don’t pass on the drugs once your AF is “resolved” - an interesting study result

medicalxpress.com/news/2018...

EDITED to point to the full BMJ paper - bmj.com/content/361/bmj.k1717

[BobD Volunteer]

This study applies specifically to continuing anticoagulants for life and as I have been saying for ever there is no proof that successful ablation removes the stroke risk. This study appears to back me up thank you. (Smug so and so.)

[Hidden in reply to BobD]

I think many cardiologists would agree with the study results, but it seems that there is now some solid proof that they can now base their feelings on. my consultant summed up my continuing use of apixiban as "you're safe from any further stroke while you keep taking it".

[secondtry in reply to Hidden]

Mmmmm my initial reaction to the article is not the same i.e. pro ACs

Firstly, no sample size mentioned, no serious bleed data for those on ACs or who commissioned the research?

Also, strokes 'nearly as common as with the ongoing atrial fibrillation group'; surely that is good news for the AF resolved group as on ACs the amount of strokes in the OAF group will be substantially reduced and yet they are still doing worse than the 'unprotected' group without ACs.

Lastly, I think anybody who is on ACs and doing well is best to stay there, the rest of us need to take an individual opinion hopefully based on the best research we can find.

[Hidden in reply to secondtry]

"Firstly, no sample size mentioned"

from the BMJ papaer - Adults aged 18 years or more with no previous stroke or TIA: 11 159 with resolved atrial fibrillation, 15 059 controls with atrial fibrillation, and 22 266 controls without atrial fibrillation.

full paper here - bmj.com/content/361/bmj.k1717

[secondtry in reply to Hidden]

Oops I didn't read the full paper, those numbers look statistically relevant.

[Corazona in reply to secondtry]

“Also, strokes 'nearly as common as with the ongoing atrial fibrillation group'; surely that is good news for the AF resolved group as on ACs the amount of strokes in the OAF group will be substantially reduced and yet they are still doing worse than the 'unprotected' group without ACs.”

Sort of. This is my understanding of the study. Yes, RAF & OAF have almost same risk of stroke; problem is that if GP coded AF patients as RAF (which they did with 10.5% of AF patients) they may have discontinued ACs as well - RAF patients 20% less likely than OAF to be prescribed ACs. The paper is saying get rid of the stupid RAF code (it’s only there to financially incentivise GPs anyway!!) and prescribe ACs for all AF according to risk.

I fit the RAF code (although I don’t know if my GP has coded me as such), I have a risk score of 1, and I am currently not prescribed ACs. This paper makes me want to have an AC discussion with my GP and cardiologist.

[Buffafly in reply to BobD]

I think you are preparing a leaflet for doctors about the effect of AF on patients' lives, but I think a companion leaflet, 'Ladybird guide to AF for GPs' (see my post below) as even young GPs seem woefully ignorant, had three in a row with little knowledge, would be equally needed.

[wilsond in reply to Buffafly]

Hear hear! I have the same experience with my 2 GPs! The GmC should know how poor their knowledge is in this area.I know they have to know a bit about everything,but as AF is increasingly common,this is not good!

[irene75359]

I don't need persuading to continue with anticoagulants (should I ever have my AF 'resolved') but what amazes me is that so many former AF sufferers stop; aren't they advised to carry on by their EP? A GP in the excellent practice I attend said my prescription for warfarin should be reviewed as I had not had an episode for some time and to continue was a bit 'belt and braces'. Thank goodness for this site!

[Buffafly in reply to irene75359]

I saw a GP recently about my returning AF and he (the same who advised aspirin as an anticoagulant) said 'there is a question about whether you should be on an anticoagulant'. I pointed out that I was already, not adding why, but as my father in law was fond of saying 'God forgive me what I was thinking'.

[wilsond in reply to Buffafly]

I usually say it!

[dmac4646 in reply to irene75359]

you have just answered the ? why do they stop - in many cases because thats what GPs recommend

[Hidden]

I had the copy letter today sent by my cardiologist to my GP after my last check up. in it he says "He is aware he should continue anticoagulation indefinitely". well, that's pretty much definitive then!