EP took me off medications with no anticoagulants

[Slattery]

I have been taking Diltiazem for one year, my new EP doctor took me off this medication and told me I should start taking anticoagulants when I reach 75. I an 69 years old female , in good health other than Afib. My doctors believes that anticoagulants are over prescribed for a lot of Afib patients. This EP doctor is consider one of the top IR doctors in Seattle Wa. I would like to hear your opinions in this mater of anticoagulants and when to start taking them

[Jollies]

I am 55 and have been diagnosed with af for about 4 years. I was put on warfarin straightaway and last year changed to Noacs. I have tried different medication to help control af, but one thing I will not do is come of my anticoagulants.

[Hidden]

Hello Slattery, I see you have been involved with the forum for well over a year now, so I am sure you are aware about the importance of anticoagulation with AF. Given the information you have provided, I guess you score at least two on the CHADs, but for many people, that is enough for them to want to play it safe. Things may be different in the States, but the consequences of having a stroke will be the same! As you know, we are not medically trained, but in my case, I have just had my 12 month review and I only score 1, but it was mutually agreed that I should keep on the Apixaban. From my experience, this is generally the thinking in the UK......hope this helps, John

[Rellim296]

I'm a good deal more in favour of anticoagulation now I'm 70 than I was four years ago when it was first suggested to me.

I think a seriously debilitating stroke would be a fate worse than death and if preventing it puts one at risk of a fatal bleed then I'd prefer the swift exit.

[Clareowenpearcy in reply to Rellim296]

My EP recommended blood thinners at age 65yrs. Female on no other meds, no other ailments, low BP. 3 Ablations. 65yrs is the trigger for anticoagulants in his point of view.

[Redhead1949 in reply to Rellim296]

I'm 68, and I'm with you. The 'swift exit'!

[Slattery]

My doctor is using the ATRIA scoring system which is different than the CHAD system. We are all different when it comes to Afib, one size does not fit all. Thank you for your imput.

[Thomas45 in reply to Slattery]

I have no medical training but I understood that the ATRIA score is for the likelihood of bleeds if on Warfarin, cha2ds2vasc score being more about reducing strokes by using anticoagulents. For ATRIA see mdcalc.com/atria-bleeding-r...

My cha2ds2vasc score is 2 (male aged 72, with history of hypertension), so I should be and am happily anti-coagulated on Warfarin, while my bleed score (ATRIA) is 1, which as it's less than 4 is deemed to be at low risk of a bleed on Warfarin. The research pre-dates most of the NOACS, I think. see ncbi.nlm.nih.gov/pubmed/217...

[Slattery in reply to Thomas45]

Thomas,

There are two ATRIA scoring methods , one for stroke risk and the other for bleeding risk. Look up Atria for stroke rick on the internet.

[MarkS in reply to Slattery]

The ATRIA scoring system gives a very high score to previous stroke or TIA. So of course it's going to come out well in the comparison to CHADS2VASC if you're just calculating the chances of the next stroke. However the key is to predict who will get their first stroke before it actually happens - that's where the CHADS2VASC system works better.

Personally, I don't think there's any question - you should be on an anti-coagulant, and I would suggest now, not just when you reach 75.

[Elaine1951]

I suspect he's right. I guess it's all about managing risks. Risks taking risks not taking. No real answrr

[CDreamer]

Having been a member for about 4 years now it seems clear to me that advice differs quite considerably both sides of the pond. I haven't looked recently but a year or so ago the US version of the AFA site was still advising aspirin for stroke prevention whilst the U.K. we're saying it was useless to prevent AF induced stroke.

I think the class actions for bleeds in the early days of NOACs and the the lack of bleed risk assessment could possibly have influenced opinion?

Any drug therapy, especially anticoagulants will always be a risk:benefit assessment. In the U.K. Current opinion from specialists is that if you score more than 2 on the CHADS score system and 0 on HASBLED risk (neither of which are infallible) then you should take anti coagulants.

As female you score 1 and as over 65 you score 2, without any other contributing factors such as lifestyle factors or other illness. As you can see from the answers below, most of us would be on anti-coagulants for life.

I had a break from them for a couple of years as my AF was treated with ablation and I ceased to have episodes but when my 65th birthday came I was strongly advised to go back on them and when AF episodes returned, my doctors strongly advised going back on them, which I have done.

Hope that helps.

[Jans5]

I think we need to remember that as new research is coming to light that recommendations and treatment ideas will change. I'm aware that some of the more recent research regarding stroke risk and lone afib does not correlate with what was thought say 10 years ago, also the mechanism by which a clot is formed is now thought to be more complicated than the theory as it is not supported by recent research. It may well be that EPs will take these latest results into account in the future as they should. It should be remembered that anticoagulation increases the risk of strokes due to bleeding in the brain which according to the stroke association are the worst kind of stroke and these types of strokes are in the increase in the UK. The attempt of the Chad's score is to identify when the risk of one outweighs the risk of the other. To my mind then I will not be taking anticoagulants until then to reduce my risk of stroke.

[Slattery in reply to Jans5]

Jans5,

My EP told me there is a major study going on right now on Lone Afib and anticoagulants in the US that will be out for public review in 2018. The research is getting better each year.

[Jans5 in reply to Slattery]

That's good news at least then I'll be able to make a more informed decision about whether or when to take anticoagulants.

[Hardjuice]

Interesting my EP thinks the same as yours

And has done for almost 4 years