the risk of stroke - a risk you had never had before that moment. Because of this, when you wake up that sunny morning and you wipe the stardust from your eyes, you will have to start taking anticoagulants to ensure that you live happily ever after. The End. Time for bed everyone, time for bed.....
Your consultant might believe in fairy stories Ally but there's no reason why you should. Anticoagulate Now!
Thanks for your light-hearted response it made me smile & gave me something to think about. Keep smiling & positive
There are safer alternarives now that should be considered. I am on Eliquis (there are others) but they are newer and cost more. Is that why I never hear them mentioned in UK posts?
Eliquis is called Apixaban in the UK. Xarelto is Rivaroxaban and Praxada is Dabigatran. These newer alternatives are starting to come to the fore in the UK, but are used more widely elsewhere in Europe, with the exception of Italy which lags behind the UK.
Hi I am 63 diagnosed PAF in March I went on warfarin in May after thinking it over, consultant was pleased , I scored one but at 65 he said would be two !! I feel more confident on it for sure , , if you want it be addiment , its your life after all , good luck
Go fight for what will make you comfortable! I have a bad reputation here as I don't want to be on ACs if possible. I have AF which is very clearly defined having worn many Holters, it is Rapid and Intense. If my ablations are successful I've stated I would go off of the ACs. I will only do so if I feel I have no more AF. I wouldn't hesitate to go back on if I felt I was having wobbles.
It is personal, and I believe we should be encouraged to trust our instincts, but AF has proven to require ACs if you are having episodes of AF - rapid or NOT! As others here have mentioned, "arm" yourself with information so you can get what you want!
Hope you find your solution.
There is a certain ''that makes sense'' to the notion that we are only at risk of a stroke when having AF episodes and as a result it is a widely held belief among many of us with the condition. Sadly though, it seems the notion is flawed. Simply having the AF condition, irrespective of frequency or duration of episodes, increases the risk of stroke at least five-fold compared to someone of a similar profile but without AF.
And even after a successful ablation, we are still not cured though hopefully, with a long long time free of episodes, it will feel like it.
Obviously if there are incredibly good reasons not to be anti-coagulated then so be it.....though I'm not convinced that should be an 'instinctive' decision Iris. Otherwise, keep taking the tablets. Now that really does make sense....
It would be fabulous if anyone could point me to research articles showing this 5-fold increase for all AFib patients, regardless of their specific circumstance, so I can look at these data first-hand.
The reason I ask is because I've looked, and I can't find much. What I did find is that in Sept 2014 researchers found that stroke risk is not, in fact, the same for individuals with permanent versus paroxysmal AFib. It's about double if you have permanent.
sciencedaily.com/releases/2...
Other recent studies suggest that AC might not help people with lone paroxysmal AFib, because they were found to be at no greater risk for stroke than the general population.
neurology.org/content/69/6/...
And a 2012 study published in a special issue of "Circulation" on arrhythmia states that: "lone AF patients are considered to be at low risk of AF complications, including thromboembolism, and currently no thromboprophylaxis (or aspirin) is recommended."
Similarly, several older studies or meta-analyses also report that lone AF sufferers do not have a higher risk of stroke than the general population and may not benefit from warfarin. Here are a few.
1. Alpert, Martin A., et al. Management of atrial fibrillation. Comprehensive Therapy, Vol. 22, No. 8, August 1996, pp. 501-08
2. Havranek, Edward P. The management of atrial fibrillation: current perspectives. American Family Physician, Vol. 50, No. 5, Oct 1994, pp. 959-68.
3. Aboaf, Alan P. and Wolf, Phillip S. Paroxysmal atrial fibrillation. Archives of Internal Medicine, Vol. 156, February 26, 1996, pp. 362-67
4. Pritchett, Edward L.C. Management of atrial fibrillation. New England Journal of Medicine, Vol. 326, No. 19, May 7, 1992, pp. 1264-71
And here's another recent study of interest, which shows that for the first 25 years, stroke risk is no different for people with lone atrial fibrillation than for the general population, but it then increases at about 30 years post-diagnosis.
circ.ahajournals.org/conten...
Now, I am not necessary convinced by these studies - research is filled with contradictions and you'd have to be foolish to look at a few studies and treat them as truth. And I've heard this 5-fold risk figure a lot so it gets my attention. But it must be based on something - so there must be studies somewhere showing people with lone paroxysmal AFib (NO other risk factors, CHA2DS2-VASc of 0 - 1) have this 5-fold risk, and should therefore take ACs regardless of their circumstance. But I haven't located any such research.
I don't want to get a stroke, but I also have issues with anticoagulants -- stomach bleeding etc. -- hence my desire to be certain and look closely at the literature. Any help locating relevant research studies would be really appreciated! 
Thanks so much in advance, and stay well.
Hi Thomps
I think the definitive research on this was from the Framingham study which agreed is old at around 1991 but has been continued as a study ever since and continues to be borne out statistically that the presence of AF increase stroke risk 5 fold. Now I agree this is somewhat foggy on PAF versus persistent, and speaking as someone who scores 0 CHADS but is persistent then I have no problems with warfarin or other anti coagulants.
I understand your reticence, but you may wish to look at this the other way round.
17% of all of the worst possible strokes (often fatal) are from persons with AF of either PAF or persistent AF some of whom are undiagnosed at the time of the stroke.
The risk of stomach bleed versus sitting in a corner drooling (at best as AF begets the very worst strokes) is for me at least one which I am happy to anti-coagulate against.
Be well
Ian
Thank you! Yes I know the original Framington study - but to be fair there were problems with that study and I have yet to find research that observed a 5-fold increase in stroke risk for people with lone atrial fibrillation and a CHA2DS2-VASc score of zero. All the studies I mentioned above contradict this idea, and the contemporary guidelines based on CHA2DS2-VASc don't suggest that people with low CHA2DS2-VASc scores are at a significant risk, and they don't recommend warfarin in such cases. I do appreciate your logic about stomach ache versus stroke, but there are other risks of anti-coagulants besides a sore stomach. Warfarin is a very serious drug.
Anyway, I don't want to overstate this side of the argument because I'm not against anti-coagulants - far from it! This is just an attempt to understand the current research more completely, and I do appreciate your feedback
Having had two years before I was referred to Papworth of various cardiologists not being all that helpful and not really grasping AF, I'd definitely be asking for anti coagulant. You do need to become an expert. I've had a real problem with chest infections and have had to become an expert in dealing with those and last appointment with GP was really successful whereas ones before have been dismal, not taking any notice of what Papworth have asked for, not understanding the af implication sof chest infections and certainly not grasping how very sick they do make me.
I am a very young 80 year old female. Very very physical and in good shape. My first afib incidednt was about 5 years ago after i had a margareta and wore very tight jeans. I am not used to drinking alcohol. After I was diagnosed was put on warfarin. I had abut 4 more incidents in a period of 2 years. Then I stopped having afib for 4 years but still had to be checked monthly and taking warfarin. I kicked and screamed because I thought I was rid of the beast. My cardiologist insisted on my staying on warfarin which I hate the monthly visits and blood analysis because of my age. About one year and 8 months ago during a very stressful period of moving myself I had one more incident. The stress was too much for me - apparently that's what causes my afib incidents. Now I am on Diltiazan and magnesium vitamin and have not had an incident in one year and 8 months. I have had lots of stress but don't thank goodness fibrilate. I tried 2 of the newer drugs Xaltro and Pradaxan but had bad reaction with both and went back on warfarin. So, I will remain on warfarin since it hopefully will keep me from having a stroke.
Pauline
At 69. I went off warfarin for a heria opp.5 days.. I had a stroke!! I have always been a fit tennis player and walker, the hospital may have made a mistake. But the fact remains. The warfarin is necessary.
Your doctor is responding to the official protocal based on studies and percentages, probably using the CHADD score that changes with age and risk factors. My doctor told me 1 for over 62, 1 for being a woman, and 1 for high blood pressure, making my score 3. After a score of 2, you qualify for the need to use anticoagulants to reduce the risk of forming a clot in the atrium that can then move to the brain and cause a stroke. All things must be considered, however, such as balancing the risk of a "bleed-out" in case of an internal problem or accident. Even with my CHADD score of 3, I was told my risk percentage is just slightly higher for stroke than for bleedout, according to statistics. Considering I was in full-time afib for several months before ablation in September, with no clot ever formed, and now have NO afib, I'm taking the middle road and using only half-dose anticoagulant. I'm also taking Eliquis (Apixaban), which is considered safer and with fewer side effects and blood testing than Warfarin, so if you have to take an anticoagulant, may want to check that out with doctor. Hope this helps clarify--at least from one perspective.
Thanks for your response & advice. As far as I know I am classed as low risk at the moment although I am awaiting results of 24 hour blood pressure monitoring & waiting for ECG event recorder in January.
Best wishes for a AF trouble free 2015!
I have been advised to take warfarin for AF. Will go on it as I also worry so much of having a stroke.
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Not Warfarin anymore
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Ablations and Warfarin
