Hi
If your have PAF is there a period of time post an incident (which say corrects itself within 12 hours) when you are most at risk from a blot clot or can these things hang around in the body silently for an indefinite period - presumably a clot does not stay in the heart for long i.e. it gets pushed out once normal sinus resumes?
The RISK of clots forming with AF is five times greater than for those without it. That risk does not alter with how often or how long your AF events may last. It exists period. It can remain even after successful ablation stops the AF. There are those who think that reverting to NSR provides the greatest chance of any clot being ejected and causing a stroke.
Most specialists believe that these clots form in the left atrial appendage and could remain there undetected (apart from echocardiogram). This is why attempts to remove or isolate the LAA by such as watchman device have been developed but there is evidence that clots can form elsewhere in the heart. Far better to be on anticoagulation and reduce the game of Russian roulette. (Personal opinion of course.)
Bob
There is a bit of disagreement on this point so I'd like to provide an alternative perspective. My own cardiologist - a cardiac rhythm researcher, electrophysiologist, and ablation specialist - says I am indeed more at risk during an episode of atrial fibrillation than when I am not, because that is when the blood pools. Bob's comment underscores that stroke risk may be higher than normal even if you are *not* in atrial fibrillation (for reasons unknown: you may have undetected atrial flutter or other unknown heart conditions), but the data on stroke risk for lone atrial fibrillation is not very clear and the "five-fold increase in stroke risk" averages across many factors and populations, so is unlikely to be your personal stroke risk.
At present, the most widely discussed mechanism of stroke with atrial fibrillation is blood not being pumped effectively and pooling and then forming a clot, and a recent study showed that people in permanent atrial fibrillation have roughly double the risk of stroke than people in paroxysmal atrial fibrillation. In my own case, he recommended an anticoagulant as a pill in the pocket to be taken during any episode and for 48 hours following.
You may want to go on anti-coagulation as a general preventative, but this is not a universal recommendation - and recommendations have also been clouded by drug companies campaigning for "every person with atrial fibrillation to go onto (our financially lucrative) anticoagulant".
My approach is this: (a) adhere to the guidelines based on your CHA2DS2-VASc score which for me does not recommend anti-coagulation (risk 0.78% per year); (b) use a pill-in-the-pocket if I do go into atrial fibrillation to lower my overall risk even further; (c) make life-style changes to reduce my risk of stroke yet further.
Yet many on this community will advise you to go directly onto anti-coagulation, and that is an understandable choice. I've seen how stroke can devastate lives, no one wants a stroke. But there is a risk in everything we do every day, and anticoagulation also carries risk. The CHA2DS2-VASc approach is based on current, leading-edge research, so that is my approach.
There is a bit of a problem with pill in the pocket anti-coagulation as pill in the pocket in that you need to always know when you go into AF- I always think I know- and expect you do too- but I have heard many talks where doctors say patients have thought they heaven't had any Af but then it has shown on a long term monitor
Yes excellent point and I totally agree. I guess taking the PIP even for 60% of episodes will still result in risk reduction, and nothing we do eliminates stroke risk. A friend of mine had two strokes in the past two years while taking daily warfarin. Her "risk" was low from a statistical standpoint, but she had two strokes anyway. Conversely, taking anticoagulation when you have major, obvious episodes should reduce your risk (even if you have other "silent" episodes), but it won't eliminate your risk of stroke.
Ultimately, we each need to decide on a level of risk with which we feel comfortable, and respect the decisions that others make. Personally I'm delaying regular anticoagulation for a few years because my current risk of stroke is very low according to leading edge scientific research, whereas the health risks of taking regular anticoagulation are currently high in my case.
Thank you that's really helpful - what do you take as a PIP as a matter of interest?
Apixaban (newer anticoagulant; fast acting)
Does it have an antidote? J.
Yes it does! This is new - and a very welcome development as that was a pretty big downside of this new-generation drug!
While we must be advised by the Professionals let us not forget that we are also responsible for asking questions , not matter how silly they seem. Most of the Doctors I have come across in life would like patients to think that they have X-Ray Eyes and as we both know, they do not. Two years back I was put on one of the new drugs (at my request) but as much as I had researched it I never asked the question regarding an antidote. I was appalled to establish that the wonder FDA and NICE had let this drug into the marker place. I swiftly returned to Warfarin for all its tried and trusted reasons. J.
Good morning T, I understand it is correct what you say in principle however with respect to Chads, Chads is a 'Rule of Thumb' despite how some EP's may wish to describe it and therefore I personally would always to stage one step above the recommendations. Have a good week. J.
Yes, very understandable! And I agree CHAD2VAS2 is a rule of thumb, but at the same time it is not just a rough guess: the system is based on massive population studies across many decades and rigorous statistical analyses, so it has scientific validity. But where I am sympathetic to your approach is that all research works by averaging across (and hence ignoring) individual circumstances, and we are all unique. You may not represent the "average" so erring on the side of caution is a sensible approach!
I understand the prudence in your decision Jnh but…
Based on my past professional life (not in medicine!) I always advised 'one step above the recommendations' as I knew most clients wouldn't follow my advice 100% but would then still be OK. I therefore do not anti coagulate with CHADS 0 but am far more cautious making more lifestyle changes than the medics advise.
Here's hoping we are both right, have a great day!
Hi Thomps95
You mention that a recent study states that people in permanent AF have nearly double the risk of stroke over people with another type of AF.
Can you provide a link to this study please?
Thanks
Yes sure, thanks for asking 
The first refers to the study in question (Sept 2014). The second is a recent study which compared various risks for paroxysmal and persistent (shows a difference there too). The others are generally relevant to the discussion, but they are only a snapshot of a large and complex literature so need to be taken in that context. It's reassuring to know so many medical scientists are as busy as bees working on our problem!
escardio.org/about/press/pr...
eurheartj.oxfordjournals.or...
hindawi.com/journals/isrn/2...
afibbers.com/atrial_fibrill...
Disertori, M, et al. Clinical predictors of atrial fibrillation recurrence in the GISSI-AF trial. American Heart Journal, Vol. 159, May 2010, pp. 857-63
Singer, DE, et al. The net clinical benefit of warfarin anticoagulation in atrial fibrillation. Annals of Internal Medicine, Vol. 151, September 1, 2009, pp. 297-305
Hart, RG and Halperin, JL. Do current guidelines result in overuse of warfarin anticoagulation in patients with atrial fibrillation? Annals of Internal Medicine, Vol. 151, September 1, 2009, pp. 355-56
Interesting the different opinions of EP's.
I've had AF for a decade. Since diagnosis, it's been controlled either by drugs or by an ablation, i.e. for most of the time I've had no symptoms and no fibrillation at all or hardly ever. But my EP has had me anti-coagulated throughout, and still has. I have, and always have had a CHADS/CHADSvasc2 score of zero.
For me, CHADS or the new one simply doesn't work at all.
Koll
PS. It's not just that you're 5 times more likely to get a stroke, it's that the stroke is more likely to be a bad one. That's the bit that gets missed. So the 5 times figure is, in this sense, an understatement.
_
Very true Koll. 80% of the worst strokes are AF related. This is because the clots which can form in the heart have more space and are bigger thus blocking more blood vessels should they make it to the brain. It has been said that you can always stop taking warfarin but you can't undo a stroke. The five fold increase is regardless of Chads or Chadsvasc which further increases the risk score according to whether you have any previous other conditions or are over a particular age. It is also gender specific. This country (UK) has one of the lowest percentages of at risk patients on anticoagulants in Europe and it has been calculated that we could save 8000 strokes a year if we changed that. A figure worth thinking about I feel.
Thomps you are forgetting that many people with AF are asymptomatic and have no knowledge of if or when they are in AF. For those there should be no argument. I also can't agree with your view on drug companies as most people will be pointed at warfarin in the first place on cost grounds partly but more importantly because it has been around and shown to be basically safe for so many years.
A specialist at HRC recently said that for every 1000 people he gave anticoagulants to some would die from bleeds whilst others would be saved from strokes. NICE provide a patient decision advisor which should be given to patients about to go or wanting to go on anticoagulants which is full of pretty bar charts with smiley faces showing the numbers of per thousand patients who may have stroke or bleed..
There is also HASBLED which judges your bleed risk and for sure there usually comes a point of age when your bleed risk exceeds your clot risk so then you have to choose whether you die from a massive haemorrhage or a massive stroke or that bus you didn't see. Life is dangerous and you won't survive it whatever you do.
In the end we all have to make our own minds up and yes your opinion is as important as any other in order to provide a full picture. What conclusion we end up with is very individual.
Bob
PS We should also remember that the connection between AF and stroke was only made about 7 or 8 years ago. I remember well the committee meeting at BHF when they suddenly started talking about rapid access clinics for AF to get patients anticoagulated.
But I thought the connection between AF and stroke was noted long ago? e.g., see stroke.ahajournals.org/cont...
Anyway, one way to estimate stroke risk is via the Framington website. If we've learned anything in the last decade, it's that there are big individual differences in stroke risk.
framinghamheartstudy.org/ri...
Great dialogue - I appreciate hearing all the perspectives. Very helpful.
I feel the part of the dialogue where we are all struggling and where we are in the hands of the drug companies (either directly or indirectly where they commission independent research and take the decision whether to publish or not) is on reliable statistics.
You can probably guess whereas I am very grateful to drug companies for the drugs, I am quite cynical about their marketing influence in the medical arena.
Eg I may be x5 more likely to die driving my car on the motorway today than staying at home but if the chance of dieing is 1 in 1000 I will still go, just drive more carefully.
Agree!
Blurred, I think might be a better description. J.
Also there is mounting evidence now that amiodarone and one other of the antiarrhythmic drugs actually causes embolism especially when used with warfarin. I also use a pill in the pocket, heparin injection, and the general medical advice is for 48 hours if the afib has been over 12 hours. Additionally, there are many doctors who have high success rates with natural anticoagulants, such as magnesium, vitamin E, fenugreek, etc. The bottom line is that very little is really known about Afib, it's a guessing game.
Hi life-choices! Which other antiarrythmic drug, aside from amiodarone, is there evidence for that it increases embolism risk?
i can't remember what the other drug was. I do know that amiodarone is a toxic form of iodine and has been removed in some countries. i personally think it is better to take real iodine, but under the care of a naturopath trained in dealing with AF because like always the dosage is critical. Not so easy to find, and i can't afford it at all as the mandatory health plans here do not cover any alternative care (or very little - maybe therapeutic massage and then only partial)
Hi Life Choices
There is no such thing as a "natural anti-coagulant" when you are dealing with AF, the risk of stroke is so high that anyone using alternative therapies or drugs to anti-coagulate is putting themselves at massive risk. Naturopath or not, please do not go down this route you need warfarin or one of the NOACs if your CHADS2VASC score is high enough, there is no alternative.
More than enough is known about the stroke risk in AF to support this, this is certainly not a guessing game, much more like Russian Roulette if you fail to anti-coagulate properly.
Be well
Ian
Hi Ian. I appreciate your concern and know that you mean well & feel strongly about your opinion. So do I, and there are ample studies and scientific evidence on both sides. Obviously if one is pharmaceutically inclined one will prefer the drug route. If one is alternatively inclined one will prefer the alternative route. To be honest, western medicine is the new kid on the block, and holistic approaches and eastern medicine have been successful for a few thousand years. 95% of the medical problems in my life have been iatrogenic, so you might know where I stand, although I am integrated, and will take meds when I haven't yet reached the formula with the alternative to achieve the results, for whatever reasons. A lot of it is financial as nothing even remotely non - pharmaceutical is covered by any national health plans in my country. Those who can afford it, go private. There's no guarantee in anything, I know people who have had strokes on the anticoagulants, those who are safe with the alternative methods. Medicine is a guessing game, an experiment and I have finally found in life that 1) my body is my most informed doctor, and 2) my gut feelings should never be ignored.
I hope for health and wellness for all of us, Ian, whatever our choices.
Hi Life Choices
Look You have an absolute right to take whatever you wish, BUT this is a forum for people with AF and many new sufferers come here for advice and guidance.
One of the biggest challenges is the subject of anti-coagulation, and people are very scared of being asked to take "rat-poison" or all of the other ill informed and just plain wrong opinions abouts warfarin and the NOACs.
But let's be very clear for the sake of those people.
There is no scientific evidence whatsoever that alternatives to warfarin,heparin or the NOACs will assist in preventing AF related stroke.
There are no independent peer reviewed studies supporting this.
There is no medical evidence that alternatives will anti-coagulate to anything like the level needed to prevent the 5 times greater risk of the very worst strokes that we are all under the threat of.
This is not about choosing the drug route, there is no other route which protects to the same extent.
You know people who have had strokes on warfarin, yes of course, and you know people that have not had strokes without taking warfarin.
I know people who smoked 60 a day for 50 years and never got lung cancer is that supposed to prove the smoking is not harmful?
By all means take whatever therapy path you wish, even if I don't agree I support your right to do this, what I cannot support is putting people at risk through mis-information, make an informed choice not an uninformed one,
Of course there are no guarantees but there are currently no alternatives to the drug regimes to reduce the risk of AF related stroke.
I wish you well
Ian
Actually i thought it was a forum about AF, with the freedom to discuss. I didn't realize it was only a pharmaceutical forum. I will withdraw from the group.
But, I might add that you are wrong to state that there are no alternatives that equal the current medical approach. A rigid approach and refusal to examine the alternatives is also misinformation. Fear mongering is so strong in the medical field I really have to question the reason for this. It isn't necessary.
As I said the medical mistakes and forcing of medical treatment in my family has cause deaths and much suffering and forced me and my family to search out and make informed life choices.
All the best.
I also find that saying you are 5 times more likely to get a stroke a bit meaningless. 5 times what? Instead, I've seen figures saying that 25% of stroke are caused by AF. That means more to me, i.e. 1 in 4 strokes due to AF, it's an actual figure, almost . Don't know whether it's right though?
About right Koll and those strokes are 80% of the worst and least survivable ones.
The reality is that nobody can predict who of us is going to have a stroke so we play the numbers game based on statistics, because we have nothing else. I look forward to the day when medicine is more personalised so that we don't have to take tons of unnecessary drugs which in themselves come with inherent risks 'just in case'.
My perceived risk is currently very low, CHADSVASC2=0. I have had 2 Ablations and currently no AF episodes so not taking any medications for AF but tons for Myasthenia. I am more afraid of the interactions between drugs than stroke risk so no anti-coagulation for me. My EP wants to review this when I reach the magic 65 as that is the perceived age when my risk suddenly increases.
I like the idea of anticoagulation as a PIP for those with lone PAF. To return to the original question, how long does a clot hang around? I honestly don't know but not indefinitely. I believe the danger lies as to where it may travel to if it forms in the LA of the heart but then gets thrown out when returning to NSR before being broken down by the body.
Anticoagulation may lessen your risk, it won't eliminate it.
As an aside, I agree, as does my EP, that there needs to be far more research on lifestyle changes, supplements and sleep apnea, the biggest factor for AF returning after successful ablation. My sleep study results came back positive for sleep apnea so I am being fitted for CPAP machine on 22nd Jan.
Agree, interesting discussion and not everyone on this site is for anticoagulation for every AF regardless but agree it needs to be an informed decision made with your EP's advice.
My E.P. said that the body breaks down clots in around 6 weeks. Unfortunately that gives plenty of time for that clot or a bit of that clot to break off and travel to my brain! I think I will stick with anticoagulation as I have already had 3 T.I.A.s.
I do however think that everyone should weigh up the pros and cons and make their own choices. The main thing is to be equipped with all the up to date knowledge. X
Revised Stroke Acronym
F - Face
A - Arms
S - Speech
T - Time to take an anti-coagulant
It's a thought....
As Koll says, 25% of strokes are caused by AF. 30% of strokes are cryptogenic - i.e. considered to have no known cause. However the latest research shows that a significant proportion of these cryptogenic strokes are actually caused by AF. So the figures for number of strokes caused by AF are a little on the low side. TIAs are also associated with AF, so you need to be very aware of dizzy or "greying out" periods lasting just a few minutes.
There are other factors not included in the CHADS or CHADS2VASC scores that I would consider if I had a score of 0 to work out if I should be on anti-coagulants (e.g. atrial volume, BP variability, LAA shape). The 0.6% - 1% risk of stroke figure quoted for a score of 0 is likely to be an underestimate.
Mark
There are some really good points on this topic, thank you all. I have a question, I have lone AF and I'm satisfactorily anticoagulated at the moment although only for the past few weeks. I was having pretty much asymptomatic episodes every week. If a clot has / had formed will the warfarin eradicate the danger, or will the clot still be present?
Let me tell you about strokes. Strokes are the fourth leading cause of death in the UK and worldwide. There's two main types of strokes. There's thrombotic strokes and haemorrhagic strokes. Now, in thrombotic strokes an artery supplying the brain is blocked, that could be in the neck or inside the skull. Thrombotic strokes make up 80% of strokes in the UK.
In a haemorrhagic stroke, a blood vessel inside the brain or surrounding the brain bursts, and they account for 20% of strokes in the UK, but in Asia, for instance, they are the majority of the types of strokes you get there. It's important to distinguish between the types of strokes, but, clinically, it's difficult to do, so a doctor can't look at a patient and say if it's thrombotic or haemorrhagic. You need a scan to do this, either a CT scan, computed tomography, or an MRI scan, magnetic resonance imaging, so it's important to get to a hospital as soon as possible and have a scan to try and find out what type of stroke it is.
Thrombotic strokes can be caused in a number of ways. If an atherosclerotic lesion in an artery supplying the brain fissures, it can cause a thrombus to form, blocking the blood vessel, so part of the brain becomes short of blood. What can also happen is that the atherosclerotic lesion fissures, a thrombus forms and then breaks off, and this travelling thrombus or embolus will move downstream, and it will lodge in a smaller blood vessel, blocking that blood vessel. Another way that they can form is when you get something called atrial fibrillation, and that's when the heart is beating very fast, but ineffectively, so the atria of the heart quiver.
Now, this means that blood in the atria can stay there for longer, and a thrombus can form. This can be swept as an embolus through the heart into the aorta and then up into a brain artery and lodge there and block it, so atrial fibrillation is a cause of strokes, and that's why it's got to be treated.
Haemorrhagic strokes are caused when an artery bursts, and this can be an artery inside the brain, which is called an intracerebral haemorrhage, but can be an artery surrounding the brain. These are called subarachnoid haemorrhages, which get bleeding into the cerebrospinal fluid. The prognosis of haemorrhagic strokes is worse than thrombotic strokes, so, though they don't cause all that many strokes in the UK, they're actually more dangerous.
There's something known as transient ischemic attacks or TIAs, which are sometimes known as mini-strokes. Now, this is when you may get showers of aggregated platelets that block the flow of blood to the brain for a short time, and they cause symptoms lasting just a few minutes normally, and there may be loss of brain function, so, for instance, you may feel dizzy. Now, these don't cause any lasting damage, but very important, because if you're getting transient ischemic attacks, it means you're much more likely to get a full-blown stroke, so if you're getting them, you must see your doctor and get some treatment.
How are strokes treated? Well, once you've had your scan, a CT scan or MRI scan in a hospital, if the scan shows you've got a thrombotic stroke, you can get treatment in the form of a protein being injected into your bloodstream. This is called tissue plasminogen activator or tPA. This causes an
Heart Health: A beginner’s guide to cardiovascular disease
©University of Reading 2014 Thursday, 21 August 2014 Page 2
enzyme to be activated, called plasmin, and that breaks down the fibrin holding together the thrombus, so it will dissolve.
Now, it's important that you get the scan and the treatment within four hours from the onset of the stroke. Otherwise it doesn't work. And, in fact, less than 5% of people get tissue plasminogen activator because they don't get to a hospital and have the scan done in time. So speed is very important. If the scan shows that the type of stroke you've got is haemorrhagic, then there aren't many treatments available, except for surgical techniques to open up the skull and then to surgically stop the bleeding, so we desperately need better treatments for strokes. That's a big unmet need.
Heart Health: A beginner’s guide to cardiovascular disease university of reading
Thank you, Offcut, that makes really interesting reading. This subject is a biggie, and everyone has their own take on it, so it's good to have an open debate with different opinions and some medical expertise thrown into the mix.
Thanks Offcut, very interesting.
PS. I assume you mean that Thrombotic strokes make up 80% of strokes in the UK?
_
Well Proofed. It would work out at 80%.
I am lone PAF diagnosed March 2014, my AF is a lot worse now then when diagnosed,every day to be precise, Despite various meds, diet management, no caffeine chocolate etc and literally no alcohol and basically now pinning all hopes on an ablation, date Yet TBC, however to this date I have not been prescribed any anti coagulant should I be concerned, due to meet EP this month.
Wow, all these posts have been very enlightening if not a bit frightening. I have a CHAD score of 4, because of my age (78) and being female. I have been in permanent AF since the 13 th November 2014 after having been admitted on the 28th October with AF and chest pains. After all the tests the Cardiologist decided to up my dose of Bisoprolol from 5 to 10mg and add a new drug Digoxin on the lowest dose along with 20mg Rivaroxaban to be taken with my existing drugs for high blood pressure and osteoporosis. These drugs worked until 13 th November when my AF returned with a vengeance. I have been to my doctor and told him that I needed to see my EP to discuss an ablation and as I was willing to pay I am seeing him on 23rd January. Now my question is as I have been in permanent AF all this time, what are the odds of me having a stroke? I had a TIA in September 2012 after being on Aspirin for 10 years for spasmodic AF. I am not happy to go to our A&E as I only see a Cardiologist if I am admitted. I am having an ECG at my Health Centre this afternoon just in case I am back in NSR by the time I see my EP. Oh, and I had a pacemaker fitted on the 30th April last year for Bradycardia.
Any advice and help would be gratefully appreciated. What would I do without this marvellous site and people.
Di
Hi Di,
On the ablation front ... I had 24/7 AF 10 years ago (age 54), it had probably been 24/7 for a few months. I don't know for sure because it gradually built up, and then accelerated. But it was very much 24/7 at the end.
Anyhow, I had an ablation to get rid of it and get off the drugs. The ablation worked very well indeed, 100% in fact. Before the procedure, the EP said to me that because I was 24/7 it would be easier to fix because "they would know whether they had got it straight away" (his words) and less likely I would need a repeat any time soon (think he said that). He actually forecast 5-15 years and I may need a tweak, and he was spot on. It was 9 years on when they came to do the tweak (another ablation), but during the procedure, my tiny bit of AF went away so they couldn't do anything!!!
I'm not you, so we're different and this may not apply to you, but just thought I'd mention it.
Haven't a clue about the stroke risk but if you're doing everything you can to reduce the risk, then not much point in thinking about it I'd say. Just my thoughts for what they're worth !!
Good luck with the ablation. Be interested to hear how you get on.
Koll
.Thank you Koll, your comments have helped a lot. Will let you know after my ablation.
Hope you have a calm 2015.
Di
gosh why does this go on and on and on we all either take the opinion we need anti coagulants or we dont but read all the evidence and base you decisions on informed by the evidence. Personally i have made my decision after weighing up the evidence both the pros and cons. Better safe than sorry
Well done frills, that is the only logical way to do it. If one was to keep going round and round in circles, with what ifs etc., we might not die from AF or its associated causes, but most likely die from OLD AGE. J.
Oh dear, all these initials. As a fairly new member can somebody decipher CHADS for me please. Having said that I'm relieved to have so much knowledgeable information. Thank you all.
Hi Helena
Yes we use far too many acronyms don't we, it's because we are fed up with writing out "electrophsyiologist" in full so we say EP for example so here's a quick guide
AF Atrial Fibrilation of course
PAF Paroxysmal Atrial Fibrilation (comes and goes often with attacks)
Persistent AF In AF 24/7 the heart never goes back into rhythm (me)
Permanent AF Uncurable persistent AF
NSR Normal Sinus Rhythm (where we all want to be)
EP Electrophsyiologist (specialist for our condition)
NOACs Novel Oral Anti-Coagulants (at least they were novel when they came out)
CHADS Congestive Heart failure, Hypertension, Age, Diabetes, Stroke (no wonder we use an acronym)
CHADS2Vasc All of the above plus Vascular disease, and we usually use this one now as it's more reliable
TIA Transient Ischemic Attack (also known as a mini-stroke)
PIP Pill in the Pocket (Often used when getting an attack)
HASBLED Hypertension, Abnormal renal/liver function, Stroke, Bleeding History, Labile INR, Elderly, Drugs/Alcohol concocimitantly (Bleeding risk score bit like CHADs for stroke risk)
Have I forgotten any anyone?
Be well
Ian
CHADS is a system for determining stroke risk in people with atrial fibrillation. The first scheme that was developed entailed only a few yes/no questions (CHAD = C - do you have Congestive heart failure?; H-do you have Hypertension? A- is you Age > 75?; D-do you have Diabetes?; S-have you had a prior Stroke?). For the first four questions, if you answer yes gives you 1 point; if you answer yes to "prior stroke" you get two points.
With more research and data, CHAD2VAS2 was developed as a more precise means of evaluating stroke risk. This includes additional questions to acknowledge other stroke risks (vascular disease? Age 65-74? Sex?).
Precise risks are dependent on CHAD2VAS2 score, and those estimates have been documented in articles such as: Prevention of stroke in patients with atrial fibrillation: current strategies and future directions. British Medical Journal. 2012. There are a few alternative risk assessment schemes such as "ATRIA" but CHADS2VAS2 seems most widely used (the ATRIA primarily differs in that age counts for a lot more)
It's important to recognize that individual risks vary even if they have the same CHADS score, because CHADS only considers a limited number of risks. So for serious decisions, you need to consult with a cardiologist who knows your personal circumstances and is in touch with the recent research.
Thank you Beancounter and Thomps95. The list you've given is very informative, Beancounter. I don't think I've had the CHADS2VAS2 so assume it's a self estimate?
Hi Helena, not not self assessed, but many online calculators, one of my favourites is here
careaf.org/topics/af-stroke...
And the whole site is great as well
Ian
Thank you Beancounter - I've discovered from the site that my CHADS2VAS2 is 4. I agree it looks an interesting site.
Blood Clot 
AF and blood clots
Post ablation AF
Blood clot in heart - anyone else ?
Stroke Risk, Aspirin or Anticoagulant?
