One year post-stent medication

[Seankevan]

Dear all, I'm seeking some assistance in relation to two matters:

1. Approaching the first anniversary of angioplasty placing a single DES in the LAD (90% blocked - eek!); prior to very flukey diagnosis of erratic pulse in recovery after exercise completely symptomless. Not had single detectable episode of AF since the stent and have monitored very carefully ever since. First consultant, the one who performed the stress ECG and the Echocardigram and who performed the angiogram and angioplasty advised that it was likely "on the balance of probabilities" that the stent would resolve the paroxysmal AF. Howeve, a subsequent Consultant took a contrary view and advised that even a single episode of AF, which may have been related to the original large blockage, and despite zero recorded episodes of irregular pulse since, means that, under current guidelines, the original diagnosis persists. The absence of any further risk factors aside from stable cardio-vascular disease (good pulse, BP, fit and active 52 year old) meant that he did not prescribe blood thinners, warfarin etc at this stage.

Can anyone assist me as to which of the two views I should rely upon? In other words, can a single stent resolving a very large blockage and no subsequent irregular pulse readings whatsoever mean that my paroxysmal AF has been 'cured'?

2. I am currently on 40 mg statins (didn't tolerate 80 mg very well), 2mg ARB Candersartan, as well as 75mg Clopidogrel and daily aspirin. I was told that after one year I could drop either the Clopidogrel or the daily aspirin: does any one have any advice! but that it was "up to me" which one I discontinued. Am confused by that advice and wondered if anyone can assist?

Thank you all, very much, in advance.

[BobD Volunteer]

Difficult for us to advice really other than to say that aspirin is no longer recommended for stroke prevention although it may be useful regarding your stent. AF can occur in isolated circumstances due to other problems but is more often a progressive condition. The only way I would be comfortable saying it was a one off would be if a 14 day Holter monitor showed no events. Many people are unaware that they have AF events (asymptomatic) so you may be having these and not knowing. Your current risk profile would give you a CHADSVASC score of only 1 and under current guidelines this would not mean anticoagulation. Many of us would disagree and it therefore becomes a personal choice. Have a look at CAREAF website and read all about anticoagulation and AF which may help you to decide whether to confront this issue.

Bob

[Seankevan in reply to BobD]

Many thanks Bob. I had a seven day ECG (I think that's a holder isn't it) from the cardiac unit and no events at all. I have also been frequently using an Omron that detects irregular heart beats and it's not indicated a single oddity in 12 months. I do recognise that there are real limits to the 'power of positive thinking' though and do understand that AF can be a symptomatic for many, it's just that I would have thought there would have been something by now. Anyway, I will have a look at the website you recommend but with a CHAD score of 1 (I move automatically to a '2' at 65 I understand!) But I must say that I am inclined not to go for the anticoagulant option at the moment in the circumstances. But many thanks again for you assistance. I think I will stick with the Clopidogrel for the moment too and leave the aspirin. Best wishes, SK