AF Association

New 2017 European Afib Stroke Risk Guidline, No Gender Bias

Dr. Camm from St George’s Medical Center, London and one of the principal authors of the original CHA2DS2-VASc guidelines which automatically gave women with Afib one point on the Stroke Risk scale has changed his mind. In a new study the gender bias is reversed “gender is no longer an important consideration “

What are we to believe?

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Could you give us a little more information & background please?

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I heard this discussed at a conference in London where Prof Camm was giving updates in November ( amongst others). They used to add a point for women as after the menopause they don't have the hormonal protection that previously was there. I think it's very odd because surely it should mean that men should be given an extra point as they haven't had that protection at all???

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No wonder we get confused.

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Hi Slattery :-) I think we discussed this last year didn't we....

The deduction of one point from the CHADS 2 score for a woman does make a significant difference to a decision which is difficult to make in the first place.

The decision about taking AC is usually based on the advice of a consultant with the onus on the patient to make the final decision. I felt I was 'damned if I did and damned if I didn't ' where making a choice on anticoagulation was concerned.

I guess this new pronouncement may be taken into consideration in future when advice is given.

For people like myself who were advised to take ACs and did so before this new pronouncement was made , it would be difficult to change that decision now and I am not sure I want to because I feel right or wrong AC's provide a level of protection and peace of mind.

Unless more research is undertaken I don't think we will know for sure what course of action is the best with regard to starting AC.

I am not going to worry about a decision I can't change :-)

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And it may only mean men should have an extra point so we are all treated the same!

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.....Further to my post above, one thing I have considered is we have been told about the possibility of blood pooling in the hearts of AF patients as mentioned here in the Apixaban information for patients...

''The main risk associated with AF is stroke. As the blood is not being properly pumped away from the heart, it may collect or ‘pool’ and a clot could develop in the heart. If the clot leaves the heart and enters the small blood vessels of the brain, the flow of blood may block and result in a stroke.''

''https://www.eliquis.co.uk/patient/atrial-fibrillation/complications

Note there is no mention of comorbidities there, so if people with AF have an increased risk of having an ischemic stroke by the very fact they have AF before the CHADS 2 calculation is applied (which just introduces addition comorbidities increase the risk further ) surely the logical thing to do is to take anticoagulants if you have AF regardless of the CHADS score .

Shhhhh ....don't anyone mention HASBLED ,that just adds to the confusion :-)

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" surely the logical thing to do..." – NO! with a CHA₂DS₂-VASc score of 0 the risk from anticoagulaton (about 1% per year) is about 2½ times higher than without.

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Hasbled scores vary with the individual

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The 1% annual risk is with a Hasbled score of 0. If higher the risks from anticoagulation are even worse.

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Believe the evidence!

If new evidence shows no gender influence (and it was always slightly doubtful) then work with that. John Camm would not change his view without very good data.

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I live in uk an USA during the year. I have paroxysmal afib,couple of attacks in 3 years. Am female,under 65. Cardiologists in both countries,independently,have recommended that I take apixiban if an episode lasts more than 2 hours,continue until they stop,then take one additional tablet. Discontinue

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Hi Lindaj :-) that is interesting and very different from the way Aixaban is prescribed here for AF . For many once prescribed it is taken twice a day every day possibly for life.

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The first time this was prescribed for me in this way was by a cardiologist in the uk

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