Suppose a woman has been diagnosed with Afib. She is otherwise healthy - She has no other health ailments - all she has been diagnosed with is Paroxysmal Afib. Her blood pressure is low normal, her cholesterol level is low normal, her weight is low normal.
She has a healthy lifestyle. Her diet is primarily whole plant based - all meals are prepared at home - no deep frying prepared meals… mainly fruits, vegetables, nuts, seeds, pseudo grains...
She is also physically active.
Because she is a female, and she is between 65 and 74 years old, her CHADS score is 2. According to this score she ought to be taking anticoagulants.
So, the question is, should she REALLY be on Blood Thinners, that is, will benefits outweigh risks of being on blood thinner in her case?
Thank you kindly.
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Ruza2020
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I will just say to you what was once said to me. You can always stop taking anticoagulants (they do not thin blood) but you can't undo a stroke. AF makes us five times more at risk of the worst kind of unrecoverable strokes. Your choice.
A few years ago ( I am not up with latest numbers) Britain was one of the worst countries in Europe for having at risk patients anticoagulated and it was calculated that 8000 deaths from stroke a year could be saved if that was changed. A lot of this was down to GPs who traditionally are rather reluctant to prescribe Whilst I am sure we have improved we could still do much better.
I have been taking anticoagulants for about 10 years now.
I have had no side effects.
However 4 years ago I was unlucky enough to severe the artery in my hand, a very serious matter. The doctors were aware that I was taking Warfarin and took the necessary steps to safeguard my life. It was a bit scary at the time but I am here to tell the tale.
I have no problem with continuing to take anticoagulants as I know that without this medication my risk of stroke would be significantly higher.
Many are reluctant to take all sorts of medication but for me it is definitely the lesser of the two evils.
Pete
No, but your choice......having worked with stroke victims for me, it’s a no brainer!!
If you have been diagnosed with Paroxysmal Afib, then your heart is not always beating correctly - that's the problem, because it means clots can form and cause a stroke. It's because you have PAF that you need to take an anticoagulant.
Thank you guys. It is interesting to see that all responses, so far, have been unanimous.
Have a great weekend all!
All the answers are unanimous but.... I have PAF, age 67, mild high blood pressure, annoying osteoarthritis, otherwise I think Im pretty healthy. I do take xarelto and often wonder if it is worth the $$ and risk. But I take it as that is what todays science tells us is best.
You don't mention your AF record or your age. If you were under 70 and you can confidently say AF episodes are not re-occurring, with no other relevant health issues I would say anti-coags are not a No - brainer (sorry, poor pun not intended). Many are convinced they are essential but personallyI have not seen sufficient stats to overcome my distrust of Big Pharma's influence over research and medical practitioners e.g. what is the strata of risk levels for your 'healthy lifestyle' category for and against taking them. Myself male at 67yo with a similar healthy lifestyle, I have not taken them to date on a regular basis. However, I am currently looking carefully at all the information here and elsewhere including taking into account the practicalities of my life if I had a mild stroke - decision time again!
The only thing I would ask you to bear in mind, if you are unfortunate and have a stroke, there may NOT be a chance for a secondtry!!!(Pun very much intended)
I had an ischaemic stroke in December 2019 and was thrombolised within 3 hours. Subsequent investigations identified AF as the cause as my heart was pumping too fast to allow the chambers to empty fully causing the clot. I am on 10mg of Bisoprolol and an anti coagulant among other meds and very lucky to have had no after effects from the stroke. Bye the way I was 73, very active sailor and yoga practioner
I'm Chads 2, last year I saw 4 different doctors to get some advice on taking anticoags..
two advised againt taking anticoags and two said take them, they all have varying views on the subject I learned
I did start to take them but found I was forever gettings cuts and bleeding took age age to stop Im quite active and always doing DIY projects where as before it wasnt an issue now it became one,
I decided after a few weeks I couldnt live like this so consulted with a doctor before making a decision to stop taking them it wasnt a big deal he just said ok stop taking them and that was that,come back if I change my mind...
If my chad score rises I'll go back on them at present I'll live with the small risk
No, they are not over prescribed, probably far too under prescribed, in my opinion. You may not WANT to take them but all the evidence is in - you have AF and are over 65 so no discussion as both factors raise your stroke risk significantly whilst other factors may influence your general health but are not of relevance on this matter.
Agree with all the other replies - if you like playing Russian Rouletter then go ahead and try. I stopped a/c’s after being AF free for over 12 months, aged 63 and had a TIA - couldn’t get back on them fast enough.
A word of caution to anyone like yourself who starts anti-coags for a while and then stops, I understand (sorry can't remember the source) there is an increased risk of an issue than if you had never started. So the morale is proceed when you are absolutely sure you want to stay on them for life.
See my reply above. I’m no longer in AF but wouldn’t consider coming off them now as the evidence shows that even after successful elimination of Af after ablation, which was happened in my case as I was so desperate to come off them, the stroke risk remains.
Whilst everyone is entitled to share their opinion, if that opinion is expressed by someone who is not medically trained and is at odds with everything I have heard from people who are, then hopefully, the opinion is probably best ignored.......personal view of course.
As I understand it, atrial fibrillation and flutter cause a physical disturbance in the blood that naturally pooling in a part of the upper chambers of the heart. This creates the conditions for micro-emboli to form and these can go on to develop into a thrombus.
So, to my knowledge, anticoagulants are very important to us indeed.
Wheras I fully understand CDreamer's opinion, Anticoagulants can have undesired side effects also such as internal bleeding. If someone has had 7 ablations they should take A nticoagulants. However, if a first ablation has worked effectively and one has had Paroxysmal type A Fib prior to ablation it may be possible to stop them once the healing process period has passed and no recurrences if A F. It is a personal decision and one has to weigh up all risks, and make an informed decision.
Hi F -M. I think it’s important to note that anticoagulants do not cause bleeding. They can make a bleed worse but they are not the cause. Aspirin on the other hand work differently and definitely can.
Absolutely a personal decision. As humans we make decisions based upon our emotions, not reason although some people are under the illusion that we do. So, it depends upon which you are more scared of - bleeds or stroke. I’ve never had a bleed in about 6 years of taking various DOAC’s but I have had a TIA, which I interpreted as a warning. I now have a PM so a/c is absolutely a requirement for me now.
As Hilly says a/c does not cause bleeding, but obviously blood takes longer to coagulate so bleeds go on longer but very rarely need interventions to stop bleeding.
My EP absolutely disagreed with your opinion and tried to persuade me to continue - my CHADS score was at that time 1 - for being female, I pushed, he reluctantly agreed that I discontinue after 12 months free of AF, I had a TIA a few months later - that convinced me that a/c’s were required, even after AF has been eliminated.
Advice seems to vary between various countries so I think we need to all need to take individual conditions into account, take the best available medical advice, read and inform ourselves and then make our own decisions.
So much fear about anti coagulants, amongst doctors as much as patients.
I share your skepticism about Big Pharma. Bear in mind that a CHAD score of 2 (mine also) translates into a possibility of a stroke to less than three percent. Big Pharma has convinced the medical profession that it is imperative to reduce the risk to virtually zero. Hence, the conventional wisdom to prescribe anti-coagulants generally. A three percent risk is not statistically significant. Period. My quandary is that some patients (me included) suffer side effects from anti-coagulants like warfarin that can be lethal (i.e. uncontrolled bleeding, gastrointestinal bleeding). In my case warfarin caused a clot to leak in my eye, which left me blind and the need for a vitrectomy to restore my sight) and gastrointestinal bleeding. As long as my chances are not significant, why are doctors over prescribing anti-coagulants? My cardiologist is quite upset that I do not take an anti-coagulant and has refused to take into consideration my unique situation. In addition I have two very small hemmorhages in the other eye and I'm reticent to play Russian Roulette with them for a statistically insignificant chance of an event. I was diagnosed with atrial flutter four years ago. And my echocariagram is one of a person thirty years my junior. If my CHAD score moves me to a significant chance of risk, of course I shall recalibrate.
I can understand that for you the risks seem higher for bleeds than for stroke and that is where it then becomes a risk assessment and a personal decision. For the majority, who do not have these sorts of complications, then the evidence that I have seen, the statistics on strokes for AFibbers are such that I am more frightened of stroke than bleeds and convinced, having read many studies and talked to quite a few doctors, of their efficacy and safety, but there are exceptions and we all react differently to some types of drugs. There is quite a list that I need to steer clear of.
The risk factor will increase every year, although your CHAD score may remain the same.
I am not as sceptical as you are about ‘BIg Pharma’ but I know how it works, having worked for several companies. It is about making money, the capital system we live in means it has to be that way.
Best wishes and I hope you don’t ever become one of the AF stroke statistics.
I was advised to continue anticoagulants throughout all the years not just because I had numerous ablations.
The decision is yours but you know how I feel about it. I would rather have the limited potential for side effects from taking anticoagulants than risk the increased risk of stroke without.
Only way to find out is not to take them. Then if she has a massive stroke or develops dementia from micro emboli she’ll know the answer and may be able to come back and tell us 💜
This is not a kind reply! I have tried all the anticoagulants except Pradaxa and had to stop taking them due to severe side effects.I'm terrified of having a stroke.Some of us are not lucky enough to be able to take them and carry on as usual.The reason I haven't tried Pradaxa is because it is not advisable if you suffer from stomach ulcers.
I’m sorry, but it is very rare as far as I know for people to have side effects from anticoagulants so my comment was aimed at those who don’t have a problem. There is a procedure available for those who can’t tolerate anticoagulants - Left Atrial Appendage occlusion, maybe you could investigate that. I appreciate that you are in a very worrying situation 💜
I may be wrong but I think it can be if you are unable to take anticoagulants for some reason. What side effects did you have? It’s very difficult if you can’t take a vital medication - I am allergic to penicillin and when I developed sepsis from a bowel abscess the doctors actually groaned when I said I was allergic 😞
I am right but unfortunately the procedure requires you to take an anticoagulant of some sort - aspirin/clopidogrel beforehand according to the Royal Brompton and Harefield website ☹️
Have sailed the Atlantic twice, Vancouver to San Diego (just two of us) and would do more, alas the bones are a bit stiff, but I am healthy and comparatively fit. My cocktail includes apixaban, yes bleeding to death wouldn’t be much fun but heh, a stroke, No choice!!
The latest recommendations from the European Society of Cardiology is that if the 2 points are for being female and age (ie over65) and there are no other comorbidities then anticoagulation is not mandatory. My cardiologist said I did not need an anticoagulant when my score was 2. Then I had a TIA. It was very subtle and came 6 months after my last afib attack. But my score went up to 3 so onto Apixaban straight away. If I had already been on Apixaban I probably would not have had it.
My concern as being similar to yourself in aspects diagnosis age sex lifestyle I’m more worried about the risk of stroke.....you can listen to your doctors and make your own mind up but their guidance is important. I take the medication don’t like it but it makes life easier.
You may like to listen to the podcast in the post I put up recently. Interestingly the professor who was speaking believes if anything doctors are underprescribing anticoagulants. I'm relatively low risk (but I had a history of hypertension in pregnancy and then again when my AF was playing up) but having had an ablation abandoned because doctors found a blood clot in my heart, I'm happy to take them. I have proof that a blood clot can be formed very quickly in my body (I was off anticoagulants for 2 days before the procedure) and I havewitnessed the effects of stroke first hand on family members.
I feel the question is pointless really because if the answer is ‘yes’ then we are all being duped and are falling for conspiracy theories - without proper consideration of our own health. Are we all really so gullible? I think not.
No "conspiracy theory" or "duping" required for a drug to be over-prescribed. It's a valid question the poster is asking. For years and years all doctors everywhere said everyone over 65 (regardless of whether or not they have afib) should take a baby aspirin daily as stroke prevention. Now that has been completely retracted in the past year. But at the time, it was neither conspiracy nor duping that had doctors getting all their 65+ patients on baby aspirin.
My issue with the question is that if my answer is ‘yes’ then I am taking a fairly powerful drug which I believe to be over-prescribed. That is an untenable situation and would lead me to be anxious that my treatment was not effective. So I would feel duped into taking something which I perhaps don’t need.
The issue with aspirin advice is that it was considered to be suitable at the time but medical knowledge moves on and, hopefully, improves.
Who decides if something is over-prescribed? This is where conspiracy theories gain purchase unless we apply the science, rather than the anecdotes.
Yes, aspirin advice was considered suitable at this time... and has since proved not to be. The rush to use OACs for nearly all Afib patients , now viewed as "suitable" may later not be seen that way. In which case it is currently being over-prescribed.
And only time will tell. For me, living in this time, the evidence in the UK indicates that a/c is are still under prescribed for AF, which is why we have such a high stroke death rate.
Aspirin hasn’t been recommended for stroke prevention for AF for at least 5 years, to my recollection, in the UK. I know in US the advice was different and some doctors were still advising that aspirin was ok.
Anyone who has mental capacity has the right to refuse medical advice and treatment. There are a few I wish I had refused but anti coagulation is now not one of them but if you go back and look at my first posts from 2013-2014, I was very against them, especially Wafarin, but BobD and a few other took time and patience to help me understand just how important they were.
No!! Too many folks want to do away with blood thinners. They are not thinners but anticoagulants. Natural is not better. Quit trying to find ways. Dangerous and not productive
Being that my CHADS score is zero I have not been prescribed a/c's. AFib on and off for last 8 years. I did take aspirin for approx 5 years but was advised/ told to cease taking aspirin this year.
Yes people do worry about the risk factor My surgeon was concerned I was on Rivaroxiban so I had to stop it for 3 days before he removed most of my pancreas, my duodenum, gallbladder and bile duct! After the operation I had the anticoagulant the injected into my belly 😟 and then back on Rivaroxiban a few weeks later when out of hospital- the possibilities of stroke or blood clots outweighed the bleed risk !!!!
I was just wondering how your Chad score is 2?. I have been resisting bloodthinners for years and am still not on them as like you my blood pressure is usually normal, my usual heart rate is around 64, my cholesterol is a bit borderline at around 5.6 though, I have never had a stroke and have not been diagnosed with anything heart related except PAF. When I was taken ill in Tenerife because I could not correct the A-Fib and my heart rate was about 150, the hospital put me on Edoxaban and Bisipropol but when I went back for my outpatients appointment the very nice Consultant agreed that as my BP and heart rate were usually good, I need only stay on them for a month till any danger of a clot having formed while I was in A-Fib for 2 days has passed. If the doctors in the UK try to put me on blood thinners I will resist as I believe my CHADS score to be zero till I reach 75. One thing I did come to realise though is that Bisopropol, which I thought was for BP, is also given to lower the heart rate so when I have an A-Fib attack I take 1.25 of Bisopropol with my 200mg Flecanaide and it can, though not always, shorten the duration of the 'Blip'. I hope this helps.
You might not be using the most current calculator for your CHA2DS2-Vasc score. Here is a link to the current calculator: mdcalc.com/cha2ds2-vasc-sco... (includes 1 point for female and 1 point for 65 or older).
Thanks PlanetaryKim for the link. It is the same stroke-risk-calculator I used. You are saying the same thing I have said in my post -- 1 for being F + 1 for being between 65 and 74 = 2. And the score 2 or higher = High risk. Accordingly, an individual with score 2 ought to be on anticoagulants. Right?
My understanding is that current US guidelines say women with score of 2 or higher should be on OAC. But current European guidelines say women don't need to be on until they score 3. So you and I, both scoring 2 and being physically fit, etc, are - in my opinion - in a bit of a grey area. If we are more concerned about stroke risk than the risks of apixaban or warfarin, then I guess we take the OAC. But I am right now more concerned about the OAC risks. So I am not on any OAC.
This summary of Eliquis (apixaban) side effects is very thorough and concerning: drugwatch.com/eliquis/side-... . It goes into some detail on the fact that if you start and then stop you have significantly increased your clotting/stroke risk over where you would be without starting in first place. And of course the risk of uncontrolled brain bleed, GI bleed, liver damage... I say uncontrolled because the antidote for apixiban/eliquis, is still not widely available. Whether the ER at my small hospital would have it if I should come in with a brain bleed... I don't know. There are class actions lawsuits against Eliquis/apixaban for these reasons.
My point would be, for anyone else reading this, it is not an easy choice to make. And not as clear-cut at all as many of the pro-OAC people are claiming. There are very real potentially life-threatening risks either way one goes with this.
There were huge class actions in the US against many of the OAC’s, especially Dabigatran if I remember correctly, back when they were first released as they got the dosage wrong for elders. US and European advisories differ + in Europe we do not have the huge litigious burden that makes healthcare so expensive in the US. Unfortunately, we may be going that way though!
This is very much my question too. The experts seem to say it doesn't matter if you have afib once a year or constant non-stop day and night. Stroke risk is the same and need for OAC the same. But logically and intuitively that does not make sense to me.
I am hoping I have seen the last of my afib (because a certain drug causing it has been removed from my life). But only time will tell. So I am not keen to go on to an OAC at this point. Nor have I had any OAC for the 5 years I had occasional atrial flutter. I had a single 4-day Afib episode earlier this month. I don't particularly want to roll the dice on stroke. But OAC such as apixaban also has potentially serious consequences, and will actually increase your stroke risk if you start it then stop it. So... for now I am monitoring my pulse obsessively to make sure it is not arrhythmic. And working on lifestyle factors (stress, sleep, hydration, computer exposure) and taking some supplements (Vitamin C, D, Magnesium bisgylcinate, Co-enzyme Q10), all in hopes of keeping my heart steady and strengthening it further. Will re-evaluate if I have another episode.
Statistics are numbers - taken from the number of people within a population who die or suffer a stroke. Those statistics are then used to calculate risk factors. CHADS is a very blunt tool but the best one we currently have. There are no knowns for us as individuals on this subject so we must learn to live with uncertainties as best we are able. All I can say is that I am much happier now, having been satisfied that for me, a/c is essential. Have no idea what my current score is but when I made the decision, I didn’t have any AF and it was 1 for being female.
A bleed probably will be, if it’s an intestinal bleed, be controlled. I talked to an A&E doctor about this and they remarked that with such bleeds most resolve on their own, without interventions. If it was a catastrophic bleed caused by trauma, with or without anticoagulants, there probably would be little they could do anyway and the modern anticoagulants would be unlikely to have made much difference. That of course is anecdotal and personal opinion, but from someone with a fair amount of experience. Apixaban has a 12 hour half life so that watch and monitor to see if the bleed stopped on it’s own was the preferred option.
Stroke, on the other hand, especially AF stroke, was unlikely to be reversible and you would be living with the affects for the rest of your life. Anyone who knows someone who has suffered a severe stroke will know that is not something any of us would want to survive and live through.
I do think I these discussions are useful as they help us to define, know and express through our feelings, thoughts and help us to come to a decision that we can live with comfortably.
A brain bleed would also probably affect you for rest of your life. And one of the articles I read - I think the link I posted - said due to low availability of antidote for eliquis, must wait 24 hours from last dose before blood can clot itself properly. 24 hours of brain bleed will not have a good outcome. this is what some of the lawsuits were over.
i think the part that disturbs me the most is that if i start it (reluctantly), and then subsequently stop, as i am likely to... I would actually be at increased stroke risk from where I am right now.
It’s certainly a dilemma and a difficult one and it is your decision and you must be content that it is the better of 2 evils and that, at this stage, is the best we can do.
My brother had 2 significant brain bleeds, not on any anticoagulants but a heavy drinker which probably had the same affect and he seems to have fully recovered, after surgery to cauterise the bleeds.
I wouldn't worry too much about your cholesterol level provided you have no other issues turning it into an issue e.g. high BP. My C has been around 7 for 25 years and the medics tried to put me on statins several times, fortunately I resisted and 6 years ago when I had my arteries checked following the onset of AF they found them all clear!
Hello. I have PAF following mitral valve replacement plus high cholesterol and controlled BP. Cardiologist has agreed -based on LAA surgical excision and clear arteries under exploration plus low calcium score-that I don’t need to take anti coagulation. However if in permanent AF must take.
Thank you PlanetaryKim for the article on Eliquis. All drugs come with risks and side effects, and as the saying goes "What can cure you can also kill you
If one is relatively young , is fit and healthy with no other underlying conditions, and if ablation has proved to be successful, why would one continue taking drugs that may not be necessary.
I have already posted that when I stopped taking Eliquis/Apixaban some months following my ablation, the headaches and visual disturbances also stopped immediately. That was my personal experience, and everybody reacts differently to drugs.
Thank you everybody for such a lively discussion. It appears that some might have misunderstood the intent of my post. The post was NOT meant, by any means, to encourage anyone to disregard their medical providers’ advice, nor to encourage anyone not to take their anticoagulants.
There is no doubt about it, it is a tough call for many of us Afibers when it comes to choosing a ‘right’ approach regarding our Afib management.
But at the same time, I believe, we ought to educate ourselves as much as possible about this beast we have been endowed with, sadly.
Dr. John Mandrola (well known electrophysiologist) says: “The most effective way to treat AF patients is to provide them with information… Af is nuts. It can cause heart failure, and stroke, or it can cause nothing. It can disable some and others don’t know they have it…”
He continues to say: “…Yet even more remarkable than the vastness of AF’s prevalence is its diversity. AF could be the most diverse disorder of any organ system. For instance: The incidence of AF increases with age, but it affects the young and middle-aged as well.
Wear-and-tear diseases like high blood pressure, sedantarism, obesity and sleep apnea increase the likelihood of AF, but AF also afflicts the athletic and nimble.
The symptoms of AF can range from truly asymptomatic to completely disabling and everywhere in between.
The prognosis of AF can range from innocuous to near-catastrophic…”
Truly crazy and difficult to treat affliction.
Here is a link to Dr Mandrola website for those who wish to check it out. It is very informative - I highly recommend it.
Personally I wouldn't have taken Dabigatran for the reasons stated i.e. healthy lifestyle etc. BUT I went into persistent afib and that is a different situation entirely. This is because regardless of lifestyle factors long term afib can cause clots to build up in the heart. This makes cardioversion dangerous unless you have been anticoagulated for at least 4 weeks.
Hi Mike. I agree - blod thinners are must if one is to have cardioversion... In my case things have changed since I wrote that post. I too am now in persistent Afib. I had many DC cardioversions since May of last year. With great deliberation and hesitations I started taking Amiodarone.
And you are right no lifestyle, in my case, helped...
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