Anti-coagulant

[Kbuck1234]

Hi,

A point of clarification - if you have infrequent PAF do you need to be on anti-coagulants full-time as protection even with a low stroke risk score?

[feejbee]

I would say so as you never know when AF is going to kick in so it's rather a case of Russian roulette. I was diagnosed with lone PAF in January ,had TIAs in February and a full stroke early March .I was 58 years old and no other risks. I didnt score as a risk on the CHADS scale.

My advice is don't take a chance .

Fi

[Hidden]

I've always had a CHADS score of zero, and still have till my next birthday, 65, when my score will go to one. But, nevertheless, I've been anti-coaged for years at request of my EP. After my ablation 8 years ago I had zero AF symptoms, but I was still kept on aspirin (later changed to Warfarin) permanently. I don't have any symptoms now because my drugs work great, but still on Warfarin at request of my EP again. I quizzed him last year as to whether I needed Warfarin and he said yes.

I have no other conditions other than a tendency to have high'ish cholesterol but that is also controlled by statins.

Koll

[Froggy]

In a word, yes. Can be very risky otherwise. Take on board what Fi and Koll have written. Take care x

[Jason1971]

Hi Kbuck, there is a calculation in place called the CHA2DS2-VASc score that assesses stroke risk factors in patients with atrial fibrillation. There are several factors to this, but I think you'll find a lot of people on this forum would suggest anti-coagulation is a must, as the outcome of a stroke outweighs the possible effects of anticoagulant issues. However, the medical profession do have this system for a reason I guess, so if you're in any doubt I would have a Google and read for yourself. There are also quick risk assessment calculators you can take. Quite a simple test.

[AnticoagulateNow in reply to Jason1971]

"...there is a calculation in place called the CHA2DS2-VASc score that assesses stroke risk factors in patients with atrial fibrillation."

Sorry Jason, that's slightly misleading! CHADS assesses ADDITIONAL stroke risk factors. The five-fold increased risk, irrespective of age or frequency and duration of AF, is ever present - unless one is on anticoagulants.

[Jason1971 in reply to AnticoagulateNow]

Thanks for the clarification. I'm anti coagulated to the max myself, pending my ablation. I find it a bit of an inconvenice personally, but beats the alternative I guess. Had a few issues with bleeds, but nothing they haven't been able to resolve. I know you're a strong advocate for anti coagulating and rightly so.

[Thomps95 in reply to AnticoagulateNow]

I understand some people are anxious about stroke and feel anticoagulation is sensible. But it's important to communicate information accurately. My understanding is that AF increases stroke risk 5-fold averaged across many types of people in various circumstances. That is, the so-called "five-fold" risk is not homogeneous. The CHA2 DS2 -VASc and HAS-BLED schemes were designed to provide people with atrial fibrillation with more precise estimates of their *absolute* risk of stroke and bleeding. These risks can be found in various tables and they are absolute risks, not risks "on top of a five-fold increased risk of stroke."

The recommendations based on the CHA2 DS2 -VASc and HAS-BLED systems are used by the latest European guidelines on AF management. I think it's sensible to take them seriously and not dismiss them.

I love this forum to get other perspectives, but we need to take a balanced view, read the literature, and talk to cardiologists / electrophysiologists who know the research on atrial fibrillation and stroke risk. Anticoagulation is a wonderful development in medicine, but it also comes with risks. These are difficult decisions.

[Bryonny]

Dear kbuck, my consultant recommended anticoagulants even though my CHAD score was low, he said he used this as a guidance and took into account my medical history and changes within the heart.

[AnticoagulateNow]

YES! You need to be aware that strokes sadly are not rare in the general population. They are responsible for the second largest number of deaths among mankind globally, and simply having AF, irrespective of your age or the frequency or duration of episodes, increases your own risk by a factor of five over others without AF. Don't be misled by CHADS. CHADS or CHADSVASC highlights 'ADDITIONAL' risks so please don't equate a low CHADS score with a low risk of stroke.

Get the protection of anticoagulants (and that doesn't include aspirin) and you lower that overall risk dramatically.

[Mattpga]

Hi. I've asked the same question myself. I've had PAF since i was 40 and after a 48 hour episode last year was put on warfarin (i'm 50 now). As my stroke risk CHADS thing appeared to be 0 I questioned it too, and so did a nurse, but they still told me they wanted me to carry on taking it. When i had the latest 24 hour holter it showed 'several' instances of AF, where i thought i hadn't had any. They were all short but made me realise i am probably in AF more than i realise so i just carry on with the warfarin just in case.