Blood thinners

[afibtennis]

I was recently put on Pradaxa along with Flecainide and Altenolol instead of taking as a pill in a pocket as I have had 6 episodes of A fib over the past 2 years with the episodes coming closer in time.In all cases, I have been completely aware of my episodes. My question is whether I need to be on the blood thinner (Pradexa) on a daily basis.I have heard from other sources that if I were to get into an accident, I could possibly bleed to death due to the blood thinner and that if I have another episode of A fib, I could take the blood thinner at that time and it would still protect me against a stroke. As long as I took the blood thinner within 24 hours of the A fib, there would be very little risk of a stroke. Any advice?

[Hidden]

To put the answer in a ' nutshell ', once you have had a diagnosis of AF your stroke risk is thought to be the same whether you are actually having an episode or in normal sinus rhythm.

Sandra

[BobD Volunteer]

Not sensible I'm afraid. If you have a stroke risk the number of events and or frequency of AF is of little importance . Such ideas are dangerous as indeed is the idea that an accident could make you bleed to death. Scare stories such as this do nobody any good.

To start with these drugs are not blood thinners and although this has become currency for them it miss-describes their function. They are anticoagulants which slow down the clotting process. It does not stop it so normal ways to stop bleeding still work even if they do take a little longer. Of course any head injury should be investigated especially if it involves loss of consciousness or nausea but for most practical purposes your risk of thrombotic stroke far exceeds any bleeding risks. The lack of reversal agents of some of these new anticoagulants does not make them dangerous and even warfarin which has been used for years and which I have been on for twelve needs specialist treatment should a major blood vessel trauma occur. I work with metal and sharp objects and have never had any issues with excess bleeding.

The next point is that you may well be quite unaware of an AF event in your sleep or even during the day so even if this idea was a practical one you could still be at risk as you may never know you had been in AF.

Provided that your CHADS2VASC score says you should be on an anticoagulant it would be unwise to do other than prescribed .

[voyagersprit]

Pradaxa is your liferaft if anything goes wrong. You will be fine on it but carry a notification alert card with you at all times

[Rellim296]

I was very dubious indeed when I first took an anticoagulant, but decided that death would be better than almost total incapacity from a serious stroke that could have been prevented. As time went by and I was fine, I lost the fear and trepidation. We know lots of people have strokes, but how many people die because they're on an anticoagulant who might be saved if they had normal blood?

[elmbury]

As a previous respondent said it all depends on your CHADS2VASC score. I am in permanent AF and talked it over with the cardiologist and his view was that I did not need an anti-coagulant because of the very low risk in my case. You should look at your own score - I am sure the professionals did - and if you feel your risk doesn't justify the prescription talk it over with them.

[Drounding]

I'm also on Pradaxa with PAF. I tend to bruise slightly more easily and small cuts take a little longer to stop and heal but you shouldn't be concerned about bleeding to death. The risk of stroke due to being diagnosed with AF is considerably higher than the risk of bleeding to death due to some freak accident. For info Pradaxa does actually have an reversal agent called Praxbind which a hospital can use if needed.

[CDreamer]

I was very reluctant to take anti-coagulants on a daily basis for life - I researched thoroughly, I talked to my doctors, I came off them when my ablation worked for 2 years - and then I had an episode and my first thought was panic because I wasn't on them!

I am now! A stroke from AF caused clot can strike many days or weeks after your AF episode. Don't risk it!

[CDreamer in reply to CDreamer]

PS risk of stroke much higher than that of bleed.

[Drounding]

I remember Dr Sanjay Gupta in one of his videos saying that the increased risk of stroke in patients diagnosed with AF is not purely due to the AF itself but the company it keeps. In other words people with AF are more likely to have a stroke whether in AF or not.

[CDreamer in reply to Drounding]

He posted a new video this morning on NOACs, aspirin and bleeds, worth a look.

[Lizzo]

I was taken off warfarin a few months after my last successful catheter ablation, but, last October (about 6 months afterwards) I suffered a TIA (Transient Ischaemic Attack or mini-stroke). Tests following this showed that I had, unfortunately, gone back into AF, and this was the most probable cause of the TIA. I have now been put on Pradaxa as an anticoagulant in an attempt to prevent a future occurrence. I was told that I was put on this particular NOAC because it has a reversal agent in the event of an accident.

So, I hope that this tale will help persuade anyone who questions the need for anticoagulants that they are indeed necessary for anyone who is susceptible to AF. Strokes and TIAs are no fun, believe me!

[Vony in reply to Lizzo]

Lizzo sorry to hear what you have been through but glad you have come through it. Just out of interest, did you have any other known risk factors for stroke aside from AF? Best wishes

[Lizzo in reply to Vony]

Thanks Vony. I didn't have any other stroke risk factors apart from AF. As far as I was concerned, it came from out of nowhere!

I had an ECG, Head CT and Carotid Dopler tests at the hospital on the day of the TIA, and all came back clear. It was only when I had a 48hr ambulatory monitor fitted that they discovered the return of the AF.

[Vony in reply to Lizzo]

That must have been awful for you. And scary AF was your only risk factor glad you are sorted and protected now

[Mazza23 in reply to Lizzo]

I too had a TIA a couple of weeks ago thank good ness I am still taking Apixaban the out come would have been much worse no lasting side effects thank goodness

[djmnet]

Six episodes in two years; that sounds wonderful to me. Mine come every 6 days like clockwork! I take anticoagulants (Apixaban), but no other drugs even when in afib.

[dave1950 in reply to djmnet]

At last - someone like me! Mine are very regular about 10 days, then stop after 18-36 hours. Only have very minor obvious affect on me. CHAD score only 1 but after a year a new electrophysioligist persuaded me and I am on Apixaban which has no obvious side effects on me.

[Vince66]

Keep taking the Pradaxa I've been on it for three years. If I do cut myself usually stops bleeding soon after may be a bit longer to stop than usual. In the box the tablets come in there is a card which you fill out and keep in your wallet in case of an accident. Strokes are not nice at all so do all you can to avoid the risk of having one.I used to be on warfarin I bled worse when I was on that.

[timince]

The good news for those of us on Pradaxa (dabigatran) is that a reversal agent has been developed for this NOAC specifically. I have PAF and take Pradaxa with no known side effects and play tennis too! If you are on daily Flecainide and Atenolol you should discuss with your clinician taking these as a PIP whenever an AF episode starts. I have been doing this very effectively for a few years now. And make sure to take a daily dose of magnesium chelate.

[afibtennis in reply to timince]

That is how I started but the A fib episodes were increasing in frequency to almost once a week while playing tennis. I was already taking 800mg of Magnesium. THe kicker was when I was woken up by a fib while I was sleeping! So the EP recommended daily doses.

[timince]

Luckily my PAF is triggered by indigestion (vagal nerve) not exercise. I gym twice a week no problems.

[timince]

Also, IMHO, if you've been taking your anticoagulant, there is no crisis if you are woken up by AF. Just take your PIP and they should bring you back to SR within a couple of hours. Discuss with EP.