Risks of stroke vs. bleeding

[1275]

I’m 72 but quite active, biking, ladders, etc. I’ve talked to two cardiologists and they say it’s a toss-up between the risks of the blood thinner (severe internal bleeding following a head injury for example) and the risks of blood clot/stroke. That’s why I wrote for comments on the forum.

[jeanjeannie50]

I'm going to post about my bleed, look out for it.

[PlanetaryKim]

I have similar concern and feel that for some of us the risk between stroke and bleed is a toss-up. Oral anti-coagulants not necessarily in everybody's best interest. My opinion. But some cardiologists seem to share that opinion (although not my cardiologist).

[jeanjeannie50 in reply to PlanetaryKim]

After my experience, I agree with you Kim and have to decide which is my greater fear. At the moment taking anticoagulants wins as they could also help prevent the side effects of internal blood clots if I had the covid19 virus.

[PlanetaryKim in reply to jeanjeannie50]

good point about the covid and clot risk there.

[Hidden in reply to PlanetaryKim]

My cardiologist does think my risk of a brain bleed is greater than my risk of a stroke from a clot due to my history of bleeding on Warfarin and Xarelto. So many doctors are in lockstep with the conventional thinking and fail to practice personalized medicine. What is good for thee may not be good for me.

[Hidden]

If you're reasonably careful, which I guess you are at age 72 and aren't involved in hockey, boxing or rugby, then I would thought that having a head injury severe enough to lead to a bleed is far less likely than a stroke?

[CDreamer in reply to Hidden]

Certainly in my view.

[Hidden in reply to Hidden]

One can trip and fall at any time. Unless we plan to go around wearing a helmet, we are all susceptible to a head injury. If on a blood thinner the results can be catastrophic.

[Hidden in reply to Hidden]

Balance of risk I guess. Likelihood of fall with injury to head vs stroke! Personally I've known loads of strokes victims, so for me that would be top of my list.

[Hidden in reply to Hidden]

Sadly, we know so many people who fell in old age. They either hit their heads and had a brain bleed or broke a hip. My wife and I always remind each other to be careful because we are only one fall or illness away from a catastrophe.

[CDreamer]

Considering any medication is always a risk versus benefit assessment. It really depends upon individual circumstances and the best assessment tools available are 2 scoring systems which Doctors use, and you can do for yourself - CHADSVASC and HASBLED

You may find this link useful. mdcalc.com/cha2ds2-vasc-sco...

There is a link to the HASBLED on that page.

In my experience, in the end, individual choice comes down to ‘what are you most frightened of?’ In my case having had a TIA and a very tiny taste of the devastating affects of a stroke - I choose anticoagulants.

Jean is rethinking because she had a traumatic recent experience with a nose bleed.

My personal view is that most bleeds are devastating at the time and very scary and in Jean’s case it will take time to recover but she will recover, not many stroke victims from AF do or able to return to normal life.

It all depends upon personal circumstances, co-morbidities and age as these factors up your risk of stroke, no matter how well and fit you are.

[Tryfan]

Age 71. Fit, cyclist, hill walker, all round active, clumsy, not risk averse, enjoys challenges.

Bit like you I guess.

Last year I decided unilaterally I didnt need Apixaban. I felt fine no noticed episodes of Afib. A very occasional ectopic beat but fit and well.

A couple of months without, my GP rang and wanted to know why I hadn't requested a repeat script. I explained all the above feelings. A week later another call this time accompanied with a letter from Cardiologist whom I met when I was hospitalized with Afid 14 months earlier.

My GP showed me the letter. In no uncertain terms it stated to not take Apixaban was my choice but the risk of a thrombosis was real and that would be catastrophic to my health and well being. My choice, your choice. I choose to take the medicine as I dont have any known side effects.

Best wishes on your choice.

[Hidden in reply to Tryfan]

If you had "micro" brain bleeds like I had on Xarelto, you might think differently. It was as if I had developed Alzheimer's overnight. Everyone around me noticed that I was no longer functional. Good thing I had just retired because I could never have continued to work.

Thankfully, after stopping the drug, my memory returned over a period of a few months as the blood was reabsorbed.

[Tryfan in reply to Hidden]

Yikes, that does sound frightening. I guess it does come down as with most things in life risk balance. For myself I have three very good friends who I go on holiday with a couple of times a year who happen to be GP's. They said for me the biggest concern was banging my head. Accepting that, they were at one - take the pills. So that's where I am at. At my last review it was disheartening to hear my GP say your on them for life. But its a balancing act. Just hope I'm stacking the weights on the right side of the balancing scales. Best wishes.

[Spangle14 in reply to Tryfan]

My GP told me that the have to carefully the evidence the risk of stroke with Afib - she said that there have been many litigation cases because people were not told of the risk and sued when they or a family member went on to have a stroke, so there is a very strong reason for clinicians to get that message across.

[secondtry]

Yes I share your dilemma. Firstly, I have not found enough info on the stroke risk, just the often repeated x5 more likely without ACs but I need more & have asked this question on the surreyasg.co.uk Zoom meeting tonight. Secondly, like you I am pretty active for my 67 (3 miles walking daily, smallholding and pre-Virus walking basketball),prone to minor injuries and in the past have had stomach issues with aspirin. I am not complacent as had a DVT 20 years ago, found I had Factor V Leiden hetero and my wife had a mild stroke last year & still recovering. However, the bottom line is so far I have not taken any ACs but do not allow myself to become sedentary and take Krill oil & garlic plus 2 pints+ of filtered water daily. The matter remains under review!

[Steve101]

Difficult one. My thoughts are that a stroke is likely to have a devastating long term impact on you and your family. Where as hopefully a bleed whilst traumatic is less likely to have a long term impact. So like Jeanie I would stick with the anticoagulants, even if I hadn’t had a AFIB episode for a long time, particularly if the side affects weren’t bad. The thought of a stroke is a greater fear for me than a bleed.

Steve

[Thomas45]

Not a difficult choice at all,the choice between being incapacitated for life or a rare bleed. A no-brainer. I take Warfarin daily and have my own INR meter for peace of mind.

[irene75359]

Having seen the utterly devastating results of a severe stroke, and eventually losing that person, I would never stop taking anti-coagulants unless I had someone with me, awake, twenty-four hours a day to watch over me.

[Ianc2]

Walking, cycling, atc, great. I have become a bit wary of ladders though.