Out of AF, but have had a stroke / TIA

Following my second catheter ablation last year, I am now out of AF, and was taken off warfarin about 6 months ago. However, three weeks ago, I had a couple of symptoms which are indicative of a stroke, and was taken by ambulance to A&E after my husband dialled 999. I had a head CT, which showed no evidence of a bleed in the brain (apparently it was too early to tell whether there was a clot), so I was put on Clopidogrel. I have also had an ECG and Echocardiograph, which were both "normal". I have been reading some earlier posts on this site, where it was said that drugs such as Clopidogrel were not as good as warfarin at preventing strokes, so I'm somewhat concerned for my future health. Has anyone else had a similar experience, or got any advice for me?

17 Replies

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  • It is different - like aspirin it is an anti-platelet whereas Wafarin and NOACS are anticoagulants. The first is usually given after an event the latter to prevent an event.

  • When there was a possibility (later disproved) that my wife had suffered a TIA she was given Asasantin.

  • There is plenty of evidence that even successful ablation does not remove stroke risk which is why many of us chose to remain on anticoags for life. That said you haven't actually had a stroke diagnosis yet form what you say so could still be spmething else.

  • Clopidogrel as stated is an antiplatelet and is the best treatment for strokes and ministrokes that are thought to be atherosclorotic in origin.

    Warfarin and NOACS are best if the event is thought to originate from the heart (cardio embolic), so indicated for AF

    It sounds like you have no evidence to suggest a recurrence of AF and maybe you do have evidence of atherosclerosis, as most people of a certain age will have, hence the decision for clopidogrel

    Its reassuring to know your CT was OK and clopidogrel may save you from future stroke events

  • A CT scan does not show as much detail as an MRI scan - that's the best scan to show any clots. But it might have been a TIA in which case there wouldn't be any evidence now anyway. Your CHADS2VASC score would now be at least 2 so that would indicate a proper anti-coag.

  • Thanks for your comments. The hospital have not yet confirmed that I have had a stroke/TIA. I am having a 48hr heart monitor fitted at the end of the month, and will then see a consultant. One concern I have is that this is a different hospital from the one where I have been treated for AF, and a different hospital trust too, so I don't think there is any sharing of information. I obviously told them about my AF and that I had previously been on warfarin. I guess I need to discuss this with a consultant when I get to see one!

    I am 58 years old, so fairly young to have a non-AF related stroke!

  • I live in Eastbourne and there is no sharing of information with Brighton only 22 miles away as they come under different trusts

  • It's very poor, really. As a retired computer programmer, I know that it should not be difficult to design computer systems to allow information sharing. It is dangerous not to!

  • The problem is that I see people at each and in the middle when I'm often not sure which area I'm in.

    I had an appointment with a consultant at the Nuffield in Haywards Heath. When I spoke of an MRI I had at Eastbourne he said that it was a CT scan. I said no, the CT was at Brighton the year before.

  • I've had all my AF treatment in Leeds, but since I was taken to hospital in Wakefield by the ambulance, I didn't have any choice in it, so I'm having my stroke treatment in Wakefield. It should all be joined up,especially for those poeiple who are unable to speak up for themselves.

  • Here hospitals in Hastings, Eastbourne and Brighton take a weekend each to be the one taking stroke and heart attack patients. Hastings and Eastbourne come under the same authority.

  • This stinks of financial constraints. The convenience or well-being of patients is not a consideration. How can it possibly work satisfactorily if there is no electronic communication between hospitals in different authorities?

    My GP has told me that they receive test results etc. online from the Leeds hospitals, but there is no such arrangement with the other Yorkshire hospitals.

    If (heaven forbid!) I'm ever in an ambulance again, I guess I should insist that they take me to Leeds? That would go down well!

  • A month after my mini-stroke (as my consultant's letter referred to it), I have been informed by letter that the 48hr ECG has shown that I am back in AF, and that I should go back onto anticoagulants. He mentioned warfarin, but then said that one of the newer anticoagulants may be better, as they are more likely to act quicker and produce a more rapid reduction in risk of stroke. I have been on warfarin previously, so know about all the regular INR monitoring required, but can anyone advise on life with the "newer" anticoagulants please?

    I'm really disappointed to find I'm back in AF, as I have had two catheter ablations, and do not fancy another! I have been on amiodarone in the past, too, which was effective, but not the sort of drug to take for any great length of time, due to its potentially detrimental effects on various organs! I have also had one cardioversion, which worked for a couple of months, so I do not see this as a long term solution. I am aware that, as one consultant once put it, "AF begets AF", so I am unlikely to ever be free of it long-term, but it would be good to hear some positive tales from any other long-term sufferers of AF to cheer me up!

  • Some of what you say is good as a mini stroke doesn't have any long term implications and some's not so good. Very tedious to have AF back. On the anticoagulation front, I'd say that I feel much more secure on a NOAC (Rivaroxaban) as I feel I have steady, constant protection. No food issues, no tests to see how well it's working, just an annual check to make sure it's not being detrimental. I didn't get on at all well with Warfarin and never really felt it was protecting me.

  • Thanks for your reply. I never had any problems with warfarin - just got fed up of the regular blood tests, and avoiding certain foods. So, if I get the chance to go on a NOAC, I feel I should take it!

  • I am in AF permanently. I was on warfarin for over 3 years but changed to apixaban 7 months ago. No regrets, no problems and no testing - great.

    All the best with your decision.

    Marion

  • Thanks for that, Marion. I'm glad that things are going well for you on apixaban. I love the thought of no testing! I shall try to persuade my doctor / EP that I should take this route.

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