Atrial fibrillation: medicines to help reduce your risk of a stroke – what are the options?

[Bazillion]

nice.org.uk/guidance/cg180/...

This guide from the UK government body NICE ( National Institute for Clinical Excellence )is 36 pages long and we should all be given a copy to read.it gives in depth information on choices weshould be given before making a decision.

These bodies cost a lot of money and are there for our benefit. Drs May be the experts but we ultimately have to be given informed choices to make an informed decision NOT be told what is best for us

NICE guidelines give advice to healthcare professionals on the care and support that should be offered to people who use health and care services. You have the right to be involved in discussions and make informed decisions about your treatment and care with your healthcare team. You should be given relevant information that explains the options in a way you can understand. For more information see About care in the NHS on the NICE website.

About this decision aid

This information is intended to help you reach a decision about whether to take an anticoagulant to reduce your risk of stroke, and which one to take if you decide to do so. Your decision depends on several things that this decision aid will help explain. Different people will feel that some of these things are more important to them than others, so it’s important that you make a decision that is right for you personally.

You may have just been diagnosed with atrial fibrillation (AF for short) or may be considering changing anticoagulant treatment. This decision aid is designed for you to work through with the healthcare professional who is helping you make this decision. You might also find it helpful if you want to talk your decision over with your family or friends.

The information is based on the recommendations on anticoagulants in NICE’s guideline on atrial fibrillation. The guideline covers all the care and treatment that you can expect, and is explained in our information for the public about the guideline.

The above link is to the advise guidelines for patients with AF on anti coagulation. All patients are meant to be given this information but very few are. It’s only because my wife is a retired nurse and keeps up to date on these things.

[BobD Volunteer]

I reviewed these documents when they were in the early stages of development and frankly lost the will to live about half way through. The charts and statistics were in my view confusing and overly complex and while I have not seen a copy since I do recall that it did try to balance Chadsavasc against HASBLED which I think is slightly confusing. HASBLED was described to me by one who helped prepare it as an aide memoir of things to address before considering anticoagulation rather than a directly comparable scoring system for example .

Whichever way you play it UK is one of the worst counties in Europe for having at risk patients anticoagulated and we could prevent a lot more strokes if this was changed.

[Finvola]

In an ideal world, perhaps Bazillion. When I was diagnosed with AF and advised to take Apixaban, had I been presented with a 36 page document to read, never mind understand, I would have flipped completely.

Even now, four years on, I find the data on anticoagulation to be a cumbersome read and my choice would always be to take the advice of a trusted expert.

I don’t want to take anticoagulants but I want a stroke even less.

[Hidden in reply to Finvola]

IMO, and for me, reading these posts and learning from others' experiences gives me well-rounded guidance for knowing what's important to ask my caregivers and ultimately discussing with my doc what will be best for me. Guidelines are often necessary. But, in my opinion, at least here in the US Healthcare system there is, along with info, the sneaky agenda of how to cover one's professional A** in order to avoid the US legal system.! Just my opinion. irina1975

[sugaredalmonds in reply to Finvola]

I have just been looking on here for someone who is taking Apixaban as I was switched to it yesterday from Aspirin after a visit to A&E with a quite frankly terrifying esiposde of af!

I had been on aspirin since I was first diagnosed just after my sixtieth birthday (now sixty six).

The cardiologist said if I were a member of his family it’s what he would advise.

I too of course am fearful that a stroke may happen, & I know to many this probably sounds pathetic & stupid, but I am also equally as fearful of all of the medication!

Have been since day one & it has never become any easier!!

So, if you or anyone reading this has anything positive to say about this particular med I would be pleased to hear it, but please people nothing negative or frightening as my imagination can do well enough with that.😉

Thanks

[Finvola in reply to sugaredalmonds]

Hello sugaredalmonds. When I was prescribed Apixaban my cardiologist said it was his preferred anticoagulant as it had the lowest bleed factor.

As it is a twice daily dose, its half life is about 12 to 14 hours, which I prefer to a once daily drug.

In over four years taking it, I’ve had no side effects that I am aware of and the only testing needed is an annual kidney/liver function test which I had to arrange with my GP.

You have reached the magic age of 65 when anticoagulation is probably advisable - as you probably know, aspirin is not recommended as an anticoagulant for AF.

I fretted about taking it at first, but then thought ‘others can manage, why not me’. Best wishes with it, safe in the knowledge that your stroke risk is addressed.

[sugaredalmonds in reply to Finvola]

Hi Finvola

Thank you for responding so soon 😊 & your positive comments.

They have presciped me two tablets twice a day, is that what you take or is it one twice a day?

[Finvola in reply to sugaredalmonds]

I take one 5mg tablet twice a day which is the usual dose. Under certain conditions - eg over 80 years of age and/or impaired renal function and/or low body weight, the doseage is halved to one 2.5mg tablet twice a day.

Have you been prescribed two 5mg tablets twice a day?

[sugaredalmonds in reply to Finvola]

It says on the box apixaban 2.5mg tablets, take two twice a day

[Finvola in reply to sugaredalmonds]

That’s the usual dose of 10mg daily, then. 🙂

[sugaredalmonds in reply to Finvola]

Thank you so much for helping to ease my mind, it is much appreciated 😊

I will have a follow up hopefully tomorrow with my go & then over the following weeks appointments at the hospital, all the usual stuff.

[jeanjeannie50]

Interesting, thank you for posting.

Jean

[Bagrat]

It is a similar format to the NICE decision making guidance for statins but for some reason the statins guidance is for the risk over TEN years I (being a cynic) feel this may be because the annual risk reduction for an individual taking statins is very small whereas with anticoagulation it is not. Interesting read for a wet day,

[MarinaT]

My brother in law had a massive stroke last December. He was in a coma for 10 days and is still in hospital now unable to walk or perform simple personal tasks. He is only 63 and faces the rest of his life in a nursing home. The cause? Undiagnosed af. I will certainly be forever grateful for my cardiologist' advice to take Apixaban.

[Finvola in reply to MarinaT]

How dreadful for your brother in law and the whole family, Marina. We are indeed fortunate to have been diagnosed and prescribed anticoagulation.

[Hidden in reply to MarinaT]

Hi Marina, I'm truly sorry your brother-in-law's AF journey has gone in this direction. So hard not only for him but for you and the rest of the family. Best wishes. And hoping there will be some surprising good outcomes the docs can't yet see. Take care. irina1975.

[Bagrat in reply to MarinaT]

So sorry to hear of this life changing event you all have to bear. Indeed we are very fortunate

[brit1]

I was put on Eliquis last summer due to several AF episodes (prior only had them every couple years). I am not comfortable taking 5mg 2xday so I take 5mg at night and 2 1/2mg in the morning as I take fish oil/CoQ10 every morning. I am 80 this year but weigh 148lbs and have no kidney issues so cardio said I should take 5mg twice a day so hopefully taking half in the morning won't be an issue.