a/f and blood thinners

[jesse-james]

hi everone I have had a/f for two years and after reading your posts i'm a bit worried my cardioligst said I don't need blood thinners because my blood pressure is low and only 58 anyone else out there like me

[BobD Volunteer]

Go to AF Association website and check your risk score in CHADS2VASC2. Many doctors take this as gospel whilst many of us prefer to be on anticoagulation (note not blood thinner as it doesn't ) . At the end of the day it is up to YOU if you go on them

Bob

[Therealsue]

Jesse-James - I was 56 when I was first diagnosed and like you, had no other factors that would contribute to stroke - normal BP, not diabetic, not over-weight etc and I wasn't on AC's either. I decided to go for an ablation (exactly one year ago today!) and so had to start on warfarin for that. My EP was quite cautious and kept me on them for a good six months post ablation. By this time, I'd become part of this forum and the AC's had become my comfort blanket. I had no side-effects and so I decided to stick with them. I switched to rivaroxaban (one of the new ones), last November as I didn't like the dietary restrictions of warfarin. I've had no problems with this either. My EP and I will make a final decision in July when I see him as to whether I stick with them long-term. I think ultimately it will be my decision though and I probably will. The ablation was a complete success, and I've had no AF for over a year, although the current thinking is your stroke risk is still present due to changes in the atria caused by the AF.

[PeterWh in reply to Therealsue]

My thoughts are that it must be your decision and your decision alone based on his opinion and all the other information you have gleamed (including from this forum). Don't also forget that although you have been AF free as has been said before AF is never cured [at present at least!!] and that you can go back into AF at a later date. Obviously some people are asymptomatic and can end up in persistent AF or others may have minorish symptoms which can be put down to other things (like I did initially) and in which case you could be at a higher stroke risk without realising it. For those who have AF "attacks" they know better when they are in AF. Obviously we are all much more knowledgeable about AF now that when we started on this journey.

One thing that would be interesting to know (and I suspect there is not much research / available information) is can someone who say was largely symptomatic have an ablation and then some time (maybe years) afterwards be largely non-symptomatic? Also the situation regarding the reverse?

[Hi-1964]

I too am like you 51 no other risk factors and my consultant and Dr refuse to put me on saying risk of bleed is the same as stroke risk 1% . I worry every day that today maybe the day !!

[Thomps95]

I'm 58 and take daily flecenaide to control atrial fibrillation, which it controls well. I am following the CHAD2VAS2 recommendations and not taking anti-coagulation. It doesn't worry me. In fact, a recent study reported that if you have a CHAD2VAS2 score of 0, your stroke risk is identical with or without anticoagulation (just as "aspirin" does not decrease stroke risk in people with atrial fibrillation even though that sounds counterintuitive; warfarin does not reduce stroke risk if you have a CHAD2VAS2 score of zero, as counterintuitive as that might sound).

Nonetheless, stroke is on my mind and I am always looking at the current research on stroke risks - and am careful about diet, exercise, sleep, and so forth (stroke risk is correlated with dozens of things you can control).

You also need to consider your personal sense of comfort. If you are extremely anxious about stroke, then AC could be a great option. Just be aware that anti-coagulation is not without its risks. Yesterday I fell badly, slamming onto the pavement after slipping and giving me terrible bruises on my arms and legs - if I'd been on anticoagulation this might have been problematic. However, lots of people on this forum have been happily on anticoagulation for decades without any problem, and it has probably saved many from stroke - so it's hard to advise.

[NiceNana]

Hi-1964, you say that you were told that the risk of bleed is the same as risk of stroke -1%. I've never seen it stated like that. Surely the risk of stroke is proportional to the number of AF episode that you have, so that percentage would be different for everyone. Interesting, as frequency of episodes is not taken account of in the CHADS2VASC2 score.

Jesse-James, I hope that you get the treatment that is best for you and that you are happy with it.

Lynn

[Hidden]

I have had AF and arrhythmias for over a decade, not had any score on the CHADS system (till I reached 65 recently, so now 1) and no other factors to worry about that I know of. But my EP is keen for me to stay on AG's, and probably for life or till I get much older, don't know really, I'll ask when we get there touch wood

I asked him recently why he wanted me on AC's when I have always had a CHADS score of zero, and he as good as dismissed the scoring system as far as I am concerned and said that "you do not want an AF related stroke", and that the risks outweigh the bleed risk.

I should stress that I do not know that this is his general opinion, but it is his opinion relating to me.

Koll

[teach2learn in reply to Hidden]

It must largely depend on the individual doctor's experience and opinion. Following my successful ablation (after months of full time afib) and a CHADD score of 3 (over 65, female, high bp, and history of afib), he didn't insist on anticoagulant, saying it takes 12 to 24 hours of persistent afib to be in serious danger of clot (whew, dodged that bullet before ablation) and that without active afib, risk of bleed out and clot, while on AC roughly the same, 1 and 1.5 respectively. Considering the nasty bruising with slightest rub on skin while on AC, I am choosing to forego until/unless I go into afib again. Each have to weigh our own risk tolerance and use best judgement.

[PeterWh in reply to teach2learn]

The problem is that many people can go into and be in persistent AF for a long time with no or minimal symptoms that can be explained by other things. Also read that risk is increased for those who have an atrial appendage (some do and some don't).

[teach2learn in reply to PeterWh]

Yes, it's true there is risk, especially those who are asymptomatic. I know of several personally in that situation. "Fortunately" I am not one of them and am completely aware of when heart is erratic. Felt like a wild squirrel loose in my chest. Due for six-month checkup soon and will re-evaluate. I'm aware of one woman who needed heart surgery for additional problem and had the offending area of atrium removed. No more place for clot to form!