A few days ago during a discussion on the need for anticoagulants I commented that every fifteen minutes somebody in UK had an AF related stroke. Originally I wrote every fifteen seconds but my mental arithmetic told me that was too many so I changed it to minutes..
I have now found the original data from which I had drawn my comment and found I was still wrong.
EVERY FIFTEEN SECONDS SOMEBODY IN THE WORLD HAS AN AF RELATED STROKE.
Sorry for any confusion.
Bob
Uhm cheery.
Cheery indeed.........but are all those AF strokes occurring in people, that are NOT on an anti coagulant.........or may not even know they have AF at all....
I don't suppose there are any stats like that are there, Bob?
Bob, thank you and I hear what you say but I honestly find it difficult to believe that these statistics have actually been collated. Is there a central world wide register for registration every time someone has a stroke?
Apparently so according to the paper I have read based on world statistics..
Also many of these are people who were not protected either because they did not know they had AF or because they were not anticoagulated. Remember that anticoagulation does not remove stroke risk completely but it does return it to a more normal level by about 70%. You don't have to have AF to have a stroke of course.
Thank you. May I know the link to the paper you have read, please, Bob?
It seems it could be worse than that. According to the Stroke Association there's a stroke in the UK every 5 mins and one in the world every 2 secs. See:
stroke.org.uk/sites/default...
Scroll down to the "Key Stats".
Thank you Mark but are these AF related strokes?. General guide suggests that 20% of all strokes are AF related so that sort of works out OK. That 20% of course is known to be amongst 80% of the least recoverable.
whats even more terrifying is that many GPs are not prescribing anti-coagulants and even worse still using Asprin.
Two of my GPs (it's one of those practices where you see someone different every time you go) were reluctant to put me on anti-coagulants (at age 68 with new AF!). It wasn't until the EP ordered it that I started taking them, and then only after about 3 weeks delay. Is Apixaban (Eliquis) that expensive?
Cots of drug higher but less monitoring makes the case for the newer drugs at circa £800 pa.
Thanks dmack4646 . I suppose I can see this as a return on my years of paying taxes. I have troubled my doctors very little until this year.
That's very expensive compared with warfarin - annual cost £5 for drugs, £100 for monitoring strips, £50 for calibration checks, and just as good as the NOACs with modern monitoring
the Aristotle study would suggest the differences are minimal in both cost and effect.
I think the argument is that the cost to NHS of regular testing at hospital or health centre makes DOACS about equal. I agree that if like me you have a good record of compliance with Warfarin there is no need to move to DOACs but interestingly Prof John Camm recently stated that DOACs were safer and better than Warfarin. I'm happy on the big W but that may change as I get older.
The problem I have with Aristotle is that warfarin was set up to fail. The mean TTR was just 62% in the warfarin group. That's just not good enough. Aristotle was paid for by Bristol-Myers Squib, the makers of Apixaban, so there is an incentive to make sure it looks good in comparison to warfarin.
My point about warfarin testing is that a blood draw costs about £25. A self test on a Coaguchek costs about £2. For those unable to self-test, a nurse at the surgery could carry out a finger-prick test in about 2 minutes for a cost of around £4.
So if you want an NOAC to appear favourably against warfarin on a cost basis, you make the comparison against poorly controlled INR (so there are more strokes with warfarin) and against old fashioned blood draws (so it's more expensive).
If comparison is made against better controlled warfarin and finger prick devices, then suddenly warfarin is just as safe and effective as the NOACs as well as being much cheaper.
Whilst I agree in principle Mark I do wonder how they cost the phlebotomist at the health centre/surgery? Even using Coaguchek and a £4 strip I bet it works out nearer £20 or even possibly more. They have the computer system to maintain plus appointment staff all of which have to be amortised.
I'm very happy on my warfarin.---just trying to be balanced.
Hi Bob,
The £4 is my estimate of the cost. A full blood draw by a phlebotomist plus testing at a hospital centre costs around £25. However a finger prick by a nurse and a Coaguchek XS Plus (the professional version) takes about 2 minutes. So with an extra 3 mins to enter the results and advise on warfarin dosage, a nurse could treat 12 patients an hour at a cost of around £24 per hour or £2 per patient plus £2 for the strip, Assuming a test every 2 weeks that's £104 p.a.
Of course if you self-test then te cost is simply that of the test strip - about £2 to the NHS.
OK my calculations may be slightly out one way or another, but I think you get my drift. INR can be tested very cheaply nowadays.
I hope I'm being balanced - at least more so than the NOAC trials!
Cheers, Mark
I must be very cheap then Mark since I am usually on 8 week intervals. and out of the last 22 entries in my yellow book only four are slightly below 2. (1.8) I do adjust my dose myself , however , if there is a falling or rising trend.
For me it is a no brainer and my gift to NHS after the thousands they must have spent on me already.
NICE does support the use of both self testing and NOACs so IF your CCG is in line (many are not) then from the patients point of view it is cushty .
I agree re any drug trials.
I am one of those in the statistics! I had been on warfarin following my AF diagnosis, but was taken off after my second RF catheter ablation. I suffered a TIA a year ago, which thankfully has not left any long term problems, and am now on a NOAC (Pradaxa) and statin. If I had my time again, I would argue against being taken off warfarin in the first place, and would urge everyone else in that position to do the same!
AF and stroke 
Atypical stroke after many years of AF
AF, STROKE, HEART FAILURE 
AF or not AF
