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Paroxysmal Atrial Fibrillation without anticoagulant

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”.

34 Replies

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.


Thanks for your reply. So far as I know, there isn’t a particular anticoagulant that stands out as being safer than the others from the point of view of bleeding. For the time being I’ll stick with the GPs advice- although he seemed relieved not to have to make the decision.


I take Eliquis and I have read it has the lowest risk of bleeding of all the anticoagulants


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.

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Thanks for your reply. I’m definitely going to look into this Sotalol. The company who makes it is going to ring me tomorrow and I’ll ask the GP to comment on its safety.


I've just asked a similar question, didn't see your post before asking.


It seems that the risk is difficult to quantify. My GP did say that if/once you reach Chads2vask 2 you should definitely take the anticoagulant.


That seems to be best practice based on the stroke risk with that score. NICE recommend that AF sufferers with a CHADSVASc score of 2 and above should take an anticoagulant.


I'd feel safer taking it I think, although my score is 1 and that's for being female. (with Afib)


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.


Hi, the main concern is bleeding from the brain which the doctor at the hospital mentioned. I’ve had conflicting information form different doctors about the risk. One said it’s about the same as the stoke risk, another that it was much less. I’m not so worried about minor things like shaving etc..


A HASBLED assessment is usually used to factor bleeding risk. However, you may be influenced more by Jamila123’s comments below.

Personally, I tend to lean towards not taking a medicine if I have doubts but you must make your own decision.



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

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True. My GP has said it’s a reasonable decision, but other doctors have indicated that they think the decision is unwarranted. None of them, however, were able to specify the probability of serious bleeding.


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.

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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.


Two points come to mind:

1. I don't believe that medicine is a 'perfect science'

2. Sometimes it's difficult to make sense of studies because of the terminology used.



Yesnn ow where u are coming from

But u do need to know the research is often bias and not correct

People need to think


I think that is exactly what I was saying.(or trying to say!)


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.


Yes, CHADS one is “equivocal” but 2 or 3 elevate the risk substantially.


im on sotalol and Eliquis.....I still get some afibs/PAC's but no bad bleeding nor bruises on arms....my 2 buddies cannot understand why I don't have black and blue arms...

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also...my score is 3...stinks...


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


I refused an anticoagulant ... take aspirin 80 mg instead ... along with other blood thinning natural supplements. My cardio is okay with it. I have PAF ... had two episodes in two years.


As yet I have only had a couple of episodes involving *fast* beats (although I’ve had plenty of ectopic

beats and occasional periods of irregular beats, which usually last for 2-3 hours). What do you do by way of exercise, diet etc. to keep the PAF at bay?


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.


Thanks. Sounds pretty demanding!

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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.

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Stroke -v- BleedI read on here from a cardiac nurse that the likelihood of having a stroke not taking anticoagulant is less than a bleed


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