Apixaban question - should I stop taking it?

[Borderstories1]

Just this evening saw a gp I’ve never seen before because my usual is away. He was reading all of my notes and asking lots of questions. He wondered why was I still taking the anti coagulant? He said my risk score was 1 and so the drug was more dangerous than my risk of stroke and he thought I should stop. I’m 39 and have para af. However I do get very regular episodes of af currently (see my last post; 9 at least this October already). I will ring to book an app with the cardiologist tomorrow. The gp said he would write a letter too. The gp said if the appointment is within a week or so I could keep taking the Apixaban until I double check with the cardiologist but if it’s 3-4 wks he advises I stop the drug.

Any advice or knowledge about this?

[CDreamer]

Sounds as though you are doing exactly the right thing in asking for cardiologist’s advice and I wouldn’t change anything until you have a answer from your cardiologist.

I would also ring the AFA and talk to them and name your GP practice and ask their advice.

There is a risk calculation called HASBLED which calculates your risk of bleeds which always needs to be balanced with other risks - to your knowledge did your GP use this calculator or give you reasons as to why you are at higher risk of bleed than stroke? Or are they just biased against anticoagulants do you think?

There are some GPs who seem to be very anti - anti-coagulation but my understanding is that with a score of 1 for someone with regular PAF episodes anticoagulation is recommended, score 2 and that would be very strongly advised.

In your position - I would wait for the cardiologist’s appointment or letter and continue to take and if this GP refused to prescribe or renew then see another GP.

[Borderstories1 in reply to CDreamer]

Thank you that’s great advice.

[Bagrat in reply to CDreamer]

Amen to that

[Borderstories1 in reply to CDreamer]

What is the AFA? Thanks

[CDreamer in reply to Borderstories1]

Atrial Fibrillation Association - they campaign, educate and advise both patients and medics on AF

heartrhythmalliance.org/afa...

They are interested in GP practices who do not seem to be updated on latest advice on anticoagulation.

[etheral]

Seems like with continuing episodes of AFib you are in definate need of anticoagulants. Besides seeing the cardiologist I would get a new GP.Do no stop taking the Apixaban.

[Hidden]

I am a 1 and I take it, I was given the option to stop as my last echo showed my previous mild LVH had gone but I refused as my left atrium was still very slightly dilated if it drops to normal size I will reconsider. They all seem to have a different view my EP told me I was now a zero as my previous high BP had gone as well due to weight loss, however some say once you score any points on Chad Vasc your stuck with them ! I prefer not to risk things like stroke as I still have episodes albeit very infrequent

Andy

[Hidden]

Your risk is the same if you are in AF or not as I understand it.

If you score a 1 on chads2vasc then AC should be considered. It depends on your attitude to risk.

[Dodie117]

You should ask to see an EP (electrophysiologist) as opposed to a general cardiologist. They are specialists in arrhythmias.

You could then discuss your meds, anticoagulants and explore ablation.

A score of one is borderline so you may get conflicting opinions on this.

Good luck

[Restcfo1]

The answers below seem to be the safe answer. I, like you have a risk score of 1, but am older and did not like the side affects of Apixiban. I am a CPA and I found that it impacted my cognitive ability. I told my Dr. that I wanted to get off of it and he was OK with that, but said that once I hit 65, he wants me back on it. I have minor bouts of Afib every so often, that I treat with Metoprolol twice a day if needed, however, it usually only lasts a couple of hours. My Dr. might have a different answer if my Afib bouts were more serious.

[rosyG in reply to Restcfo1]

just to say strokes have been known after just 6 minutes of AF so don't rely on length of episode in decision making

[Restcfo1 in reply to rosyG]

Understood, but I think it depends on the type of episode. When I have an Afib episode, my heart rate rarely gets over 90 bpm and is usually in the mid 70's.

[rosyG in reply to Restcfo1]

unfortunately not- the problem is the heart is not passing the blood through at normal speed and this allows blood to pool and then clot-the rate doesn't affect this process

[vernaloliver]

As far as I know you have to be on it for life depending on what you have obviously x

[Jumper]

Your Chads score is 1 . So you have a factor other than AF and as you are less than 70 is it because you have hypertension or diabetes perhaps? Can you make lifestyle changes to reduce your CHADS score to zero ? Go to sparctool. Com you can use it to find out your stroke bleed risk for the various anti coagulant drugs. A bleeding risk is a major risk that requires hospitalisation. If you can reduce your Chads to zero the bleed risk will generally exceed the stroke risk with an anti coagulant . At Chads 1 there is very little difference in stroke/ bleed risk. It depends on what anti coagulation you use. Hope this helps with any decision you make. I agree with others see an electrophysiologist as you may benefit from ablation.

[Borderstories1 in reply to Jumper]

I only have a score of 1 because I’m female. I guess I’d have to be male for a zero score?!

[Borderstories1 in reply to Jumper]

I just checked out the website and scoring. I think I may be a two? I’m female and also once had a major bleed ten years ago from a miscarriage and needed surgery to stop it. I wonder if that counts as a point? I will def bring this up as I think my risk of bleed/stroke are currently pretty equal although the number of af episodes I’m currently having make me wary to stop anti coagulation...

[Jumper in reply to Borderstories1]

Hi

The major bleed should be put in the has bled side of the calculation . Your chads score will remain as 1. You are doing the right thing by questioning and getting further advice re your concerns about ablation I can fully appreciate your apprehension I was the same prior to my procedure but AF is progressive and it had dragged me down to the point that I didn’t feel I had a real choice as my quality of life was very diminished. I tried to look beyond the procedure and hoped for a better future. It worked for me . It is not a cure but success is relative. From 50% or more time in AF to less than 1 % I have my life back. It is a journey .

[Bigsweet]

Hi Borderstories1 It is confusing getting conflicting advice but this often happens due to different levels of knowledge and experience of the medical professionals. My advice is similar to how CDreamer has already responded and I would recommend you follow this.