Alarming new stroke statistics out today from the Stroke Association showing a very significant increase in 'younger' men and women experiencing these awful life-changing and life-taking occurrences.
For those of us with the added risks associated with AF, can we ever be 'too young' to be on anti-coagulants?
Saw that article, too ACNow - very alarming. I wonder how many were caused by undiagnosed AF - and if methods of detection and identification of strokes have improved.
Draws my mind back to a patient in the next bed during my recent
ablation. On discussing medication she had never heard of anti
coagulants, I tried to explain and urged her to go on HU site but I knew
I was getting nowhere, her husband said ' she takes aspirin thats a
blood thinner'.
Remember that the link with AF and stroke was only really made public in 2007 so we have come a long way even if there is still much to do.
Bpb
Saw this article too. Made very interesting reading. It did state the overall stroke rate is decreasing, but it's increasing in people in their 40's & 50's. I do think lifestyle, eating and drinking habits have a big part to play in this, but being in my 40's and an AF sufferer I take solace in knowing I'm anticogulated.
The patient I mentioned was only mid-forties and another surprised was
using an electronic cigarette. I dont know if it was working, I wouldnt think
so, not sure how they work nothing seemed to be happening. Im always
surprised by how many young people are still smoking even when the
risks are well known. Dont get me wrong when I was young I made the
same mistakes as everyone else, including smoking, but in those days
most everyone did. Funny enough I hated the taste but eventually you get
used to it. My husband began working in dfferent hospitals and one was
Killingbeck Hospital in Leeds, he saw people struggling to breathe and
never had another cigarette, took me a little longer but thats was well
over 35 years ago. Just a thought.
If you are correct and all of us with AF and PAF, flutter and the like need anticoagulants, why are the EPs saying we don't?
What do you know that they don't?
Pat
Of course not everyone is suited to take anti-coagulants Pat. I'm not saying they are. There are a number of good reasons, I'm sure, why doctors might advise against anti-coagulation. But If I was one of those so advised, I would expect to know and largely understand the detailed reasons why. All I'm suggesting now, following today's disturbing report, is that being 'too young' is perhaps no longer such a valid reason.
At the end of the day the final decision is our own. But please, unless you have no capacity for reasoned thought, that should not be simply because "the doctor says so".
How ridiculous to suggest that those of us not taking anticoagulants have not researched this ourselves and have no capacity for reasoned thought!
That we blindly follow our EP's advice, when instead we should be following yours I suppose!!
That's exactly why you do this; to aggressively push anticoagulants on those who are advised they do not need them by a qualified specialist who is obviously not as qualified or as specialised as you in this field.
I have read other dictatorial condescending comments of yours on posts where supplements are being discussed. There you tell others never to take anything without their doctors advice!
Which is it to be?
Perhaps I could suggest you change your already aggressive name to 'Antagonisenow'!
Get over yourself!
Who is saying you have to take anti-coagulants? Not me. May I respectfully request you read posts before responding to them. And you call me aggressive!
In your post you inferred that your EP had told you that you don't need to take anticoagulants. That's fine, but you don't seem to know why. I would want to know why my EP told me not to take anticoagulants. That's all.
I'm really a very nice person Pat......but you're right, I'm not a great fan of supplements when used as 'replacements' for important medicines. Too much magnesium can make you very tetchy, that's for sure.
Pat everybody is entitled to opinions. Tolerance on this forum is essential and just because you or I may not agree does not make either of our views wrong. I frequently point out that content on the forum does not replace the relationship with your doctor or healthcare professional. Regarding supplements some of the suggestions have been downright dangerous and as a result AF-A posted a warning and some guidelines to future posting last week.
There is no doubt that the link between AF and stroke has been underplayed for many years but equally the whole Chads/Chadsvasc debate has developed much more over the last two or three years. Many doctors still worry about anticoagulation based on older values and yes there is no doubt that each individual needs to balance the risks of stroke against those of bleeding based on their own circumstances not just because "doctor says so." The PDA which was produced about two years ago to help patients decide if they wanted to take anticoagulation laid out all the risks on both sides of the argument . It was intended to be given to all patients who presented with AF prior to any discussion with the doctor about the drugs. Sadly it seems never to have got very far.
I know and respect your views just as I do ACnow's. Personally I fear stroke about as much as I do dementia and whilst it may be too late for the latter I intend to avoid the former. Fortunately I have now reached an age where my score agrees with my decision. Sadly those poor people who had strokes after being told they didn't need anticoagulation as they were far too young are not so fortunate.
Bob
Like you Pat I have been told I don't need to be on Anticoagulants by three different EPs. one in Swansea one in Cardiff and one in Bristol and I have also seen two different GPs in my practice and they have told me the same thing just dont know what to think.
Pat, I hold the simplistic view that if one is diagnosed with any sort of AF, regardless of age, then forget about CHADS scores, or any other bloody score. Anticoagulate immediately and for life. Once that tiny bit of the heart becomes damaged/dysfunctional then you are always at risk of some sort of stroke. My cynical view is its all about the loot in the moneybox (the NHS piggy bank). CHADSCORE is a convenient way of restricting access to funds by saying certain people who have a score of 0 or 1 and they are at a certain age so they are excluded. Easy peasy way of keeping the budget in check. Nothing to do with caring GP's, Consultants or EP's.
It would be interesting to know the correlation of all these stroke victims in this article with CCG's who are badly managing their finances - forget AF. I bet there is a strong correlation between the two.
Cheers
John
I am so sorry that you are so cynical about the NHS. I don't think there is enough loot in the money box to treat serious diseases which can be helped with drugs that these days can cost £1k per pill!
I really don't believe that Doctors withdraw preventative, very low cost meds from people who need them for the reasons you propose. If this is your personal experience then please provide evidence because my experience is totally the opposite.
Use this site to assess whether or not you are a high stroke risk. Keeping risk factors low is imperative. Note also that hypertension controlled with medication is still a risk factor.
Risk for stroke is a calculation based upon individual age, circumstances and lifestyles and other illnesses. There is NO one solution.
Surely reducing your risk profile by controlling BP, risk of diabetes, exercising and weight control along with sensible drinking would be far more sensible and far less expensive for our society than medicating everyone?
I view this more as a wake up call for younger people to make the changes now, if they want a long and healthy older life.
Agreed.
I think the various CHADS scores don't really take one's personal circumstances into account at all. We score for our age and we score for gender and things like hypertension, but there doesn't seem to be any minus for being a good weight or being fit, living fairly soberly or eating well. Where's the A* for a healthy lifestyle?
Good point I had never thought of it like that. and the medical profession often ask those question in a consultation to gauge one's general health. most of those questions are also asked when dealing with life or travel insurance.
Don't you think "healthy" is the norm we as a population should strive too be? The new scoring system will tell you to OAC with less than basically perfect health. There is no reward in trying to live longer - other than say....actually living longer!
It's only about 18 months since my GP, at my request, agreed to take me off Warfarin and put me back on aspirin, which I was on for about 7 years beforehand. CHADS score was zero. Cardiologist insisted I needed an anticoagulant and that CHADS was irrelevant in my case due to enlarged LA making me more at risk for stroke. GP remained doubtful but I've had Rivaroxaban for the last year.
I've seen all the stats, read all the guidelines. I still think that anticoagulation is a bit of a blunt tool and there should be a better way of assessing personal risk. I feel
that although AF increases the risk for stroke many times over, there is still a much bigger chance of not having a stroke. I am still taking the Rivaroxaban but mainly because the doctor says so. Does this mean I have no capacity for reasoned thought?
Certainly not Mrs Pat, certainly not.
I have AF and AFl and am just waiting for my GP to hear back from my EP advising him how to start me on a NOAC (Rivaroxaban), so I can go on the list for an ablation for both conditions.
My GP convinced me a few months ago that I did not need anti-coagulating yet as I didn't score high enough using CHADS vasc2 etc. I am female, approaching 60, and do have intermittent high BP. I have no history of stroke/ TIA (BUT my Mum has recently had a brain scan which they said showed she has probably had more than a few TIA's-all undiagnosed!) I have no diagnosis of Peripheral Arterial disease, but have some of the symptoms, and my Dad had emergency surgery for just that disease! My point being that I may not actually score as needing anticoagulant but on balance feel I probably should be taking it anyway. Both my maternal grandparents died from complications after having strokes! I do not want to do the same.
I cannot agree with aussiejohn's assertion that the clinical experts who put forward the NICE guidlines are being neglegent and being told what to recommend by Whitehall beancounters. If that was the case then would NOAC's have been approved?
With regrds to the original ( and subsequent ) posts of anticoagulatenow, as far as I can see the Stroke Association report does not mention any increased risk to AF patients - not disagreeing there may be one, but surely we need to get the expert opinions before we questioned reasoned decisions made.
There really is no doubt Dave that those of us with AF are at greater risk of stroke than others in the general population. Is it not therefore a perfectly reasonable extrapolation to suggest that if there has been a significant increase in the number of people in the general population who are having strokes then those of us with AF are at increased risk?
By all means seek 'expert opinion' for confirmation but... it's not rocket science, is it?
ACNow, the article does state the overall number of strokes have decreased, but increased in 40 - 54 year olds. As somebody asked earlier how many of these could be AF related and more importantly if there was a considerable amount, how many could have been avoided if they had been antcoagulated?
True Jason but we'll probably never see the thorough and detailed analysis that you suggest and which I agree would be very helpful. But if you can't accept, prima facie, that a 'number of strokes' (probably very many) would have been avoided if individuals had been properly anti-coagulated (and I'm not saying you don't accept that) then I wouldn't know what to say to you.....
I'm fully aware of the increased risk to AF sufferers but it is still your assumption that you are trying to suggest is fact.
I am not necessarily disagreeing with you that it might be true - but we don't know yet.
We seem here to be talking about the UK. What's the situation elsewhere?
The Stroke Association survey was UK based but globally stroke is the No 2 killer of mankind. However, the Stroke Association report spoke of issues around obesity, lack of exercise, diabetes etc so it might be too simplistic to suggest that their findings would be replicated internationally outside the developed world.
I was meaning at what age does anticoagulation become advisable.
I don't know Rellim. Wow! There's a surprise....
Yes, wow indeed!! Perhaps our members elsewhere will enlighten us ....
There is not an age that anti coagulation becomes advisable. Having seen my mother have an af stroke, nothing would induce me to stop ac, but that is personal experience. I am now on it for good as have a pacemaker
Eileen
Thanks, Eileen. This takes us back to my original observation way up above. I haven't noticed family history creeping into the equation.
65 has been selected in the UK as a point at which one is discouraged from not being on anticoagulation if one is at risk. I 've just been wondering if there is a different suggestion elsewhere in the world.
I'm sure you're doing the right thing angiek. The suggestion that at 60 you don't need anticoagulants but at 65 you do is just too silly for words. But here are some anyway.....
I went to see Doctor Wagner, my GP today. He’s a nice man, very caring. A German I think, who came to England from Argentina in the mid ‘70s. My wife thinks he’s probably the son of a senior Nazi. She might be right but credit where credit’s due – he’s been a good GP to us.
“Mr Case, sit down please.”
“I’ve had a letter from the hospital about your visit to Mr Chatto. He wants to start you on warfarin next month, on your 65th birthday, the 22nd I believe.”
“The 21st” I corrected.
“But that’s a Sunday, I don’t think we can do that…we may have to take a chance for a day.”
We? I thought. It’s me that’s taking the chance Herr Wagner not ‘we’!
“Can’t I start taking it the week before?” I suggested.
“It’s possible Mr Case, it’s possible. Though it does seem an unnecessary waste of NHS resources – it doesn’t actually do anything until your birthday, you see?”
LOL - You couldn't make it up could you?
I think we are in danger of treating anticoagulants as some sort of vaccination, i.e. give it to everyone and the disease will be abolished.
There is an article on the BBC website today, for which I don't seem to be able to provide a link, quoting a report about people being over medicated and indeed over-tested. The cynical may think that this is an example of the NHS trying to save money. However, it reiterates the useful points that some people have made about medication not being the only answer in every case, especially where symptoms or test results are borderline.
I think that's a pretty good analogy actually Mrs Pat.
I have a vaccination to reduce my risk of contracting something very nasty. Isn't that exactly why I take an anti-coagulant? But you don't give everyone a cholera or yellow fever jab - you target the needle at those at special risk of contracting those diseases, such as those traveling to disease hotspots. Equally, there is no suggestion that we give everyone an anti-coagulant. Just those at special risk of stroke - those with AF for example.
However, if a relief worker going to West Africa had previously experienced post-vaccinal encephalitis, they would be advised to avoid either of those vaccinations. For entirely different reasons, some AF sufferers should avoid anticoagulants because the contraindications outweigh any benefits; those especially prone to bleeds for example.
The difference, in the context of discussions here, is that while the relief worker knows why she is off to Liberia without the jab, too many of those with AF haven't a clue why they are left unprotected!
Yes, a very good analogy indeed. Thank you.
But some vaccines are offered to the population at large, mostly in childhood, regardless of personal risk from the disease. In those cases, a communicable disease is involved and there is a dual benefit for the community and the individual. AF is quite different.
A contraindication is different from being given information and making a choice. But if we trust doctors to prescribe when necessary then surely we should accept that there are circumstances where they may not. It's the lack of information that's the issue.
I seem to remember, a few years ago, that there were medical professionals advocating that everyone over 50 should take aspirin, statins and BP medication.
I take your point Mrs Pat but the big difference between now and earlier generations is that we are all much better informed today than we ever were. Almost entirely because of the internet of course. It enables us to find out about the most obscure things in this world, in seconds. Three hours ago I wouldn't have had a clue what post-vaccinal encephalitis was. Now, I have a reasonable understanding why my fictional relief worker shouldn't go anywhere near a yellow fever vaccination!
All this means we are able to question doctors much more than we could have done in the past, particularly when it comes to our own medical conditions. Most of us on this forum will know much more about AF than the average GP. And I say that without a whiff of mis-placed arrogance. A consultation with a GP today is much more of a 'partnership' than it used to be. And so long as there exists a mutual respect for each other, I think that's a very healthy situation.
Re your last paragraph....I might have dropped the aspirin by now but otherwise, would that have been such a bad thing?
But the doctors hold the "whip hand" as they do the prescribing. Easy not to take medication if you so choose, but harder to get them to prescribe if they don't see fit.
Er - statins. My GP thought of prescribing them for me but the way she put it was "I don't suppose you'd want to take statins, would you?" When I said no, she nodded her head. Some of them have potential intractions with at least four drugs used in AF - Warfarin, Amiodarone, Diltiazem and Verapamil.
And why would you want to give BP medication to someone who hasn't got high BP?
Are we both looking up stuff on the internet?
Good points again. Gosh it's been a long day. I didn't mean to but it seems I've ruffled a few feathers, fallen out with falling to pieces and generally taken some stick. Never mind it's been an interesting posting session and tomorrow's another day!
Now, what exactly is pneumonoultramicroscopicsilicovolcanoconiosis apart from being the longest word in the English language. I hope I haven't got it......
Daily express yesterday page 21 report on increase of stroke "The root cause of stroke appears to be our increasingly unhealthy lifestyles with smoking high blood pressure and growing rates of obesity" as usual not a mention of AF 
Are there really more smokers than, say, 20 years ago?
I doubt it Mrspat, but the initial article relates to people in their 40's & 50's and maybe the damage was done in their earlier years. Drinking, recreational drugs, junk food (Obesity) and stress probably all play a part too. Throw in AF and and the odds don't look too good do they?
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