Following on from a post I put up yesterday I came across this article...

Interestingly I recently asked the question of the medical profession " If it was known how many people with AF who had decided not to or were not on warfarin had gone on to have a stroke despite registering 0 on the CHADS......No one seemed to be able to answer the question but agreed there was an element of Russian roulette in the decision.

10 Replies

  • Thanks for posting sports coach. I have found over 3 years that there becomes a big element of self prescribing. The medics tell you the most cautious approach because there is no real come-back on them for over-prescribing. You then have to take the responsibility over whether to go for an ablation or the higher level of drug use.

    I have found no statistics on strokes for Lone PAFers who follow a healthy lifestyle with no other comorbidities under age 70. One small scale research project on under 65 (I think it was) found there was a very low risk and not the much quoted x5 more likely to have a stroke which applies to the whole population of AFers some with a very high level of Comos.

    I personally use the threat of a stroke without 'full medication' as a lever to change my lifestyle and diet to the best I can achieve - I tell myself it may not prevent a stroke but it could lessen the effects and the changes could stop me getting other illnesses.

  • Even with CHAD score 0 people with AF and not anticoagulated are still at slightly higher risk of stroke then those who are without AF. It is a gamble but the odds are in your favor so you can more focus on living your live and not wait for stroke to happen at any time. If your score 1 or higher then anticoagulants should be considered as some newer ones are safe to be taken for longer time.

  • Looks like a good idea - trouble is electronic records would be needed to -

    "The Intermountain Mortality Risk Score is based on lab values typically collected from a patient -- a complete blood count and basic metabolic profile -- which sync automatically to a patient's electronic medical record so physicians have the score readily available."

    Is that going to happen anytime soon with NHS - somehow I think not.

  • You have it right when you say Russian Roulette. We have had more than one member here on a score of 0 and no anticoagulation who quickly had a TIA or stroke. I have also observed that many doctors particularly GPs are frightened of anticoagulation and often reluctant to prescribe, especially if one of their patients had ever suffered a GI bleed. As always with AF one needs to become one's own expert and make one's own choices.

  • My husband had a 0 score and was as fit as a fiddle, hence no anticoagulant. He had two strokes within 10 days.

  • Sorry to hear that.

    It is a risk score though and although very unlikely that shows it is by no means absolutely certain

  • I believe that it is the uncertainty people struggle with and which is a large part of anxiety experienced with AR.

  • Did he have PAF, or permanent AF? Had he had an ablation?

  • Exactly, we have a condition with an uncertain course of which we are frequently reminded.

  • Risks are probabilistic, so we shouldn't make major decisions about taking tablets because we "know someone" who had a stroke. Stroke risk is never zero - children and teenagers get strokes too. It's more rational to base decisions about our medications on existing research.

    The 2010 European Guidelines for the Management of Atrial Fibrillation are based on research. That research shows that individuals below the age of 60 years with no CHAD2VAS2 risk factors (lone AF) have a stroke risk of 1.3% over 15 years (cumulative). That's ridiculously low, so anticoagulation is not formally indicated. But of course it's still not zero. Some in that category will suffer a stroke, just as there will be strokes among people without AF, among children, and among healthy teenagers.

    I understand many people are really fearful of stroke - and some prefer to take anticoagulation even though it is not indicated - as a safety net - they're not too concerned about bleeding risk. That's fine too - it's an individual decision.

    We can also reduce stroke risk with exercise, healthy diet, and avoiding stress.

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