Here is the scenario. Have had four cases of AF in last few months one month sort, then a few weeks to a few days apart.
Cardio suggests increasing flecaninde to 100 mg morning and 200 night.
We discussed blood thinners - he said maybe we should consider using them because I have had quite a few episodes lately. I was quite resistant as my chads vads is 0, heart is fine other than AF.
Of course I get the risk of stroke (and with 2 kids I want to be there), but also I see a lot is said re risks of bleeding, whether gastro or other.
We discussed Noacs, and I also asked him about antidote etc.
Any thoughts guidance etc or pointers to other posts appreciated.
It's all a changing situation
Thanks all
A
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Andyt36
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I think anticoagulation sounds quite worrying and all the possibilities fan one's fears and it can seem a big thing. In reality, I think most of us are full of trepidation when it gets suggested and soon settle in to the situation and find it is far less worrying in practice than it seemed at first. It gets ever more relevant as we age year by year..
Perhaps ignore the antidote red herring - anticoagulation antidotes are not swift to step in and other things can be used to save the day instead. We are all at risk of a fatal bleed if the injury is bad enough and it has always been so but we have never given it much thought before when we were normal because not so many people actually come to an end in that way.
The thought of taking anticoagulants worried me slightly at first but after 4 years of Apixaban, I am more concerned with the effects of a stroke than the possibility of a bleed, but my CHADs score is 2.
If your cardiologist is advising AC’s then seriously consider taking them. You can reconsider your decision if necessary.
This link gives good info on risks - HASBLED score is useful too.
It's difficult as 47 is relatively young. The problem is we often hear from younger people on the site who have had strokes or TIAs in some cases. Some of the NOACS are not suitable if you have any history of gastrointestinal bleeding so it's best to look carefully at each one.
You don't say how long you are in AF for- ( but strokes have been known after 6 minutes of AF ) but obviously timing will come into your decision.
If the cardiologist is suggesting it I would consider it carefully. A minor bleed is much easier to deal with than a stroke. Contact sports are not too good when AC so your lifestyle also comes into the decision.
No, 48 hours is the cut off time for cardioversion- for first episodes when people are not AC . After that they AC for period of time and then cardiovert the person. I think the 16 hour episodes may be why your cardiologist is suggesting AC but it may be other things in your medical history. We have a patient support group in Epsom and several consultant speakers have said one can have a clot forming after just minutes of AF. Another interesting point is that I heard a speaker at the Europe AF conference discussing AC and he said they had found lots of micro emboli in the brains of people with AF so it might be an argument for AC younger people with AF. There is nothing definite about tis yet but it may be worth thinking about.
I have had AF for years but was kept under control until august this year i was experiencing breathless episodes a lot since july & doc put it down to anxiety/panic disorder. Got worse & almost passing out 1 morning the doc sent me in for tests & my heart was racing although i couldnt feel it fast i had heartburn symptoms for 2 full days that i couldnt get rid of & tirns out it was coming from my heart! I was given a ct scan after a blood test for clots was positive & it showed lots of clots in my lungs!! Was put on an ac straight away & digoxin at triple rate for 3 days. I too was & still am worried about my rivaroxaban as i know warfarin has an antidote but my doc says that they do have ways of helping if that ever occured & rivaroxaban is deemed the safest of the 2 & no need for checks all the time. My thinking now is i could have had a bigger clot that could have produced a stroke or heart attack so i am very lucky as i was never put on ac until they were diagnosed. Hope this helps as it is hard to make a decision.
Only 2 since november & not as bad as before flecanide but had quite a few before that, had dizziness & breathlessness with it but being on blood thinners since blood clots diagnosed has been better as now i know ive a lot less chance of stroke etc. They should have had me on them before that though & i wouldnt have got the clots.
Stroke risk has nothing to do with the time or frequency of AF events. You have AF therefore you have a stroke risk five times that of non AF people. That said as has been said before it is not the AF that is the problem it is the company it keeps which is why we use CHADSVASC which is not foolproof.
Several of our members of similar age have been told that anticoagulants were not needed but then had strokes .
Reversal agents (they are not antidotes) are a red herring as has been said as the half life of NOACs is short and in any case unless you have an arm or leg torn off by a train or something normal first aid is enough to stop bleeding.
To sum up I paraphrase Dr Fey at last years patients day. " We can always give people blood transfusions but we can't undo a stroke. "
You pays your money and you makes your choice as my old boss used to say. The only right answer is what is right for you but don't look back.
If your gums ever bleed then you have gum disease which needs proper attention. That is a fact. 60 + years of NHS dentistry which never addresses such matters did for me and I now struggle with three monthly hygienists appointments trying to retain what few teeth I still have and yes mine bleed on warfarin sometimes. Off for a deep root scrape this morning actually. Deep joy!
I'm a similar age to you and was also worried about NOAC's not being reversible , but as Bob points out that is a red herring, it can take hours to reverse warfarin anyway and the half life of NOACS is pretty short, plus if you are bleeding a lot they will pump you full of platelets / blood anyway.
As for the bleeding when on them, I never bled from gums and as I do quite a bit of diy on the house and cars I did cut myself a few times. With pressure on the wound I don't think I bled much more or much longer than I used to. So I really wouldn't worry about that.
Now I am in NSR following my ablation (9 months) I am off the anti coags, it's my choice and I know the risks, but I did have a few other reactions to taking them, mainly gastric issues. If I go back in to AF I will be reaching for the edoxaban though. (My EP said that in my shoes he would do the same)
Just a point about bleeding Andy - anticoagulants make clotting take about twice as long, it’s what they are supposed to do. I get frequent nosebleeds and always pinch for 20 to 30 minutes, instead of the normal 10 to 15. Minor cuts ooze for a bit longer but it’s nothing to worry about. All that AC’s do is slow the clotting process, they don’t stop it completely.
Yes I am on Pradaxa and it is a good blood thinner and I honestly never worry about bleeding......if I get a cut it is no different than before.....I would say it is honestly a non issue
Hi Andy. I was really worried about taking Apixaban but because of age, high blood pressure, etc, I had no choice. However, I have had very few issues. I go to the gym regularly and notice I bruise more easily but minor cuts, nose bleeds, etc, have not been a problem and have stopped without medical intervention. I've been taking Apixaban for a year now and have had no side effects.
Hi Andy, I certainly am not going to try to persuade you one way or the other, just balance up the advice here. I have read it is the other co-morbidities that you may have (hence your medical advice) that you need to take more into account re stroke risk. Also on the internet 'The AFIB report, Natural approaches to stroke prevention' lists a variety of Vitamins plus fish oil, exercise etc. In addition, I would say you need to be stable without periodic AF episodes.
I myself am male, 64, on Flecainide with no AF for 4 years and my cardio says even when I reach 65 (CHADS score 1) it is not a definite anti-coag start. I use quite a bit of good quality olive oil in my diet and plenty of water, as well as low sugar & gluten plus best locally sourced organic food prepared from scratch. I have a sneaking suspicion that if there were stats of people your age with no comorbids and good lifestyle/diet the increased risk of stroke would be marginal. Lastly, I don't think the anti-coags come with just a 'bleed risk' after all they are tampering with a sophisticated machine and some researchers think there are other risks.
I have had canine root removed and have eye injections at moorfields and stay on Apixaban and no bleeding . Bleeding risk may increase with age and change in renal function but even then dose is reduced to counter this.
Whilst I disagree with Bob over his comment that timing is immaterial( may be more true in older people who have more co morbidities that favour stroke) I whole heartedly agree with his point about fixing a bleed versus reversing a stroke. However you have a difficult decision to make because of your age- just research as much as possible so you make an informed choice. Hope all goes well
P s one further point is that often, not always, the clot forms in the atrial appendage and when the heart suddenly goes back into sinus rhythm this can be pushed out and round the circulation- so I think it is relevant to consider how often this occurs. Have another talk to your cardiologist and get his thinking on why he is suggesting AC
I am 44 with a CHADs score of 0 so was told I didn’t need any anticoagulants by my EP. I guess ultimately we have to listen to the advice of the professionals and then make an informed decision that is relevant to us as an individual; it’s not easy.
I am 49 and also had a perfectly healthy heart other than the AF and Flutter. I wound up taking Xarelto for 4 weeks before my first ablation in October, and continued them 8 weeks past my second one in November. I was terrified as well at first, but to be honest I never even realized anything different taking then the whole time. I was just given the okay by my EP to stop them January 2nd, as the second ablation seems to have stopped both issues completely so far.
In my mind, the biggest risk from a 'bleed' is not uncontrolled bleeding resulting in bleeding out, but a bleed within the skull due to an impact. When on AC, this could be more damaging or even fatal due to the increased pressure within the skull impinging on the brain. This is more likely with older people, as your brain shrinks with age and this stretches the blood vessels which connect the brain to the lining of the skull, making them more susceptible to damage. Younger people like the OP are more likely to have such a concussion, but less likely to suffer the bleed from it.
At my age of 68, this is a real concern, but then so is stroke risk. I'm happy to use Apixaban and take more care to not have a knock on the head. I'm also happier to risk death in a severe accident, rather than a stroke out of the blue which leaves one useless or worse. Your view may be different.
During my initial consultation at the AC clinic I happened to ask a question about reversal (only really out of interest). The AC nurse just put me on Pradaxa (dabigatran). She said 'it's not normally prescribed because it's expensive but it has an antidote and you expressed a concern about reversal'.
If you're really worried it might be worth expressing your concern about reversal....
I used to worry about reversal with the new anticoagulants until whilst on warfarin, I had to have My INR quickly reversed to normal by a vitimin k injection. This was to stop a potentially life threatening bleed. It took 12 hours to reduce my INR from 2.3 to 2, so not exactly a quick fix! Now I take apixaban which has a short half life so as soon as the next dose is missed I will be less anticoagulated. X
I'm on Apixaban and have been for 4 years. Last Septeember, I had a major, life-threatening thoracic bleed (the reason was not related to the AC) but I'm still here and I don't think the treatment I received was significantly different to anyone else in a similar situation. Maybe I received more blood products to keep me stable but I am still here! Reversal doesn't seem to be as critical as one might imagine. I usually describe the effects as a life-threatening injury might be a bit more life-threatening.
I am a 54 yo male with constant Afib, just diagnosed in October 2017. I got checkded because my brother in law had a stroke and his wife told me he had Afib. I am diabetic and have high blood pressure (both well controlled). I wanted to take an AC but my cardiologist recommended against it. I made an appointment with an EP DR and he was perplexed as to why my cardiologist recommended not taking an AC. I have a CHAD score of 2. Needless to say I am on Eliquis and seem to have no problems from taking it.
My brother in law is 61 years old. He was worried about bleeds associated with taking an AC and he refused to take them. He had a massive stroke in September 2017 and has had many mini strokes since then. He is now in Hospice care and is a fraction of who he used to be. Unconscious, unresponsive, and fed by a tube. He had 3% chance to have some type of bleed. He had a 5X the rate of someone without Afib of having a stroke. Unfortunately, he played the odds and lost.
Trust me on this, if you saw my brother in law in the hospital bed as he is you would run to the DR and beg to be put on an AC. You can't look at this as you used to be without Afib. You have a major medical problem that must be treated or you may suffer severe consequences.
James thanks that is very sad and very lucky for you I guess. Well I am still reviewing and have an appointment with one EP at the end of the month so hope I will be ok till then.
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cheers 
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