Looking for some advice if you could help me, I have paroxysmal AF, and I am fortunate that I only have about 1 event a year although I am plagued with ectopic beats, my cardiologist has stated that I have a very irritable heart.
Unfortunately I have had a bad month throughout December my Apple Watch has stated that I have gone into AF twice and after a particularly bad episode I went to A&E who carried out 2 ECG’s 4 hours apart that both stated that I was in AF although oddly enough when I went to see my cardiologist last week (he is a well known and very well respected cardiologist so I trust his opinion) he told me that the ECG machine, my Apple Watch and the 2 consultants that viewed the ECG’s in hospital had misread them and that in fact I was in sinus rhythm on all of them, albeit with many ectopic beats. Whilst in A&E the 2 doctors that I seen told me that they did not recommend taking anti coagulants due to my risk being only 1.3% (I’m only 45, male but have well controlled high blood pressure - no other issues) they said that the risk of not taking them was not dissimilar to the risk of taking them and they recommended considering taking them when I was older, but when I seen my cardiologist he said that whilst I am borderline - if he had my issues then he would take them and suggested that I consider taking Apixaban, I am an active person (weight training, fitness etc...) and as such would really rather not take them but obviously do not want to take a risk in regards to stroke (I have a young family who need me), the conflicting advice has me in two minds, could you please offer any advice, thanks in advance - Karl
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karl1524
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I have a box of Apixaban but haven't started them yet as I'm not convinced I should be taking them. I'm older than you with a score of 0 but when docs give conflicting advice, one says yes and one says no then it's hard to know what's best.
I have been on apixaban for 7years.due to ten blood clots,8 round heart, and large ones in each lung.apixaban are given for a reason.if you smoke,stop now.i smoked for 54years, stopped immediately with no help.no grapefruit, pineapple (vitamin k).no drinking.you will be fine.Apixaban are ok.just carry your alert card.
Your CHADSVASC score is apparently 1 whoch makes anticoagulation advised but not essential. One must remember that the amount and duration of evvents does not affect your risk. Nobody can force you to take them but do remember that you can always stop taking anticoagulants but you can never undo a stroke. Most of us find these drugs no problem at all. I still build race engines involving working with metal , tools and machines and have never had any issues due to my anticoagulant.
Thanks Bob, appreciate the reply, I have read that the more serious bleed risks are less with apixaban than with warfarin but there is no reversal agent for the Noacs, do you see this as a major concern - thanks
There are other bleed management things they can do in the event of a serious bleed,and tge race is on to find a reversal agent by Big Pharma companies...wont be long! Ive had wisdom teeth out without stopping apixaban,badly cut hand etc. Id worry more about what Bob mentioned,itsnot how often afib occursbut how quickly a clot may form. Can happen after just 20 mins.....xx
If people did not use the rather emotive "blood thinners" monica I doubt people would worry so much about anticoagulants. I have been on warfarin for fifteen years and never yet needed any treatment other than normal first aid when hacking bits off myself. Reversal agents are a complete red herring IMHO as even warfarin can't be reversed instantly. If one has an injury such as accidental amputation or severed artery then you are in deep doo doo anyway regardless of A/c or not.
The big worry for many is internal bleeding which in fact is more likely with aspirin which attacks the stomach lining.
Thanks Bob, my cardiologist said something similar, will start taking them, whenever this condition steps up a notch in relation to the requirement of new or increased meds it always jolts me, but when I am a week or two into taking them I virtually forget about them, so hey ho, will take them and crack on with life, again thanks for the advice
Dear Bob you say that you have been on Warfarin 15yrs ,that is great you obviously have great faith in this drug. I have taken it for 2 years and it seems to keep me stable I have one question, have you ever had any problem with Gout while taking this anti-coagulant medication ? I have read that taking warfarin can cause Gout have you any experience with this issue if after using it for so many years as you say ! I just thought you would have some tips to ease the pain for as you know we can't take anti inflammatory tabs with our condition I look forward to your wise advice! Seasons Greetings to both you and your lovely wife and Best Wishes to your family. Cheers Gladys.Xxx.
I have been on apixaban for nearly seven years.i got gout after 3days on them.i eventually,after changing doctors got alupurinol.you as need lansoprazole.your hospital was wrong.i was told there is no reverse yet.you need to be careful ,show your alert card and carry it always.
Apparently there is a reversal agent for apixaban. I was in hospital recently for an operation and when I asked if I should stop my anti-coagulant, I was told no need as should there be a bleed and no reason why I should, then they could stop it. I can’t remember the name (maybe beginning with A???). Also I was told by my EP and GP that apixaban was the kindest anti-coagulant to the brain, digestive system (stomach) etc.
Looking at things scientifically, if the risk occurs only when AF is present, I would say that the cumulative risk with ten AF events is ten times what it is with one event. This assertion is based on the whole period of time during which the events occur, and also on the basis that each AF event has the same duration.
Hi Karl, I am 53 and was diagnosed at 50, I have previously had high BP but got rid of it through weight loss, that was/is my only risk factor. My EP said I could come off apixaban if I wanted, I refused and stayed on it, apixaban is the safest of the anticoagulant drugs. I am still active, classes, weights, five a side football etc and have had many bumps and bruises mainly via football. I stay on it as my risk would be same as yours which I consider too high. Stroke is not something to take risks with.
A difficult decision, what concerns me a tad is that i read somewhere if you start taking ACs and then stop albeit temporarily your chance of clotting actually increases compared to before you started; I am no medic but I can understand this may be correct. So if you do decide and have a future medical issue where you need to come off them I would discuss this with a knowledgeable medic first and don't be brushed off easily. Rightly or wrongly, I have decided to postpone starting ACs until I am 67 but I am using this as a driver to jolt me & maximise my anti-stroke lifestyle e.g. low BMI, BP, liquids, exercise, supplements, changed diet etc
I don't have all the figures in front of me but there was more of a risk of stroke by not taking them than other risks. I understand your concerns, particularly given your age and young family. I have been taking Apixaban since September and I'm still getting my head around it.
I am 59 and have had 8 /10 paf episodes over 3 years I started taking apixoban about 8 months ago and have had zero side effects. But huge reassurance.
Like a previous reply to you the damage a stroke causes is something fearful to me, I want it to be something I want to be able to say to myself I did my level best to avoid
The drug really has not affected my life 1jot I have walked over 1000 + miles this year I garden use power tools and have cut bashed and bruised myself fairly normally. (A worry I had at one time was that I did not bleed in rivers or bruise like a peach so I needed reassurance it was working! ... it is)
I would start the apixiban and reduce a lot the main real worry of afib if they do affect you then I understand that you need to stop gently to avoid risk but of course your doc will tell you the plan right for you.
Annoying thing... twice a day tablet rather than all in the morning , but that is not such a chore
I have been taking Apixaban for more than 5 years and it has caused me no problems - despite a punctured intracostal artery (long story). I was treated by my local hospital who said it is now 'routine' to manage bleeding for people on DOACs and they don't need a reversal agent.
I'd say take the Apixaban but your mileage may vary.
I have had no problem with them.....little cuts I’ve seen no difference to normal.....I’ve had no side effects...I see these anti coagulants as an extra line of defense against strokes......trouble with afib you can get it while you sleep and not know....I did and it was picked up by the 24 hour monitor........
So many things health wise go wrong in life so if this is a little helper ....I say thumbs up......but we’re all diferent.....
Anticoagulants are a comfort blanket against stroke for me. I would advise taking them if they’ve been prescribed. If you wait for the next big episode, that could be the one that causes a clot to form which could lead to stroke.
As a retired nurse who cared for many post stroke patients in my youth, I can say with conviction that the effects of an occlusive stroke (i.e. caused by clot), are devastating, life changing and life limiting.
I had to fight to be given anticoagulants after my AF diagnosis & was hugely anxious when NOT on them.
For your interest I posted the text below a while ago.
Strokes in perspective
When strokes are mentioned on this site, the most extreme scenarios are usually highlighted. Typical words or phrases used are "devastating" and "severely disabled", and phrases with specific detail like "wearing incontinence pads" and "having to be taken to the toilet". There is a whole range of outcomes of a stroke, like most other things in life. I know several people who have had a stroke, including family members. I have had a stroke. It was very difficult at first, but after eighteen months there are just minor residual issues in my case. So I believe I am well placed to comment on the subject. Some people make a complete recovery. Yes, strokes can have devastating outcomes, but what about the impact of serious accidents and life-changing illnesses? If you want to reduce your risk of accidents, keep off the roads - avoid motor bikes and even cars! I am not trying to persuade anyone to avoid anti‑coagulation, and I certainly do not want another stroke. In summary, I would suggest a more balanced perspective would be helpful whenever strokes caused by atrial fibrillation are referred to in this forum. Do you agree?
Hi, I too was borderline with the scoring ...being 57 yr female kept it down 😀...my cardiologist recommended blood thinners but my GP wanted me to have all the facts and gave me printouts on the various options and side effects etc....he wanted it to be my decision....I opted for apixoban and he agreed it was the best option and wisest choice....18months down the line I am fine with it....I am at the gym a minimum of 5 times a week so hasn't interfered there....all good and no major bleeds and minor cuts etc have healed like normal.
Hi all, thanks for the support and advice, it’s greatly appreciated and gives me comfort that I can start taking these to reduce risk whilst also maintaining a normal life - thanks - Karl
I was very reluctant to take an anticoagulant- till I had a TIA. This was nearly 6 months after my last afib attack. My CHADSVASc score was 2 , one point for age one for being a woman. According to the new guidelines from the ESC a score of 2 if you are female is now advisory for anticoagulation provided the other point is for age and not a comorbidity . My cardiologist had advised that an anticoagulant was not necessary. Luckily the TIA was very mild and my brain scan showed nothing. If it had not been for not being able to write other than in squiggles I might have doubted I had had one. I now take Apixaban.
Thanks for reply, sorry to hear about your TIA, I’m starting to take my Apixaban today based on the wise words on this forum and cardiologists advice - thanks
I stopped taking Apixaban / Eliquis in October. Firstly because I am a Scrooge and they are expensive , but secondly coz all medication can have side effects. The episodes that I have had are : one genuine in April, and two mini-episodes for 3 hours each and triggered by coming off betas. (sorted by taking a single 50mg metoprolol). I am very sensitive to betas and the ONE I took in emergency dept stopped my heart for 5 seconds and 5 times over. I found the eliquis/apixaban had zero detectable side effects.. I dont think a small isolated 3 hour episode is likely to build up clots like my one initial real episode of 10 days, so I am doing ZERO medication since October.. When I visit the UK for 8 days, I take some betas and apixaban with me "just in case"
Since you are so young, this probably will work for you, or at the very least, lesson the severity of any episodes you have:
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After 9 years of trying different foods and logging EVERYTHING I ate, I found sugar (and to a lesser degree, salt – i.e. dehydration) was triggering my Afib. Doctors don't want to hear this - there is no money in telling patients to eat less sugar. Each person has a different sugar threshold - and it changes as you get older, so you need to count every gram of sugar you eat every day (including natural sugars in fruits, etc.). My tolerance level was 190 grams of sugar per day 8 years ago, 85 grams a year and a half ago, and 60 grams today, so AFIB episodes are more frequent and last longer (this is why all doctors agree that afib gets worse as you get older). If you keep your intake of sugar below your threshold level your AFIB will not happen again (easier said than done of course). It's not the food - it's the sugar (or salt - see below) IN the food that's causing your problems. Try it and you will see - should only take you 1 or 2 months of trial-and-error to find your threshold level. And for the record - ALL sugars are treated the same (honey, refined, agave, natural sugars in fruits, etc.). I successfully triggered AFIB by eating a bunch of plums and peaches one day just to test it out. In addition, I have noticed that moderate (afternoon) exercise (7-mile bike ride or 5-mile hike in the park) often puts my Afib heart back in to normal rhythm a couple hours later. Don’t know why – perhaps you burn off the excess sugars in your blood/muscles or sweat out excess salt?? I also found that strenuous exercise does no good – perhaps you make yourself dehydrated??
I'm pretty sure that Afib is caused by a gland(s) - like the Pancreas, Thyroid (sends signals to the heart to increase speed or strength of beat), Adrenal Gland (sends signals to increase heart rate), Sympathetic Nerve (increases heart rate) or Vagus Nerve (decreases heart rate), Hypothalamus Gland or others - or an organ that, in our old age, is not working well anymore and excess sugar or dehydration is causing them to send mixed signals to the heart - for example telling the heart to beat fast and slow at the same time - which causes it to skip beats, etc. I can't prove that (and neither can my doctors), but I have a very strong suspicion that that is the root cause of our Afib problems. I am working on this with a Nutritionist and hope to get some definitive proof in a few months.
Also, in addition to sugar, if you are dehydrated - this will trigger AFIB as well. It seems (but I have no proof of this) that a little uptick of salt in your blood is being treated the same as an uptick of sugar - both cause AFIB episodes. (I’m not a doctor – it may be the sugar in your muscles/organs and not in your blood, don’t know). In any case you have to keep hydrated, and not eat too much salt. The root problem is that our bodies are not processing sugar/salt properly and no doctor knows why, but the AFIB seems to be a symptom of this and not the primary problem, but medicine is not advanced enough to know the core reason that causes AFIB at this time. You can have a healthy heart and still have Afib – something inside us is triggering it when we eat too much sugar or get (even a little) dehydrated. Find out the core reason for this and you will be a millionaire and make the cover of Time Magazine! Good luck! - Rick Hyer
PS – there is a study backing up this data you can view at:
Thanks for the reply, I have heard a number of people mention a link between sugar and their episodes, in honesty I do not have a sweet tooth so do not intake much sugar with the exception of what is hidden in foods or what is in fruit, I will
I was concerned to hear a friend of mine who is on Elqiuis had to stop it for 48rs due to a surgery - she had a stroke=:0 this concerns me as its almost like being on it raises the risk of a stroke (unrelated to afib episodes) when you come off it
I’ve been taking Apixaban for six years without any problems and have had 2 teeth taken out, numerous cuts and nosebleeds - all without stopping it.
Many cardiologists now believe that ‘the company which AF keeps’ is the cause of strokes in AF patients and this risk is there whether or not we are in AF. It follows that keeping AF under some degree of control with drugs or ablation does not change our CHADsVASC score - or an individual’s risk of stroke.
I would certainly always follow my trusted cardiologist’s advice - why risk a stroke, even a mild one? Best wishes with your Apixaban.
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AF or not ?
Ectopic beats
taking Amitriptyline with ectopic beats
Flecanaide 
I am confused
