getting on my wits end

Had 3 bouts of AF in the last 2 weeks , one last night at 3am woke to the dreaded thumping and irregular beats , er we go again I thought , so I sat up and tried to chill waiting about 5 minutes and took in some breathing exercises , no joy still there the pesky so and so , took 150mg flec and within 8 minutes I was back in rhythm , cool beans , I went to a pre booked DRs appointment today and mentioned these bouts I have been having over the last 2 weeks , and he recommended a anticoagulant whilst there we did a quick scale test to see if I needed them , im 51 , blood pressure normal 128/85 , haven't and don't wont a stroke , no history of heart failure , so eventually my score was 0. but he still recommended I start a dose of tablets to thin the blood , I suggested waiting as I have a cardio appointment in Feb and let the specialist recommend this (was this the right move ?) , can any one recommend a blood thinner warfarin is the common one to use but there 3 more new drugs on the market but don't know anything about them only they haven't got a reversing agent like warfarin , a little scary on taking them but the risks are getting higher for me so I have to take DRs advise ,

kind regards

Derek.

18 Replies

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  • I understand your dilemma, given your cardiologist app is very close and your chads score is 0 it seems reasonable to wait to see him/her for their specialist opinion and advice. However given your regular afib episodes I can see why you are wondering whether to follow your GP advice.

    Personally I think I would call the cardiologists secretary and ask if you can be given a steer on this in advance of your Cardio app. If your specialist says you need anti coags then you can go ahead with two agreed opinions. Perhaps this could be a way forward for you.

    i have taken one of the new (or not so new now anti coags ) for three years without event. There is rivaoxaban (my one ), Apixaban, dabigatran and another one who's name I have forgotten. I really personally do not worry about reversal agent as there are solutions to be applied medically if needed. I think one of the new noacs does have a reversal agent either in place or pending.

    It's a dilemma I know but ask the question of the specialist the clue is in their title - specialist, rather than general practitioner alone, two heads are better than one.

    Hope this helps a little.

  • Hi Meadfoot , advise well appreciated .

    thanks .

  • Hi Derek and I do understand your dilemma. CHADS2VASC is not a definitive system but sadly the best we have at present. There was a time when I would have said yes take anticoagulant (not blood thinner please as this is not what they do . OK I know it is common usage but it is wrong.) The problem is that there is no right or wrong answer. For every thousand people given anticoagulants some will still have a stroke. some will be prevented from stroke and some will have a bleeding event. On balance probably more people are saved than not but right now the NICE guidelines are that you don't need them. Unfortunately you can't sue NICE if you did.

    What is sure is that the frequency or duration of AF event does not change you risk. You have AF therefore you have a risk whatever that ends up as. At the end of the day only you can make the choice and the right choice is what you are comfortable with.

    All that said. , forget reversal agents. Modern NOACS are quite safe and have a short half life anyway. Even warfarin is not easily reversed no mater what one might think. Any minor injuries may bleed a little more than usual but pressure for a few minutes usually sorts them out. I have been on warfarin for eleven years and yet to have a serious bleed despite working with metal and sharp objects. (I don't juggle with chainsaws mind.)

    Nobody here should tell you one way or the other but for more information do go to AF Association main website and read all about anticoagulants.

  • thankyou for your valued advise.

  • With a score of 0 and a physician's advice to anticoagulate nonetheless, I understand your confusion as the decision isn't straightforward. To add to meadfoot's good advice, the absence of a reversal agent for 3 of the new anticoagulants (fourth one is Edoxaban) is a bit of a red herring as normal cuts and minor injuries just bleed for slightly longer. A serious injury will be a medical emergency, regardless of any reversal agent. Can you check your HASBLED score which may give you more information about your bleed risk?

    For me, the choice is between the slight risk of a bleed and the slight??? risk of a devastating AF stroke. I have a score of 2 and have taken Apixaban for 3 years, having nosebleeds from an allergy, cuts and a tooth taken out - and I'm fine.

    If you click on the AFA main site from this link, there is lots of info on anticoagulation which may help:

    heartrhythmalliance.org

  • thankyou for your valued advise.

  • Agree with the others. No great rush to start anticoagulant as your risk score is zero, wait until you see cardiologist

  • With a CHADVASC of 1 at age 68 I was expressly advised by an EP not to take an anticoagulant as I am a bleed risk. I had a stroke 18 months later, so I now take Pradaxa (dabigatran) that has a reversal agent Praxbind that can be administered in hospital for a severe bleed. I wear a wrist band stating that I'm taking Pradaxa in case I'm unconscious. I've had a canula inserted in my arm and blood samples taken, none of which have bled more than normal.

  • I have a chadsvasc score of 0 and used to be petrified of having a stroke as my amazing wonderful dad died very young of a devastating stroke (not AF related as far as we know.. He was a heavy smoker). When I got AF and heard of the stroke risk I became obsessed and consumed with this fear. My EP refused to put me on an anticoagulant. I would lie in bed with my toes curled during every single arrhythmia episode , bracing myself and praying to God I didn't have a sudden stroke. This went on for 3 years but in reality I have had AF for 10 years- it was just never diagnosed. The point I am trying to make is that lots and lots of people have AF and don't know about it... and they don't have strokes. Some poor people do have strokes and it is only after this that AF is diagnosed. But my EP reassured me so many times that these people usually have other risks. If you can wait until your specialist appointment which is very soon then try not to worry about stroke. You are young and otherwise healthy and have been safe until now. I am not medically trained and this is only my own opinion but I totally empathise with the whole AF and stroke fear. I am on anticoagulants now but only because of an episode of hand weakness last year. This weakness started after a drunk driver hit my car at speed and sent me spinning across a dual carriageway.. And my heart stayed in NSR the whole time lol. Anyway after a couple of days in hospital I was put on anticoagulants as a precaution because of my history of AF and the hand weakness which they said could have been a TIA. Further investigation ( MRI) showed damage to the spine which probably caused the hand issue. But I was advised I could stay on anticoagulants if I wanted to at my review 6 months later. I chose to. I probably don't need them but for some reason I feel psychologically better on them. Maybe my anxiety.. Who knows. Maybe I will come off them sometime and reassess chadsvasc regularly. Maybe NICE guidelines will change. The world of AF is just not black and white. Best wishes with your journey and treatment. PS. I know a consultant anaesthetist who has AF and has actually chosen not to take anticoagulants as he has a score of 2 but said percentage wise he didn't feel risk of stroke warranted anticoagulants for him as statistically it was still low. Daring in my opinion but just shows that a 1-3% risk is intolerable to me yet a higher risk but still below 10% is acceptable to someone else!!!!

  • thankyou for your valued reply .

  • War and peace reply you mean lol xx

  • lol ,

    Do you know what Dr said to me one time Vony a while ago, he said all these unnatural beats could be in my head and I could be over imagining them due to my age , well you can imagine where I would of like to of put that stethoscope at the time , luckily he has moved on to a different practice ,never never land I hope lol .x

  • I have no history nor condition other than AF, and my EP has always had me anticoagulated regardless of my CHADS score which was 0 for years until I reached 65 so now 1. I was on warfarin, now on Apixaban. It is nice and easy not to have to faff around with INR tests, and sometimes mine would go up and down like a yoyo!

    Koll

  • Thanks Koll , that's good to know ,

  • I took Dabigatran for a few years - need to be careful of acid reflux with that one as it needs an acid stomach to dissolve the gel capsule but that seems to be less popular these days. I now take Apixaban and have absolutely no problems.

    Advantages over Wafarin - 1 tablet, stable dosage; no regular blood testing other than usual annual one; don't need to declare to travel insurer as no blood testing which seems to make a difference??; research studies show a slightly less risk of cranial bleeds - which are the ones you don't want - over Wafarin.

    Which are the reasons I don't want Wafarin but others like it BECAUSE of the blood tests - we all have differing preferences. Up to you.

  • cool beans thanks for that CDreamer

  • Hi Derrick

    I am on a blood thinner called pradaxa, and there is an antidote for it, and no diet restrictions. Hope this helps

  • thx Rex, I have had good reports bk for this drug if I have to I think I will go for that one . Have to obviously be careful in my industry not to cut myself

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