Conflicting advice.

[Sixtychick]

I am very confused with conflicting advise. I have Paroxysmal A.Fib. The 1st was in April 2014 and I think was caused by a very nasty respiratory virus. I’ve ha the 2nd episode in June 2017, possibly caused by a urine infection which took 2 different antibiotics to shift it and 3rd one on Dec 10th last year, when I cannot think of anything that could have caused it. I went to A and E each time. The 1st stopped on it’s own after a few hours and the 2nd stopped after I’d been given a drip of saline, as they said I was dehydrated and the last time, I was given a beta blocker drip and it stopped within 3 hours of being given that. Each time the A and E Doctors have said I don’t need Anticoagulants as it doesn’t happen very often and doesn’t last a long time. Then I went to see my GP and she said I ought to take them and sent me to the AFib clinic and the Consultant said I ought to take them and to discuss it and look them up on the internet. Then I was asked to see the GP, who specialises in anticoagulant medication in our GP practice and he said I probably didn’t need it, as long as I went straight to A and E when I get an episode, but I ought to think about anticoagulants. Both my Dad and Grandma died from brain haemorrhages and there’s a history of strokes and heart attacks on both sides of my family. Just do it know what to do. Has anyone been given the same conflicting advice and what did you decide to do. ?

[Hidden]

It really depends on your chads2vasc score, but I would tend to agree with your GP.

Risk of stroke is increased, it doesn't matter how many episodes, how frequently or if you are currently in AF

[Hidden]

In my view ...it's a no brainer ! Take anticoagulants.

I can't believe the rubbish you have been fed, these medics aren't worth their qualifications !

Have you undertaken the CHADSVAC2 test ? I think you can do it yourself online - it'll at least give you a guide, then you can wave it at ..... whoever 😊

[Hidden]

You need to understand that we are not medically trained so we can only offer advice based on our own experiences. With a family history of strokes and haemorrhages, I can understand and and appreciate your dilemma. I guess the first thing you should do is check both your CHADsVASc and HASbled scores to try and assess which of the two may be the greatest risk. One of the problems is that it is not a precise science, but generally we encourage folk to err on the side of safety, particularly when it comes to dealing with the risk of stroke. There are many here who would argue that they would rather experience a brain haemorrhage which generally has a rapid finite result than a stroke which could have a devastating, life changing outcome and leave one totally dependent on family and carers for varying lengths of time. I suspect you are very aware of this and I don’t mean to upset or worry you further, but you need to take advice from reliable sources. No disrespect to A & E staff or GP’s but one has to ask if they are best placed to advise only because their knowledge is widely based for obviously reasons. I think if I where you, I would talk to an Electrophysiologist (cardiologist who specialises in arrhythmias) who are quite focussed on these issues. From what you have said, your AF burden is low, but if you have been diagnosed, the risks are there. I hope this has been helpful.........

[sotolol in reply to Hidden]

Hi I can only repeat what I’ve been told. No matter if you have one episode or many you need anticoagulants. Hope you get it sorted.

[Hidden in reply to sotolol]

Do not disagree sotalol, but we need to bear in mind in this case, there is a close family history of fatal brain haemorrhage which should not be ignored.

[SRMGrandma Volunteer]

The risk for stroke persists for 30 days after an episode. How much AFib you have is not the determinant, but rather your Chads2Vasc score. Strokes from AFib tend to be very debilitating. Not worth taking a chance.

[Hidden in reply to SRMGrandma]

Hello SRMG, that’s not something I have not heard before. Are you saying that anyone with AF is not at risk from stroke during the period 30 days after their episode until their next episode?

[SRMGrandma Volunteer]

No what I am saying is that the normal risk that you have is elevated during that 30 day period. Your normal risk is calculated by your Chads2Vasc score and is what you are treating for on a daily basis. Some people think once the episode is over, the risk for stroke has dropped and it has not.

[Hidden]

Thank you, I’m glad you qualified it. We frequently get posts from people anxious to find any excuse as to why they can or should stop taking their anticoagulant and some may have got the impression they could stop 30 days after an episode then take a DOAC as soon as they were aware another episode was imminent......

[doodle68]

Hi Sixtychick it is very confusing when advice is conflicting and opinions seem to vary among the Medics.

My older brother had one episode of P-AF while gardening , he has private health insurance and was fast tracked to a consultant during his one and only episode and prescribed warfarin and a beta blocker. That was about 12 years ago and he would have been in his 70s so a CHADS of 1. As I said he has never had another episode but will take warfarin for life.

I had one episode of P-AF lasting just a few moments about 20 years ago and thought nothing of it. I had occasional 'odd moments' again ignored then frequent regular episodes of what I now know was P-AF and was I diagnosed 3 years ago and was found to have a CHADS score of 3 and was horrified to realise I had gone years when my chance of a stroke had been vastly increased without my knowing.

Once diagnosed I was given the option of starting anticoagulation with a strong recommendation that I did so and having checked my CHADS and HAS-BLED it was an easy decision for me to make. I will be taking Apixaban for the rest of my life .

I am aware that in addition to my long episodes of P-AF lasting many hours easily recognisable by unpleasant symptoms I may be getting short episoes of P-AF which go unnoticed so it is important to take anticoagulants all the time not just during an episode.

Also if I only took an anticoagulant at the start of an episode how do I know a clot won't form it the time it takes to get into my bloodstream and start working.

Note on APIXABAN ..

......''Apixaban begins to reduce blood clotting within a few hours after taking the first dose. If you stop taking apixaban, its effects on clotting begin to wear off within 24 hours for most people.''.......

So once you stop taking it for any length of time it will be like starting again and take some hours to become effective , I would guess it is similar with other anticoagulants.

Every AFer has to decide what is best for their particular cicumstances , to take an anticoagulant or not is something only you can decide .