An unusually tangible post from me - to anticoagulate or not, that is the question

[Mejulie69]

My cardiologist has just written to me stating that, as I am getting unpleasant side effects from Apixaban, I should stop taking it. My CHADS VASC score is 0, and the only reason he told me to keep taking it was in preparation for cardioversion or ablation, but as the NHS waiting list is much longer than 4 weeks, I have no need to anticoagulate for the time being.

I am currently in NSR and have stopped taking Apixaban, but I think when I go back into AF I will start taking it again, purely on the logic that not taking it will feed my anxiety. It's a sort of psychological placebo, if that makes sense.

I have been watching videos of the brilliant Dr Gupta, and I'm sure he has a strong opinion on the subject, but I can't remember what he said. Will have another watch now.

[BobD Volunteer]

I think it fair to say that with a chadsvasc score of 0 you are at little risk. Dr Gupta always said it is not the AF that causes the risk but the company it keeps. If you were only on anticoagulation for the purpose of the ablation or DCCV then this makes sense. The only caveat being that if a cancellation became available you would not be properly prepared and unable to proceed.

I must point out that your stroke risk is not dependent on being in AF or even how long for. You have AF therefore there is a risk so your premise in para 2 sadly is flawed I'm afraid. With that score of 0 your risk as said already is low regardless of being in AF or not.

[Mejulie69 in reply to BobD]

Interesting. So why am I at the same risk of having a stroke when in NSR as in AF? It is AF that causes the blood clot, right? So I don't follow this logic :S

[BobD Volunteer in reply to Mejulie69]

It is a long story but basically my understanding is that AF changes the internal surface of the atria which could allow eddy currents which in turn can allow clots to form. These can then hide in the LAA (left atrial appendage ) and pop out whenever they feel like it but quite often when going into NSR.

As stated, it is not just the AF which creates the stroke risk so with no other co morbidities that risk is very low. Everybody is at risk of stroke regardless of AF or not.It is a fact of life. It is just the percentage which changes. Not everybody who has a stroke has AF but what is true is the those that do generally have the least satisfactory outcome. The last figures I read were that AF related strokes are about 20% of all yet 80% of the least recoverable.

Like all things it is a judgement call at the end of the day and as John -Boy below found out it is never 100% correct.

On balance it seems it has been decided that the risk of complications from taking the anticoagulant exceeds the current need for protection.

[Hidden]

As I've posted before, my CHADVASC was 1 as I was 68 and, an EP had told me that I shouldn't take an anticoagulant because of a bleed risk. My total cholesterol was 3.8 and my body fat was under 10% from hard work in the gym. I was relaxed and in NSR when I had a stroke that has left me partially sighted. I wish that I could turn back time and take an anticoagulant before the stroke.

[doodle68]

MeJulie you say ...

Quote ''Interesting. So why am I at the same risk of having a stroke when in NSR as in AF? It is AF that causes the blood clot, right? So I don't follow this logic ''

MJ As I understand it you are not at high risk when in NSR , the problem is that many of us with AF go in and out of NSR sometimes without being aware of it and that is when we are at greatest risk because are hearts are not pumping efficiently allowing blood to pool and stagnate with the possibility of clot formation.

IF I didn't know better I could be in permanent NSR at the moment because I am not aware of having episodes of AF Since I received medication in June which brought the horrible symptoms I had been experiencing under controlled. However I am still having episodes of AF, I can pick them up in my pulse ,on my BP monitor and I feel slightly breathless at times . So regardless of not having many symptoms, with a CV score of 2+ I remain at risk of a stroke without anticoagulation .

I have a degree of security knowing I am on an anticoagulant and it has stopped me getting into a panic at the slightest hint of AF which made the condition worse .

As your CV score is 0 maybe not taking anticoagulants isn't such a problem for you and a decision only you can take .

[Paper65]

Hi, I saw my EP for the first time whe. I had an episode of 24 hr AF. A and E had started anticoagulation and me EP advised me to stop taking it until 4 weeks before my ablation. I continued taking the anticoagulation medication for 8 weeks post ablation and have one been advised to stop taking it. He said that as I had the risk of a bleed was higher than the risk of a stroke. My GP on the other hand is of the view I should take it for the rest of my life...... When I told my EP this he said that psychologically I may feel safer on AC medication but he felt the risk was too high. It is an awful choice to make , essentially which do you feel you are at higher risk from.......I've stopped the AC.