Pip and anticoagulant

[Batbara]

im a little confused. If one has occasional afib, and uses pill in pocket, why would they need to be on a anticoagulant all the time? Why not just take a xarelto at the same time you take the pill in pocket. I have read the anticoagulant work within 24 hrs, so why stay on them 24 7?

[jennydog]

Why would you not want to take the anticoagulate all the time? The stroke prevention figure is apparently 60% and clots have the potential to form at anytime, regardless. I do not necessarily know when my heart is fibrillating. I don't know what is happening when I am asleep. I once had a 7 day monitor fitted and it showed a 36 hrs episode that I knew nothing about.

[Slattery]

You should asked your doctor this question. I have Afib with no other medical problems, I am 70 years old , eat healthy, exercise each day . I take no anticoagulants or any medication at this time. My doctor told me I should start taking anticoagulants when I am 75. I live in the US, where doctors do not believe that everyone who has Afib should be taking anticoagulants. Do more research, you may want a second opinion. I wish you good health.

[Batbara in reply to Slattery]

Yes I plan on asking that question. As for my afib, I feel it immediately and for the duration. I am extremely aware of its presence. When it comes and when it goes, I see there are quite a few people here that are not even aware when they have it,so in that instance I would not want to take the chance.

[rosyG in reply to Batbara]

The problem is that when devices are implanted it's seen that sometimes people are very aware and recode it and other times they miss it- however, it doesn't make much difference as AC take a couple of hours to work and a stroke can come in 6 minutes

[teach2learn in reply to Slattery]

My general/trauma surgeon son in law believes, from what he has experienced, that the elderly, over 85, should not be on anticoagulant at all because of the much higher likelihood of dying as the result of a fall (brain bleed) than from stroke. Just a thought.

[Dodie117 in reply to teach2learn]

On a personal level, when (if) I reach 85 I would prefer die quickly of a bleed than be in a long coma due to stroke. Indeed at 68 that is also my preference.

[teach2learn in reply to Dodie117]

Well, there's a thought!

[Hennerton]

I remember seeing a post on this about a year ago. ( I think ) There was definitely a move to trial the idea for patients with paroxysmal AF and no other health issues. Try googling or look up pinned posts on this site.

[BobD Volunteer]

Here in UK we know that we can save at least 8000 strokes a year if we can get more at risk patients on anticoagulation. If you want to play Russian Roulette then that is your affair but do it from a position of knowledge not fear. Many people have silent AF events of which they are ignorant which is why if anticoagulation is required (suitable CHADSVASC score) then it should be seriously considered full time.

Agreed the advent of faster acting DOAC's such as Xarelto have clouded the waters but to me at any rate second guessing and using such as PIP is a bit like riding a motor bike with a crash helmet in your side box in case you fall off. Wear it full time!

[rosyG]

One consultant cardiologist, when addressing our support group, said clots can form within 6 minutes of AF- it takes two to three hours for some of the NOACS to work....

[teach2learn in reply to rosyG]

Hmm, I'll have to check that one with my EP next month. He told me the clots formed in the area of the heart because of AF take 24 hours to form. Of course, strokes are caused by many things, not just af.

[rosyG in reply to teach2learn]

do check it out- people have different opinions but I have heard this several times. One Stroke doctor showed scans of a small clot that had caused a stroke in the brain and the patient had missed just one dose of a twice a day NOAC - if you think of how blood clots form after a cut then 24 hours seems a very long time!! I believe there is a point about the length of time if takes to be dislodged so check that out too as may be connected to his reply.

Whilst strokes are caused by many factors, AF strokes are about a 1/3 of all strokes and are the most debilitating. It is scary but we need to know in order to make informed decisions about AC

[Alan_G in reply to rosyG]

Find that hard to believe as my understanding is if you miss one dose there is still enough in your body to carry you through to the next dose.

[rosyG in reply to Alan_G]

there is still some left in your body but the reduced levels may mean clots form more easily- not worth the risk really

[Alan_G in reply to rosyG]

I would never do it deliberately (so not take the risk), but occasionally I forget to take one of my 2 apixabans during the day. I always find it worrying when I have to go for a procedure in hospital and then come off my apixaban for a few days. That was the case this week when I had to have a colonoscopy. It meant 4 days off coags and would you believe I had an a/f episode the day before I was meant to start them again. I decided to take the risk and go back on to them early seeing as I'd had no rectum bleeds after the procedure.

[rosyG in reply to Alan_G]

yes that was very wise! I had a 4 hour AF episode while in intensive care post knee replacement surgery in 2020 and came to no harm!

[jwsonoma]

Even a few minutes of AF can cause a clot and anti coagulants take days to reduce clotting to a safe level.

I was lucky I only lost my ability to read for an hour and didn't know for over a year it was caused by rarely occurring AF.

Unfortunately aspirin is an anti platelet not anti coagulant.

If you go on Warfarin try to get a home tester it will really help keep you in a safe zone and give piece of mind.

[Mike11]

I had two heart attacks, the first of which was silent, followed by a quad heart bypass which in turn triggered AF which needed an ablation to fix after control by numerous drugs didn't work. Over these four years (2010 - 2013) I was never 100 percent healthy, and even now suffer occasional angina and other resultant pains.

If I had known the above in advance, and that I am not prone to bleeding in the brain which I accept some are, then I would have loved to have been on anti-coagulation which might have avoided or at least delayed the above.

And of course the results of a stroke can be even worse !

Why take a risk on any of the above to avoid the hassle of taking a pill each day ?

[secondtry]

I am male, 64 with Lone PAF and very healthy diet and daily exercise (nordic walking plus walking basketball today) and my cardiologist said it is not automatic that I should go on anti-coags at 65. Its equally about your personal situation, I think my stomach is a bit weak (non-enteric aspirin has called past issues) prone to a bleed in favour of postponing ACs , on the other side I have Factor V Leiden (genetic issue increasing clot risk) favouring Acs; I don't want to add more homework & tests to anybody's life but the latter is quite common(around 15% of people I think) and very relevant to AFers, that said my cardiologist didn't seem to consider it a key issue.

[rosyG in reply to secondtry]

Hi Secondtry

There are Acs ( e g Apixaban) which don't act on the stomach I would ask for an appointment with a consultant haematologist or another Cardiologist/EP to get a second opinion and balance of risk in view of your clotting problem- hope all goes well

[secondtry in reply to rosyG]

Great suggestion, thanks Rosy.

[Drounding]

My understanding is that if you have PAF you may not only be susceptible to clots forming in the heart during bouts of AF but also more prone to strokes per se. Anti-coagulation therefore is not only prescribed to reduce risks of clots due to AF, but also to reduce the general association of stroke risk to those that have PAF.

[Pugmom63]

Im a 54 year old female diagnosed with PAF two months ago. Cardioversion followed by 3 weeks Eliquis. I was thrilled when Dr took me off Eliquis. Decision was made as I’m overall healthy no other health conditions. I thought the same as you, why be on ACs for life? Wrong move! Two more Afib episodes after Cardioversion led to two TIAs. Now on Eliquis for life. I wish I had read up on importance of AC meds. Afib can definitely lead to TIAs and worse, debilitating strokes. My Afib seems to finally be in control with flecainide. My third medication attempt. Other two did nothing for me. If Afib rears ugly head in future ablation here I come.

[dmac4646]

My cardio is of the view that as soon as you have AF of any time anti coagulation needs to be considered in line with CHADS score - there is in his view never a time you can say there is no additional risk.

[Hidden]

Because you don’t always know when AF is going to appear, you could be sound asleep? Also because the anticoagulant action does not start immediately after you take it and taking, stoping and taking again the anticoagulant pill, can trigger a stroke by itself. It’s better to be on the safe side.