Stroke risk

[lepaul]

Trip to A&E after a bout of severe irregular heart beat.

Having suffered from AFib for several years with 4 ablations I thought that I was getting along nicely , my meds were stopped including warfarin , when 6 months later it reared its ugly head again and I was put back on 50mg flecainide twice daily no warfarin , I continued to get episodes of Afib on a weekly basis, I went back to see my electrophysiologist who said we will do heart monitor for 48 hrs to see what is happening and I will see you in 9 months .I asked him about going back on warfarin and he said no as he thought it wasn't needed ,well with my age of 66 I was worried about as I have learnt over the years that there is more of a risk of stroke as you get older , but I had to go with his decision I thought as he must know best .

Tues evening of this week after 6 hours of racing bpm there was a sudden change and my bpm became very irregular and seemed different from other episodes , at times I could not breath properly so I phoned 999 , now I am very loathe to do this unless I feel in trouble , a paramedic car and ambulance arrived simultaneously , on being wired up they saw bpm bad and blood pressure high so I was whisked off to A&E .

Eventually bpm stabilised and bp improved ,while being examined by dr I had another attack which was great as dr could see it on monitor ,this up and down bpm lasted through the night , I was seen by consult early Weds morning who soon identified my flecainide needed to be doubled to 100mg twice a day plus he put me on a anticoagulant called APIXABAN its a new drug but was proven to be very good , I was very happy with this as he explained to me the higher risk bracket I was in of having a stroke due to my age .

I am sure I have run on long enough but I thought it was important to reaffirm how stroke risk is greater the older we get and being on an anticoagulant is very important .

[Finvola]

Good result - stroke risk is certainly something to be taken seriously as we age. I also take Apixaban and 100mg Flecainide, with good results so far. Hopefully, it will control your arrhythmias too.

[lepaul in reply to Finvola]

Thankyou Finola that's good to hear.

[BobD Volunteer]

To be honest I have always been of the opinion that if we have AF we should be anticoagulated to reduce stoke risk regardless of age. This does need to be balanced against the risk of bleeds but on balance think it a good idea. Although many EPs are of this opinion, there is no NICE guideline to that effect at this time.

The NOACs such as apixaban have shown to be at least if not more affective that warfarin with less control issues so well done your A and E doctor.

[lepaul in reply to BobD]

Thanks Bob ,I am certainly happy that I had the visit to a and e .

[PeterWh]

You are 100% right about Anticoagulation being so important.

It is worth noting that even with a CHADSVAC score of 1 the NHS England (I think) guidelines shows a green light for Anticoagulation. Even with a score of 0 a patient can choose to be on an anticoagulant. Remember that correcting a condition (eg high BP) does NOT reduce the score for that aspect from a 1 to a 0.

I have known people in 40s, 50s 60s and above getting strokes and very debilitating ones at that. One person spent approx 17 years paralysed from the neck down and he could only grunt, not talk. Mental capabilities were 120% though.

[lepaul in reply to PeterWh]

Thanks for your reply Peterwh , I have been worried about stroke risk for some time so the fact I was taken to different Hospital this time as my usual one had 2 hr waiting time for ambulance has worked out well for me .

[SRMGrandma Volunteer]

Interesting report published yesterday about how half of all people with AF are not properly anti coagulated and that is the huge stroke risk. Glad you are on the Apixaban now! Risk of stroke far without anticoagulant exceeds risk of bleed with them.

health.ucsd.edu/news/releas...

[lepaul in reply to SRMGrandma]

Thankyou SRMGrandma for your reply , I am much happier now I am on Apaxiban.

[AnticoagulateNow]

Good for you. Make certain the EP, who left you unprotected, gets to know. And then look around for another one!

[lepaul in reply to AnticoagulateNow]

Thankyou I will certainly be having words at my next apt ,

[Hidden]

My EP has had me anti-coagulated for a decade with a CHADS score of zero and no other history or problems. I've now got a score of 1 because I'm over 65. I have quizzed him on the matter a number of times and he has always been in favour of AGs for me. I was on Warfarin, then he recently changed me over to Apixaban.

Koll

[lepaul in reply to Hidden]

Thanks Koll for your input .

[Geza10]

I am 58 very active in sport had AF for 5 years had 1 ablation lasted a year on no drugs until 3 months ago when they said I had a TIA it lasted 5 seconds on my right hand holding my phone had a MRI scan and a ultra sound came back clear my chad score was 0 before that its a bit of a shock on Apixaban now and will stay on it till I die or a cure is found don't want to be a problem for wife and children through not being sensible

Geza

[lepaul in reply to Geza10]

Thanks Geza 10 , exactly right my neighbours husband had stroke and is in a wheelchair full time ,paralysed down one side and cannot speak , he has 2 carers as well as his wife.

[dmac4646]

I am amazed at the stats emerging that only 50% of people who should be on Anti Coagulants actually are - as Bob says anyone with AFIB should consider this - I am also amazed at the number of GP's still on the Aspirin train given the evidence against it - it would appear that there is a difficulty in communicating this stuff with front line GP's

[lepaul in reply to dmac4646]

Yes there needs to be better communication and to my mind a person with AF should be able to have AGs whether there EP agrees or not.

[PeterWh in reply to lepaul]

The can - see guidelines (Scotland and Wales may be different).

[Barb1]

When discussing anti coagulation before a hip replacement, my surgeon had no idea what a NOAC was!

[lepaul in reply to Barb1]

Oh my goodness

[PeterWh in reply to Barb1]

Not surprised.

[djmnet]

Four ablations? Makes one wonder about the efficacy of ablations (and the gullibility of afib patients). My own EP confided to me just this week that he has afib yet takes no medications and has not had an ablation, even though cyroblations are his speciality. One CAN live with afib, you know -- as long as you're coagulated.

[Rellim296 in reply to djmnet]

One can indeed live with AF, but I don't really want to, and more to the point, I agree with your EP and I'd prefer not to take medication. I've been gullible three times and believe I am the better for it.

[lepaul in reply to djmnet]

Yes that is exactly what my thought , I can and have lived with AF for several years , I just wanted that protection of AGs .

[PeterWh in reply to lepaul]

The problem with AF is that it almost always gets worse. What is unknown and varies considerably from person to person. However a key factor in deciding whether or not to go for an ablation is health. If an ablation is offered to you by an EP now then that EP believes you are a suitable candidate.

Wind on a few years will you still be a suitable candidate and offered one? The answer may very well be NO.

Other health issues may have developed in the intervening time and consequently the offer of an ablation gets withdrawn. Your AF might have developed into persistent AF and therefore the chances of succes are considerably lower. Etc.

[PeterWh in reply to djmnet]

How old is he? How symptomatic is he? It is also well known that those in the medical profession are often bad patients, especially consultants in their own speciality. He probably has private medical care so if he does need an ablation he can have one a few weeks later.

[Kodaska]

This is an excellent example of why I say one should be one's own doctor by learning everything possible about one's condition. Example: Research (via the Internet) into flecainide reveals that 100mg/day is not sufficient to control post-ablation arrhythmias; that requires 200mg/day. I'll bet that's why you were put on the higher dose. I agree fully with AnticoagulateNow's suggestion to find another doc.

[lepaul in reply to Kodaska]

Thanks Kodaska for your input . I have always had my own opinions about meds for AF and what I thought I needed ,I relied on my EP to give me the meds to control it , looks like my hunch and A and E dr has done the trick.

[jayjaybee]

Hi lepaul, hope all continues to go well for you. I would be interested to hear how you get on. My hubby had bad bout of AF followed by small stroke and is now on diltiazem and apixaban. Heart rate lowered but still irregular, so the drugs are probably working. Problem is that he is so fatigued and exhausted. First week on the meds was ok, but the exhaustion set in afterwards, now he feels incapable of even normal day to day stuff. He's not sure whether it's the AF or the meds. Very frustrating. Our spring holiday is cancelled as he doesn't feel able enough. But at least he's alive!

[lepaul in reply to jayjaybee]

HI Jayjaybee ,thanks for your post ,everything is still going well . Sorry to hear about your husband ,seems he is struggling a lot ,that's awful , I used to get fatigue on bisoprolol but not as bad as that ,although I am retired still very active and do lots volunteering in SUE RYDER shop an have 2 dogs so lots of walkng is done .I will post on here as to how things are going with me. hope your husband improves

[Barb1]

I never thought that I was gullible but I have had 4 ablations and would have another if it kept me in SR for at least a while. Symptomatic AF is no fun.

[dave1950]

I am really struggling with what I read on here as it seems to contradict everything my GP, cardiologist and EP are telling me. Perhaps every individual case is different which causes the confusion. I've knowingly been getting PAF for about four months. triggered by anxiety or anything that puts my (low 50 bpm) heart rate up. It is fast at first and then just little irregular fits and starts. I get it about every 10 days and it always lasts 36 hours and then goes back to normal. Apart from an uneasiness i feel ok when I get it. I have been put on 2.5mg bisoprolol which doesn't seem to do anything other than lower my bpm to 45 .The word ablation has never even been mentioned.

I know my stroke risk is higher now (is it though - I had an echo cardiogram in AF and they said it was still pumping efficiently?) but they basically say I have a very low level (1)risk just due to my age (66) and I could go on warfarin but it will only slightly reduce the risk further as it is low. The attitude of this supposedly top cardiothoracic unit seems to be it's not a problem just get on with it, which to some extent fits in with how I feel to some extent if they are right.

I have o idea if I should be concerned or not!

Dave

[PeterWh in reply to dave1950]

Depends on what you call slightly. Look at the statistics. It is all an approximation. What if one of the extra people who had a strone was you?

[dave1950]

Well yes, I understand that. Population statistics are complicated and as I said I realise the stroke risk is the main issue. I was just saying that as the actual AF is (I am told) not life threatening there seems to be a lot more anguish over that aspect than I would have expected. That is why I was drawing the conclusion that it must manifest itself in a multitude of various ways individual to individual and why I was disappointed with my healthcare professionals being dismissive of my individual circumstances.

Dave