I’ve recently been diagnosed with PAF and was initially prescribed a beta-blocker (Solatol) and the anticoagulant Dabigatran. After taking only three tablets of the latter I had a subconjunctival haemorrhage (the white part of the eye becomes incredibly bloodshot - it looks horrible but cleared up in a couple of weeks and is not dangerous according to my GP). However, this indicated a risk of bleeding which the GP said might happen again. I elected not to take an anticoagulant because of the risk. The GP said this was reasonable as my Chads2Vasc score is 1 which means that I am in the equivocal area for a stroke. The risk, he estimated, was about 1.3% per annum. Other medical staff expresses the view that I should be on an anticoagulant however. I would welcome any comments on this, and have a few questions. First, what is the risk of bleeding badly from taking an anticoagulant per annum? Secondly, is a good diet, regular exercise likely to reduce the risk significantly? My GP didn’t give a direct answer when I asked him this and basically just said “we all know people who eat the perfect diet and do exercise, yet they still get strokes”.
Paroxysmal Atrial Fibrillation without anti... - AF Association
Use of an anticoagulant seems to be 'standard procedure' and the 'other medical staff' may be simply following their usual process. Your GP, however, has gone through a logical thought process using the widely accepted CHADSVASc assessment. If you are anxious to reduce your stroke risk lower than 1.3% and if your GP agrees, then you could ask him if he could prescribe an alternative anticoagulant. However, all medicines come with warnings of side effects and potentially as-yet unknown risks. Some people prefer to minimise their intake of medicines for this reason.
For what it's worth, if it were me I would take your doctor's advice in this instance.
All drugs carry a balance of risk / benefit. One has to weigh up what one would rather see happen. With a CHADSVASC score of 1 you are marginal so maybe the bleeding risk is too great for you to accept. As things change then you may have to re adjust your ideas. I would be more concerned with sotalol which is not recommended for AF here in UK although some EPs do still prescribe it. It has both beta blocker and anti arrhythmic factors but can induce other arrhythmias in some people which is why it was dropped some years ago.
Regarding annual bleed risk this is so individual as to be unanswerable. The miss-used term "blood thinner" often makes people fear bleeding where as in fact one still needs an injury to suffer such. In fifteen years taking warfarin apart from maybe two nocturnal nose bleeds it has never happened to me and I work with metals. tools and machinery.
I take Apixaban (Eliquis), which is a widely used anticoagulant. It doesn’t thin the blood.
What is your concern with regard to bleeding? If you have a serious accident while on an anticoagulant then the team treating you should be made aware so that they can take appropriate steps, but minor cuts and abrasions are no problem. I still cut myself shaving occasionally and I haven’t noticed any difference in stopping the bleeding since starting on Apixaban.
Well this is going to be very controversial
I am A & E background nurse in a major stroke unit
When I was diagnosed afib
I refused to take any blood thinners that’s what health professionals call them on a daily basis
I have seen hundreds of patients come into resus
With brain bleed from these drugs
I have also seen hundreds of patients come in with strokes and no afib
Although I am orthodox trained common sense takes me to another pathway
It does not make sense to treat all afib patients with one hammer
Especially the ones with no heart disease
As the doctors still have no idea what caused it
Remember this when researching the drug companies make money from people being sick
It’s not in there interest for u to be well or the greater public
I have just thrown this in for Its up to u to use your own intellect
I hope u find the path that is right for u
Think out he box 🌸
The problem can be that if you find a path that's right for you and it's not what your doctors want you to do, it can be hard to find any peace of mind. You may feel damned if you do and equally damned if you don't, with no happy way forward.
Is it not time that heath professions (and indeed insurance companies and journalists) stopped referring to anticoagulants as 'blood thinners'?
Understand about blood thining meds but it seem to hit a nerve when mentioned on here
We know how anti goags work
What they mean is what ever processe u want to call it
Thr higher the INR the more chance u have of a bleed that’s why it’s measured
But there is an antidote vit k that’s used
Unlike the new meds which is quite worrying
Well, it's not true! That's what annoys forum members. Anticoagulants do not thin the blood and it also seems a bit patronising for anticoagulation to be presented in a such simple and misleading way.
Vitamin K has its uses for those on Warfarin, but I have the impression it gets used more for the control of high INR than as an emergency measure in the event of bleeding.
I was deeply unhappy about anticoagulation and initially refused it. Five years on I am taking Rivaroxaban and am quite at ease. I have had no problems with it, despite the odd sharp encounter with various things.
Well. Not trying to be rude I am just saying it as it is
Them meds can cause bleeding to the point
Of danger u cannot argue with this this is the truth
What ever there process u want to call it
It effects the blood and makes the blood thinner
I take bloods all day I can tell easy when some one is on the meds that effects the coag
I am not going to be backwards and forwards with this debate because it upsets people
It’ is what it is
People get effected by these statement s
I am NOT telling someone to stop
Just think for themselves and not be pushed into scared mongered Tactics by doctors
I am with Jamila & parts of other replies i.e. postpone taking anti-coags as long as you can at least until CHADS score 2. The proviso is if you have other co-morbidities, don't take your diet, lifestyle including exercise seriously past 60 my decision would probably be to take them.
I am 65 this year and have Factor V Leiden (increased clotting risk) but have an active day and know that my stomach hasn't tolerated aspirin well in the past, my eyes bloodshot sometimes and I bang my head (no not at gigs any more!) quite a bit so on balance I don't take anti-coags. Hope something there helps.
I totally agree that people should be treated as individuals. The difficulty with choice is having valid research based info at your fingertips.
We all find the anecdotal experiences offered on here a great help and sometimes a comfort. I am a retired nurse specialist and it is easy to be swayed by what you happen to have seen or experienced but it is only a snapshot of the world.
The best assistant in decision making is a good medic you trust, as much research based info as you can bear to read (but knowing good studies from biased studies is very difficult) + your gut feeling of what is right for you.
I must admit I thought long and hard about taking an anticoagulant, I looked at CHADS and HASBLED in great detail and with a CHADS score of 3 decided on balance the benefits of anticoagulation outweigh the risk, if I had a CHADS score of 1 with no comorbidities I would probably have declined the offer of anticoagulation.
I used HASBLED as a kind of quide to reducible hazards (thanks to a previous explanatory post by BobD) and eliminated some risk factors like alchohol/some medication/ lost weight to lower my blood pressure to make my decision on anticoagulation safer.
See Gwerseys post above...
[quote =Gwersey I'd feel safer taking it I think, although my score is 1 and that's for being female. (with Afib)]
There seems to be some confusion about calculating a CHADS score if you are under 65 with no comorbidities and female , as I understand it the one point for being female is only taken into account if you meet other criteria for age and comorbidities.
I have tried to explain with links in two posts in this thread....
I don't wish to labour the issue but feel it is significant for those trying to decide about anticoagulation.
I was warfarinised as soon as I was listed for first PVI ablation, and have been on/off throughout my AF journey. More recently it was stopped a couple of months post flutter ablation, then restarted with everything when the AF came back earlier this year.
It was stopped again at the back end of June because it was contraindicated with None Steroidals I wanted to be back on for my knee injury (naproxen/ibuprofen)
I was told unless he was ablating the left of the heart again I didn't need to be on apixaban etc
1. Zero red meat
2. Lots of veggies
3. Zero bread, potatoes and starchy food. Maybe very occasionally
4. Cocktail occasionally before dinner
5. Early dining ... 5 pm at the latest
6. Exercise six days per week at gym
7. Take tons of supplements
8. No sweets
9. No coffee, only dandelion tea sweetened with maple syrup
10. Try to get .7-8 hours sleep nightly
11. Take a good probiotic
12. Check blood pressure regularly
13. See my cardio regularly ... every three months
14. Drink lots of water
15. Avoid spicy foods
16. Avoid foods containing sugar ... read the labels
I am very tall and thin ... no weight issues ever.
3 years ago I had a score of 0 then P Afib caused a stroke and I lost the ability to read for about a day+. I actually had 5 spots on my brain. The ER said you had better get to your own doc immediately as the chances of a severe or fatal 2nd stroke are high.
Now I have a score of 2 and am on Warfarin for life.
I guess they play the odds. Anticoagulants are dangerous. For the Afib population group as a whole it is safer for the group to risk a stroke vs the side effects of everyone being on anticoagulants. Unless you are the lucky one like me.
If you are going to be pushed in to a higher score by age anise why wait? I would push for an anticoagulant because you often can't undo the effects of a stroke. I am a vegan so my INR wanders all over the place on Warfarin. I have a home INR tester, I buy extra test strips on eBay and test every 3 days so I stay in the relatively safe zone of 2.0-3.0.
Just saw your post and realised it is a year old but I found that in Europe the interpretation of the scoring is different and anticoagulants are only used if the score is 3 or more for women rather that 2 in England- I found the full dose of apixaban gave me bruising and the odd nose bleed and then some time later, agreed to take the half dose as I weigh little over the 60kg cut off and am 75 so going towards the 80 when the half dose is prescribed. It does seem to make me feel rather tired though and I'm still hoping to get back to more normal life after almost two years! Hope you've sorted out your problem by now. I'm not taking the anticoagulants at the moment as the pharmacy didn't have them when I ran out and if anything I feel a bit better. We have a bad record on strokes so the doctors seem to be over cautious!
A year later I’m still not on an anticoagulant. I’ve been
prescribed Apixaban which I will probably take soon. My PAF has been about the same- an average of once a month. The European position is interesting on CHADSVASC (not sure if you are in Europe). If their position was incorrect , wouldn’t that mean that there were vastly more strokes for AF patients in Europe than in , say, the US. I presume that’s not the case or the Europeans would change their position on the risks.
Well done! An EP told me that unless an episode went on for more than 12 hours or so there wasn't really a risk. You are fortunate in that your episodes are very rare. Mine have started happening far more frequently - like twice a week ,which is why I thought I should take the stuff again even though with flecainide as PIP, they don't last much over two hours and often less. Do go for the lower dose if you weigh under 60kg. Not sure where I read about the European interpretation of the score but I am in England where I was told I had a 2.2 percent chance of having a stroke and replied that I thus had a 97.8 percent chance of not having one! Why not be positive? People do have strokes who don't have AF- I know a few people who've had strokes but none of them had AF!
Problem is that an EP told me that once per month is still too often. The heart remodels and the left atrium enlarges and the episodes become more frequent. Some people don’t progress from PAF to persistent or permanent AF but between 10-20% to do per annum. Being overweight and even moderate drinking are associated with this. However, it isn’t easy to predict. It’s really an impossible decision netween the risks of stroke and a haemorrhage.