I have had 3 episodes of Atrial Fibrillation which started in 2014, last attack was last week, now they want to put me on blood thinners,because I am female and over 65. It seems to me , that for so few episodes far apart, the cons of taking blood thinners for very occasional episodes, far outward the pros. If it came more often I would have to reconsider, of course. Half the Drs I've seen say I don't need it and half do. I don't know what to do to be honest.
Blood thinners: I have had 3 episodes... - Atrial Fibrillati...
Blood thinners
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Sixtychick
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I'm in the same boat, I have PAF and scored zero on Chad score but now I'm heading for 65 I've been given anticoags, really not keen on starting them as I'm not convinced I need them.
You get conflicting advice from Drs. It makes it confusing
• in reply tobantam12
Unfortunately bantam, there is no warning so no opportunity to use hindsight. Once it happens, your life may be changed for ever........
bantam12• in reply to
None of us now what's round the corner and believe me I've experienced out the blue medical emergencies first hand but with Drs giving me conflicting advice it's not easy, I really don't tolerate meds well, I have Multiple Autoimmune Syndrome along with other issues which effect how I metabolise medications.
I have to be convinced I really do have PAF and right now I'm not and neither is my EP, will see what my latest holter shows then decide.
I do understand the difficulty with the metabolising the meds as I also have similar issues. I am clearly still having AF and so have no issue taking Apixaban and all I can say is that this is probably the one med I take that I have absolutely no issue with.
I think there is a grey area for which there is conflicting advice simply because it is based on opinion which varies as there isn’t enough clear evidence.
• in reply tobantam12
I understand and appreciate the point you are making and it is absolutely right that you follow the advice of your doctor. These comments are not directed at you personally, but are meant for anyone faced with a dilemma about anticoagulation. We are not medically trained, nor do we know the individual circumstances of everyone who posts for advice. Some of us are lucky enough to have been exposed to many presentations relating to AF made by health professionals and we try to relay that information in order that others, less fortunate, can benefit. Because the risk of stroke is such a huge factor, the general view expressed by most medics is to take anticoagulants if your CHADs score is one or above. Although the thought of taking anticoagulants can and does scare some people, the vast majority find that they do not present the problems they anticipated nor do they present significant side effects. However, the risk they are designed to significantly reduce, can have a devastating effect on someone’s life and there are no second chances. Once it happens, that’s it, the clock cannot be turned back.
Going back to your situation, the problem with paroxysmal AF is that it is difficult to detect and even 7 day holters can be, and often are, inconclusive. But something must have prompted you to seek the advice of an EP, so maybe you should consider investing in a Kardia so that you can immediately test yourself should you feel something is going on with your heart.
There are reasons such, as leaky valves, which may prevent the use of DOAC’s, but all we can do is make people aware of the risks of not taking anticoagulants if their CHADs score is 1 or more. Let’s hope your EP can confirm that you are not suffering from AF........
bantam12• in reply to
I have been diagnosed with PAF, Wenckebach, MVA and mitral valve leak and it was my Cardio who referred me on to the EP but he's not sure which problem is causing what, I'm on the list for ablation and he wants me on anticoags, to many things going on and no clear treatment plan. I'll start the Apixaban after Christmas 😞 Thanks for the advice.
• in reply tobantam12
Okidoki, they are unlikely to carry out the ablation if you have not been taking anticoagulants.....
look at your chadsvasc score (AF website) to help you decide= also HASBLED for bleeding risk. I started AC when 69 with first AF episode as know what a stroke entails and have had no problems Am n a DOAC which I changed to from Warfarin
BobDVolunteer
If you have a low CHADS2vasc2 score then anticoagulation (not blood thinners please as they don't ) may be optional particularly as some doctors do not agree with the +1 for being female. As I am sure you understand, stroke is the biggest side effect for AF so your choice. As was once said to me, "You can always stop taking anticoagulants but you can't undo a stroke."
Most people find that the thought is far worse than reality and it is one big non event.
For the record, the number and length of AF events has no bearing on stroke risk. You have AF therefor you have the stroke risk.
stopafib.org/newsitem.cfm/N...
This is interesting because it describes a study ending in 2021 which will support whether or not those with successful ablations are at lower risk of stroke.
This paper jamanetwork.com/journals/ja... seems to overturn the old belief that the number and length of AF events has no bearing on stroke risk.
This makes the decision as to whether use blood thinners or not even more complicated.
No two cardiologists agree whether the benefit of taking blood thinners outweigh the risk in my case (45 y, male, one possible but not probable TIA, 1 afib episode in 2 years, Cronhs disease and propensity to bleeding).
3 episodes is not a lot to us immortals but once you turn 65, you become more mortal and thus the need to keep you alive for a long, long time. How's that?
I have had 3 episodes since 2011. I'm 75 am very clumsy and so far have had no issues with anticoagulants. Now take a DOAC after years on warfarin.
I would wish to reduce the risk of a stroke.
Personal choice, but having worked with stroke victims and witnessed the effect it has had on them and their families, for me it was a no brainer......as has been said, frequency of AF episodes is irrelevant because once diagnosed, the increased risk of stroke is always with you. If you or close members of your family are known to have a spontaneous internal bleed risks then the decision becomes more difficult, but in the UK alone, there are millions of people taking anticoagulants. If the risks were high, I think we would all be more aware........
I’m 55 and on an anticoagulant. Although my BP is perfect now, I had very high blood pressure in my pregnancies and then some issues with it until they got my AF under control. I get a point for having a history of hypertension and a point for being female (which as Bob says some view as not being worthy of a point) so some may say I don’t need anticoagulation.
However, last year when I was about to have an ablation, the procedure was aborted because they found a blood clot in my heart (and I had been on anticoagulants prior and was asked to stop them 48 hours beforehand). So I know that my body can form a clot very quickly. Watching both my grandmother and father-in-law have multiple strokes which killed them eventually, I’ll happily take my anticoagulants.
I don’t fear a stroke that kills me - but I do fear a stroke that I survive that leaves me permanently severely disabled.
My sentiments exactly but I read recently that only 10 to 20% of strokes are fatal. That makes me committed to anticoaglants. I agree with what someone above said, thinking about taking them is worse than taking them.
After having paroxysmal AF with SVT for years I was given the option at 50 by my GP and advised it may guard against possible stroke.
Experiencing seeing people who have had a stroke I didn't hesitate to go on the Apixaban I was offered once I'd read up on it and weighed up my options , and will stay on it now for life even after my so far successful ablation this year purely as a sensible precaution .
As Kaz, flapjack and a few others have said the outcome and burden of stroke is enough to outweigh the associated risks that have to be taken into account while medicated with Anti Coagulation of any sort .
It does seem more and more people suffer Stroke these days for whatever reason, be it medical or lifestyle factors , and for me it's a no brainer especially if suffering and AF or heart related issues which carry the risk are a factor , and echoing again what Kaz pointed out , its the living with stroke that would truly scare me rather than the mortality result .
I would consult at least three medical professionals before making your decision on blood thinners. Blain bleeding also causes strokes and blood thinners can increase that risk. You can’t undo a brain bleed. The 65 age criterion for the CHADS score is arguably an arbitrary number if longevity runs in your family. The argument that about having AF being a risk factor is also somewhat arbitrary if you have had an ablation that has eliminated AF completely. Doctors are not experts in risk analysis and the CHADS score is a one size fits all assessment criterion. Hence it is inherently arbitrary and flawed in my opinion as an non medical ingoramus.
You said it all in your last sentence
I would like to see the evidence for your argument? AF stroke risk is Arbitrary? Agreed the CHADS2VASC is not ideal but as I have said before - I think we make decisions based on emotion (in this case fear) not logic. I am far more frightened of stroke - had several ablations - a TIA and now a pacemaker so it’s a no brainer for me. It seems to me that you are more afraid of brain bleeds and maybe they aren’t right for you - trouble is there is and never will be certainty. It’s always a game of odds as that is what statistics and risk assessment is.
Opinion also depends upon where you live - US seem much less likely to advise anticoagulants than Europe - mainly I believe because of the Class actions taken against early DOACS where they got the dosage wrong. I am positive that this has had a lingering influence on the US population.
More local to the UK - you might be interested in a GP survey done in the north of England. Dr Matthew Fay is a GP who campaigns for anticoagulation for AFA. Comparison studies of patients of his practice compared with a neighbouring practice who did not actively prescribe anticoagulants for AF showed a significant decrease in people suffering strokes. Now is that coincidence or good clinical management?
Thank you once again for your intelligent comments , without scaremongering. I know it helps calm my all too anxious mind.
CDreamer,
I think the article below states exactly what I was trying to say.
cardiosmart.org/Heart-Condi...
I’m cynical of doctors whenever they are tasked with risk management.
Arbitrary:
“Based on random choice or personal whim, rather than any reason or system.”
The reason or system referred to above requires diligent assessment on a case by case basis rather than arbitrary (and lazy) use of a one size fits all CHADS score that may be right “on average” but wrong “for you”.
A new study shows that people who take the commonly used blood thinningdrug warfarin may have larger amounts of bleeding in the brain and increased risk of death if they suffer a hemorrhagic stroke. ... The brain scans were used to measure the size of the blood clots.
aan.com/PressRoom/home/Pres...
As I said:
“The 65 age criterion for the CHADS score is arguably an arbitrary number if longevity runs in your family.
The argument about having AF as a risk factor is also somewhat arbitrary if you have had an ablation that has eliminated AF completely. “
I trust that this is helpful to you. That the CHADS score is arbitrary is irrefutable !
• in reply toMS444
Are you a qualified cardiologist/EP or just cynical of those who are?
The thinking & opinion in Europe differs from the US. Statistics are based on ‘herd’ averages so it is currently impossible, at present, to calculate in personal risk factors so CHADs + HASBLED are the best tools we have at the moment to assist our decision making. I would just point out however that US recommendations are dated on much older information than European guidelines. I understand they are due to be updated soon.
escardio.org/Guidelines/Cli...
Personally I refused Wafarin exactly because of the enhanced brain bleed risk but the DOACs have lower risk profile & one need not worry about INR & staying in range.
At the end of the day we all have the option to take or to refuse meds ( and aren’t we lucky to live in countries where we have options!). I personally believe we should look at the risk:benefits & do need some guidance from professionals in order for us to make an informed choice. I am much less skeptical of their biases- but that is because I live in a country with socialised Medicine so still believe my doctors have my best interest at heart - rather than lining their pockets.
I believe we do need to take response ability for our choices - we cannot leave it entirely to doctors opinion but neither should we ignore advice from specialist expertise and experience.
In the UK even after successful ablation advice is to continue anticoagulants. I stopped after a year of no AF - resulting in a TIA.
I had a stroke aged 62 and I previously I’d been told that I wouldn’t need to take then until I was 65. My stroke wasn’t arbitrary, it was awful.
Sorry to hear that, but doesn’t that support what I have said?
I am not a doctor and I didn’t say taking anticoagulants/blood thinners was right or wrong. I just said the CHADS score is based on average risk rather than individual risk and therefore it is arbitrary.
I work in a business (not medical) where risk assessment is essential for all decision making. Hence CHADS breaks all the rules I am familiar with.
Maybe your physical condition would have led to medication earlier if the CHADS score was not the only decision making tool?
Hope you recovered well from your stroke.
• in reply toMS444
Allegedly, there is only one who is capable of fully understanding the infinite complexities of the human body and many would say that person is God. Doctors and medics the world over, just do the best they can to help their patients as best as they are able with the knowledge they have acquired from other well informed and well intentioned medical teachers. We are not talking industry, trade or commerce here, we are talking about saving lives.
Using your words, not mine, “Hence it is inherently arbitrary and flawed in my opinion as an non medical ingoramus” speaks volumes. To denigrate the method universally used to not only save lives, but also prevent folk from having a life changing stroke in a forum which is totally focused on doing the best it can for AF patients is wholly inappropriate. Even hinting that such a method is flawed is inexcusable because the only motive can be to discourage people from using CHADs as a guide to stroke prevention and anyone prepared to do that is encouraging the unthinkable!
Hopefully, nothing more will be said about this subject and it can be forgotten so that we get back to doing what we do best......
wilsond• in reply to
Well said...totally agree.
"An ablation that has eliminated AF completely"? Ablation is not a cure; many posters on this forum have had to have multiple ablations with mixed results.
My first AFib event seems to have been the stroke I had at 60, almost two years ago. At the time of the stroke my CHAD score was 0 and I was in excellent health, ate well, drank little, etc. I am now on Eliquis (no other meds) and have had no issues with it. I had an ablation and my afib episodes are fairly rare and quite mild - I take Flecainide PIP. I was very lucky with my first stroke (received a miracle clot-busting drug within 90 minutes of the stroke and have had excellent recovery) and am grateful I live minutes from many excellent hospitals. But I wouldn’t want to go through that again.
Medical decisions are very personal and you must do what feels right for you. You are the expert on your experience and can supplement that experience with research to make your best choice. Gathering info from this site is a great support for that. All the best to you, sixtychick!
I represent the minority on this one and favour postponing Anti-Coags for at least a couple of years after the medics first recommend it, reasons being: medics are over cautious as no-one gets sued for putting you on ACs, drugs do have side effects and these new ones don't have a proven history yet (already Rivaroxaban has been yellow flagged), I read once started ACs you increase the clotting risk if off them for even a brief time (e.g. an operation, which get more frequent for us Oldies), a statistic often quoted is you are x5 more likely to have a stroke with AF but even if this is accepted I haven't read what the resultant odds are (e.g. if 1000:1 my personal decision would be to accept that risk), no strokes are good but some recover completely to live a pretty normal life (don't know the stats on this group), I have used AF and postponing ACs as a driver to improve my lifestyle (exercise, water intake, supplements etc) which I am pretty sure I would not have done otherwise and may as a result removed other chronic disease risks and last but not least Big Pharma has a marketing budget to promote pill sales.
All that said it is a very personal decision taking into account other co morbidities including your BMI and the cost of a stroke for the NHS budget & your family v pills. Sorry, a bit of a long answer but I hope this balances the debate a bit and something there helps. Seasons Greetings.
Hi there. I agree with BobD. I was started on AC s but the cardiologist stopped them because of a low score. 6 months later I had a TIA. I’d sooner pop my pill tbh. Had a couple of scares when having chemo of possible PE as well
Same here. Bit older, but fit and active. I was put on Apixaban, following g similar pattern as you. But after a couple of months decided like you, I didn't need it. I was called on to see GP who enquired why i hadn't re-ordered. I said reasonably as I thought that as i feel well. No incidents of aFib. Left it at that.
A month later called back and shown letter from hospital consultant saying in no uncertain terms that whilst it's my choice. With aproxysmal Afib (comes and goes with no known reason) The biggest fear is blood pooling in the ventricle and causing a stroke. I was told straight, you dont want to risk a stroke. Your chances have increased by at least a third.
So common sense dictates- the downside is more risky than the upside of taking Apixaban. As I dont have any perceived side effects decided to carry on taking it. Your choice.
My anti coagulant Edoxaban is my friend. It is the one medication that I am grateful to be taking.
Second try, I've been on Rivaroxaban for 3 years following an episode of atrial flutter. You say it has been yellow flagged. What does that mean?
I've been taking Rivaroxaban anti coagulant for 3 years now. ( anti coagulant, I am told, is different from blood thinners ) and have had no problems from it that I'm aware. My AF has not given me any issues as far as I know, since I retired 7 years ago and even then I only had the occasional spell of palpitations whilst still working, which I can put down to stress . Now though, I've been told that I have a right bundle branch block of the heart, so I think that it's likely there has been an underlying issue. As I understand it, the Rivaroxaban was offered as a possible 'alternative' to a stroke as my main issue was overpulsing whilst at rest, so the blockage - which I still need to understand more- has come regardless. It's left me thinking, I wonder how it might have turned out if I had NOT been taking the anti coagulant?
I too, was reluctant to start on blood medication, as I have been into DIY, metalwork and mechanics for a long time and often get cuts and scrapes, but at the moment, I'm still pleased that I gave in to my Doctor ( after 2 years of her pressure ) who wanted to get me onboard with the medication as soon as she found that I had AF.
I have 2 mates who've had strokes recently. I know that one was much older than me - I'm 72 - but with AF, neither was on medication.
Your choice and I'll let you know what transpires from this RBBB, if it turns out negative! Best wishes anyway and Merry Christmas. Bob
I had a particular bad AF experience 2 years ago and was put on blood thinners they don't seem to have any any effect on me at all regarding side effects so I assume everything is fine, however, a few months ago I was running low on them I cut the 20mg dose in half and I felt even better, so you pays your money and takes your choice I guess. I've worked out that sugar and very strenuous exercise triggers my AF so I can kind of control it. Anyway best of luck, personally I would go with the thinners it's the least worst option.
I found out that I had Afib when I had a stroke. I have no problems with apixaban and highly recommend it.
I was diagnosed with AF 2 days before my 65th birthday back in June. My heart rhythm has been permanently irregular since, after 2 DC cardioversions. I was put on edoxaban and have been on this anticoagulant ever since. Personally I would prefer to take the drug than risk a 5x increase in stroke risk. At 65 we are at far lower risk but this risk will increase as we grow older.
I was diagnosed with AFIB at age 54 (2017). I just turned 57. I take Eliquis and have been doing so for approximately 2 years. I have experienced no issues from taking Eliquis.
As Bob D says, you can not undo a stroke.
On the flip side, my brother in law was diagnosed with AFIB in 2014. He refused to take any AC's. He has been dead for almost 2 years now having died from a stroke in 2017.
I am similar to you. Rare episodes, very rare. Convert without intervention ... they tried for years to get me to take them, l refused. Then l had an episode recently ... maybe four months ago ... my husband insisted that l take them, so l did IT!! I took the plunge! Eliquis. No big deal! Better safe than sorry.
Hi, it easy to I have 3 A/F, in 5yrs, but I would think better to be safe than sorry, most people on blood thinner now are on rivaroxaban, your got think small blood clotts and what they can do,
Dear Sixty hi k, I'm writing this in hospital recovering from a stroke
I had an ICD ppa pacemaker procedure and was told to stop .y blood thinners to avoid excessive bleeding. The cardiologist thinks this may have caused the stroke. The risks of not taking these drugs are far higher than taking them so try to view them positively as an aid to keep you healthy. Wish you well. Hope it works out for you
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