I had a telephone consultation with my cardio a week or so ago. I've been on the anticoagulant Dabigatran 150 mg twice a day and Flec 100 mg twice a day.
I've been in normal sinus rhythm now for 12 months with two afib episodes - an extra Flec soon sorted these out. My cardio said to carry on with the Flec (I fully agree) and I asked him if I should continue with the anticoagulant. It's a balancing act with the increased risk of bleeding V stroke risk IMO.
His answer was it's my decision (bearing in mind the bleeding risk V stroke issue). So I've decided to stop taking it and have done so these past weeks. My cardio advised that when / if I go back in to afib to start again right away (if it lasts for a few hours or more).
I'm generally in pretty good health - however I know that there is still a slight extra risk of stroke even if I'm in sinus if I don't take it. There's also a greater risk of an internal bleed if I do.
65 onwards is more of an at risk group - no doubt I'll be back on it then. I'm really undecided about stopping and if I've made the right decision.
HR is perfect at the moment 53 / 55 at rest. Lower first thing in the morning when I normally check it (45 this morning) and no signs of afib at all. I'll soon know if (when!) I'm back in afib after so long in sinus the minute it happens. I have an 'emergency' supply and can soon start again if I go back into afib. I think it's pretty quick acting drug too.
I'm really unsure if I'm doing the right thing. Added stroke risk or internal bleeding risk ?
Just interested in your thoughts - I know the forum is unable to give medicial advice but what would you do ?
Deal or no deal ? I'm really undecided about this one.
Enjoy your weekend.
Paul
Edit - just to be perfectly clear. Anticoagulant's are mega important - if your cardio has put you on them STAY on them. We are all different and my post only applies to me and my personal situation regarding age / no underlying health conditions etc.
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Paulbounce
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Again personal opinions only but I will never stop anticoagulation even with no AF since the heart has been changed by the AF. Yes there is a theoretical bleed risk but very much lower than thrombiotic stroke risk for most people and as I said recently many people happily take aspirin which is the worst of all worlds. A wise man once told me you can always stop anticoagulation but you can't undo a stroke.
Here in UK we are very bad at keeping at risk patients on anticoagulation I fear compared to Europe in general. At one point we had the lowest percentage of at risk patient anticoagulated apart from Latvia and it seems in many cases to be GP reluctance with some exceptions.
Bottom line as they say is your choice but for me even warfarin has zero affect on my lfe so why stop?
If you weren't taking any medication. I could perhaps say yes, don't take your anticoagulant, (though just a year AF free doesn't seem long enough). However, you are on quite a high dose of Flec, which is probably keeping you AF free.
I'm very anti tablets and when younger used to take myself off them all the time, never consulting anyone medical as to whether I should. I always thought I knew best and doctors just handed out tablets for the reward they would get from the makers. This was the way I was brought up with my dad very anti pills of any sort and preferring natural remedies and healthy eating. Now, I don't know if I could be without my anticoagulant.
Someone who's a friend of some friends had a stroke last year and lost his sight! Also having worked in a nursing home I've seen quite a few people only aged 60 and the devastating and disabling effects a stroke had on them.
Afraid my answer in your situation is I don't know what I'd do. It's your personal choice and I'd support you whatever you decided. My feelings are 50/50 either way. If you do it I'd say you have to eat healthily though.
I’m in the ‘as few pills as possible’ camp but I was shocked to find I was having AF episodes without noticing so I’d never stop. In your position I probably would but I’d feel nervous 😓
It’s funny how there is an arbitrary line in the sand with age. If your 64 3/4 your risk is lower than the day you turn 65.
I haven’t had any known AF for 16 months (I’ve had tachycardia and ectopics). I am only 56 and am on anticoagulants and will be for life. I am borderline on the risk level for whether I need to be on them. Other than being female, the only box I tick is blood pressure. Most of the time my BP is perfect (110/70) but my EP says “any history of blood pressure problems” counts. I had major issues in my pregnancies and whenever I get sick or injured it has a tendency to shoot up.
My grandmother had her first stroke at 48 and my Aunty had one around a similar age. Two years ago, doctors found a blood clot in my left atrial appendage when they were about to do an ablation. That brought home to me how real the possibility of a stroke was.
These figures that change seemingly arbitrarily are to do with statistics. Modern medicine from.what I can see assesses risk factors with statistical probability. Health is about the individual. This might be why Paulbounce got this response from his cardiologist.
I have had similar thoughts but have followed my doctor's advice to keep taking rivaroxaban. I gather that the risk from an internal haemorrhage is far lower than that of thrombosis, and that a thrombotic stroke is far more common and more likely to be catastrophic.
As for your being otherwise healthy, that's brilliant, but I was thinking - wouldn't you need a raft of tests along with whole-body scans to be sure that there are no "silent" health issues?
I'm female so different situation re CHADVAS-2 but similar age to you. Haven't read other replies but isn't it dependent on BP? I was out on anticoagulants as a matter of course in diagnosis - though I really didn't want them. But at that point they were talking about possible cardioversion. A and E - no-one expert that Sunday morning clearly! Later I found my BP had crept up.from being traditionally low. So I've not questioned the anticoagulants. Interested to see what others say here.
Your cardio advised that when you go back into AF to start back on the anticoagulant. My question is how will you know? Yes of course you'll know if you go back to paroxysmal AF, but you won't know if you have asymptomatic persistent AF. At some point between annual cardio visits I went into asymptomatic persistent AF. I have no idea when that happened. Fortunately I was taking an anticoagulant daily, which five years after the discovery I am still taking.
This is a really interesting topic and I think several people will be interested in the replies, I certainly am. I was in 2 minds as to take them as i have had 2 ulcers and get duodenitis a few times a year. I have to keep stopping and starting to give my tummy a rest even though I take protective meds. I have PAF and I am usually really aware if I go into AF., but I am really concerned if I go into AF without realising. Looking forward to other replies and comments.
I hate taking Apixaban. I am convinced it is making my joint pain worse though not being the cause of it. My episodes of afib are symptomatic but are becoming less so. I have had 2 that have started whilst I was asleep. Both times I have woken up not feeling "right" , checked my pulse and found I was in afib. I might be having episodes in my sleep that do not wake me. I doubt it as all my episodes have lasted several hours ( longer than I sleep for) but I cannot be certain. So I will continue to take it though each time I pop that little pink pill I think " poison".
Your reply reflects my own experience of AF, almost to the letter, as do my thoughts when I 'pop the pill' which in my case is Rivaroxaban; I would be fearful of stopping it though.
I was told the afib (rate/rhythm control) was a separate issue than blood thinners. My Dr used the CHADZ score to decide if I should be on blood thinners. And my score is high enough to stay on them
However I fall alot (unrelated neurological problem)- so the concern of bleeding is high. So Dr has referred me to be evaluated for the Watchman Device which for some people will make it unnecessary to take blood thinners. I am currently being evaluated for that now. I hope I am a candidate for that surgery so I can SAFELY stop taking blood thinners under Drs care.
I had the same discussion with my GP and he advised me to keep taking warfarin as my INR was stable and it wasn't causing me any problems.
I asked him if I could maybe just take them if I slip back into AF (I'm very aware when I'm in AF) but he said he's seen too many people who have had strokes to muck about with it, it's by far the lesser of two evils.
I was interested in how quickly a blood clot can form in the heart, could be days, could be a couple of hours, but they don't really know.
If it's not causing a problem why stop them and risk a stroke?
I don't take them all the time due to a bleeding disorder so I cannot. The main drawback is that should you need a cardioversion as I did (and your useless local hospital is too incompetent to do it within 48 hours) you then have to wait at least three weeks for them to do their job before you can have cardioversion.
I'd sooner be off them than losing 2.2 litres of blood in six weeks!
I had an ablation in 2013 after a consultation I was offered A/c but declined as at that time there was a small risk of a stroke they told me,
I decided late last year maybe now's the time to take them I consulted 5 different GPs two said no and two said yes number five wouldn't commit so I thought Id give them a try
for me it was a pain in the butt I was forever bleeding due to cutting myself ,shaving, or something else..
I can see how easily you can bleed to death ..so I decided to come off I saw a GP before hand and he said just stop no drama but come back if I needed to
that's my experience hope its helps..
Hi Paul I was given the option to come off as ChadVasc score is 1 due to previous high blood pressure (now ok as I'm 20 pounds lighter than a few years back plus big lifestyle changes), I refused, feel safer on it, on 150 flec a day, odd short episode usually after stress or crap nights sleep but usually months between each episode. Personally I wouldn't take the risk, I am on apixaban which according to my limited research is the safest anticoagulant.
When I started on Pradaxa (Dabigatran) for PAF, my cardio said I was very low stroke risk, so agreed to my taking the lower dose - 110mg twice daily. This seems like a good compromise - I wouldn't want to be without an anticoagulant but am still fairly low risk so don't need the full dose.
Difficult one isn't it? Have you thought about asking Dr opinion on maybe taking a lower dose continually ,kind of a half way house between no possible clot protection and some protection.
I must admit I was very glad to finally get on to Apixaban . My GP was reluctant but consultant very clear. I was female,high BP and strong family history of stroke ,aged 57 at the time.
By the way ,take into account family history if you know it.
I have the same query as yourself, a year on from cardio version as a result of atrial flutter. I have taken myself of calcium channel blockers, with knowledge of GP, as after the cardio I had bradycardia and bigemini and also they caused me to have several lengthy nose bleeds. My heart rate varies from 51 to 72 bpm. Last week I had telephone discussion about this with GP who said he would write to cardiologist to take his advice. However, my late father had a massive stroke and his brother a less disabling stroke, which I believe makes me at greater risk of also having a stroke. I just need someone to say best to carry on forever or no need to take after a year free of atrial flutter. I had no follow up after cardioversion and was due to go to outpatients in May which thanks to virus was cancelled. Now resheduled to January 2021 which is almost 18 months after the cardio.
Some great replies here and some food for thought ! Thanks all for taking the trouble to reply.
The last thing any of us want is a thrombiotic stroke. The life changing effects can be devasting and I don't think I'd be strong (or brave) enough to cope. Daft as it may sound I would prefer a quick bleed out and have it over and done with.
In someways I feel safer not taking them. For example driving - I'm less worried about being in a collision that could cause injury. On the other side of the coin there's the fear niggling away in the back of my mind about the extra chance of a stroke.
Wilsond wrote
"Have you thought about asking Dr opinion on maybe taking a lower dose continually ,kind of a half way house between no possible clot protection and some protection"
(PS - nice to see you posting Wil. I hope all is OK with you).
Kath wrote
"When I started on Pradaxa (Dabigatran) for PAF, my cardio said I was very low stroke risk, so agreed to my taking the lower dose - 110mg twice daily. This seems like a good compromise - I wouldn't want to be without an anticoagulant but am still fairly low risk so don't need the full dose"
Now there's a thought ! I think a call back from my GP is on the cards. I wished I had thought to ask my cardio this at the time.
Is anyone else on a lower dose as a half way house ?
Andy wrote
"Personally I wouldn't take the risk, I am on apixaban which according to my limited research is the safest anticoagulant"
Cheers Andy - I'll check apixaban out. Well done for losing the weight by the way
I'm still a little undecided but starting to think 'deal' might be the best option. However with a CHAD score of 0 it might worthwhile to check out the lower dose option first.
Once again thanks to all of you for comments and opinions - I will certainly take them all on board.
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