I have my prescription but have not been able to take the anticoagulants. I have a chas score 2 (simply - female and 71). My last AF episode was over a month ago (I don’t appear to have silent ones but dramatic ones), with three a month before that and two four years earlier. Consultant said probably the heart less efficient even without more episodes and I should be on Apixiban.
Anyone else frightened of starting? It is a forever friend...
Thank you to everyone who has offered helpful thoughts. I have just read the European Guidelines, if I have read correctly Paroxysmal AF has a slightly lower stroke risk than permanent or persistent, and for women anticoagulants are to be “considered” if CHADS VASC score is 2 or over and “recommended” if 3 or over. So, at 2 I am now obsessing further!
I chose to not start pharmaceutical anti-coagulants. Like you, I score 2 (female & 65). I feel fine about the decision. European Society of Cardiology doesn't even recommend OAC for women with score of 2. For us it is to be "considered" but not recommended until we reach score of 3. So the world's cardiologists don't even agree on this.
One top EP I consulted claimed I could stop my Apixaban a month following a catheter ablation. The EP I chose in the end took into consideration the inflammatory process of my autoimmune disease (RA), which in itself puts the patient at a 40% higher risk of stroke than someone without RA. I only have a CHADS-VASC score of 2 (age 66 & female), but am fearful of ever coming off an anti-coagulant.
I have had zero problems with the Apixaban, and would dread the outcome of a stroke were I not taking it. And I am no fan of prescription meds.
It’s unfortunate that many doctors (including two rheumatologists I have seen) fail to address the high rate of arrhythmia in patients diagnosed with RA. Although it is not a recognized part of the CHADS-VASC scoring system, I don’t see why it is not put on an equal footing with diabetes or other heart-related maladies. If you have an autoimmune disease, I think it may further muddy the waters in establishing your level of stroke risk.
I would be more frightened not to take anti coagulants. I totally ignored my very infrequent bouts of afib for years, not realising it was causing clot(s) in my heart. At the age of 63 I had a near fatal massive pulmonary embolism due to clot going walkabout. I'm now on Rivaroxaban for life in an attempt to prevent any more clots - which could cause another PE, a stroke or heart attack.
And we know for sure which side of the pond you are on. You Brits are so lucky to have your NHS. I am always impressed with the levels of care I hear about in the U.K. - what I read on these forums, my lwn expwrience in London years ago and from including from friends and family over there. Consistently a cut above and especially so in Scotland.
What symptoms did you have when your clot walked about? Glad you came through and are now well.
Breathing rate went sky high, as did heart rate. Was sweating a lot and feeling nauseous. No pain anywhere though. I thought everything would settle on it's own, but it didn't so ambulance took me to hospital. Chest xray and then ct scan with contrast showed the massive PE. NHS is fantastic in an emergency situation. I did come through it all, but I am very far from well nearly two years on. Currently in heart failure, pulmonary hypertension and severely leaking mitral valve.
Interesting - I just posted about an article where people are reluctant to start A/Cs in the US. To me it’s a no brainier, having had a TIA when NOT taking them with a score of 1. I couldn’t get back onto them quick enough! I have no problems with Apixaban, I did have some digestive issues with Dabigatran 7 years ago.
It really is about looking at the evidence and the statistics and risk:benefits.
I would be interested in knowing what exactly it is that holds you back? And then what sort of information you may need?
I have found that the problem with not taking consultant’s advice, even with good reason, is that they don’t like it! I was prescribed Bisoprolol, with Diltiazem as a fallback if it didn’t suit. My GP and I agreed that in view of my asthma I should go straight to Diltiazem. My cardiologist was not happy. He also demanded a full explanation of why I had changed from Rivaroxaban to Apixaban. After I was in A&E after three days of AF I was supposed, according to my discharge letter, to be ‘seen in clinic’ but it didn’t happen......
I hope you’ll be reassured by replies here, I take Apixaban with no problems I am aware of and having seen several family members die early of stroke/suffer vascular dementia I’m happy to take it 💜
I have taken anticoagulants for many years with no problems.
I have even had 2 serious accidents one where I severed an artery in my hand.
As soon as I arrived at the hospital the doctors realising I was on anticoagulants took appropriate action and as you can tell I have lived to fight another day.
Far better than the known risk of having a stroke.
Yes. Thanks. Warfarin has that reversal shot in case of emergency. Not all the anticoagulants do. I don't think Apixaban / Eliquis does. That is concerning.
I was reluctant to start taking an anticoagulant , now I would be scared if I didn't having learnt about the stroke risk of AF and the number of people who don't find out they have AF until they have a stroke.
I also felt reluctant to start anticoagulant. But looking the stats -I agree with BobD - it looked obvious it was right for me. I am cautious and risk averse and I would worry if I weren't on Apixaban. The thought of a stroke frightens me and anything to minimise that risk is welcome.
Being told one needs anticoagulation for life is a major occurrence - probably for most of us. Having an AF-induced stroke trumps all other considerations for me and is a risk too far.
One episode of AF or one hundred makes no difference - CHADs score indicates the way to go, together with physician’s recommendation.
As for various debates and differing views on whether it is needed at certain thresholds, I’ll keep on with Apixaban until there is proof that I don’t need it. As I’m 76, guess when that’ll be. 😂
With regard to the risk of taking AC: I am very risk-averse, so don’t want to take the risk of a stroke caused by AF! Someone close to me had a stroke at the age of 38 and I’ve seen the life-changing effects.
With regard to the risk of taking AC: I am very risk-averse, so don’t want to take the risk of a stroke caused by AF! Someone close to me had a stroke at the age of 38 and I’ve seen the life-changing effects.
I am postponing taking anti-coags for the following reasons not in any order 1) My stomach may have an issue with them (longtime ago I was put on slow release clopidigrel instead of aspirin) 2) There are no statistics that I have seen that show the odds of a serious stroke for a fit 67yo with PAF well controlled; the only stat often repeated is whatever your physical status you are x5 more likely to have a stroke if not on ACs 3) The medical profession are no doubt pressured by the drug companies to recommend anticoags & have nothing to loose by prescribing them despite consequent serious bleed or other issues, whereas if they don't prescribe they could be sued, what would you do? 4) Anticoags only protect around 70% of stroke occurrence 5) I am active, work on a smallholding and quite often bang my head/other areas 6) I don't believe introducing ACs to your body will have no side effects; just recently my cardio having said take Rivaroxaban now says take Edoxaban as info from the USA is not good re the former & I understand from here that Apixaban is better than Edoxaban. All of the NOACs have not had an established track record yet.
The important thing to remember whether you decide to take ACs or not is that no one can say you did the wrong thing as either way we don't know what the alternative in your particular case would have been; IMHO the stats are still not conclusive for 'low risk' patients.
The NICE tables and graphs for risk of stroke in afib patients on and off anticoagulants at various CHADSVASC scores are far more informative than the "five times more at risk" mantra so beloved of some here. At a score of 1 or 2 the difference in risk of stroke is very small.
Thanks for doing the checking, I thought that would be the case and my cardio (despite heading up the promoting of ACs in our area) is not strongly against me postponing taking them, though of course he covers himself by saying he would recommend it.
I had a score of 2 for being female and over 65 and my cardiologist said I did not need an anticoagulant. Then I had a TIA and went on Apixaban. The TIA was very subtle but came 6 months after an afib attack. I hate taking Apixaban but that TIA could have been a more serious stroke. I was lucky.
I had a score of 1. Used aspirin on Dr. Recommendation. Had a stroke. Lost partial vision. I am on Eliquis now. Have had no issues with it. My anxiety over having a second stroke is gone. That alone has been a blessing beyond words. I am at a 2x risk of stroke as opposed to a 6x plus risk given my history of previous stroke and AFib. That's my story. I know it's a tough decision, in my case, my stroke made it an easy one for me.
As am I maddiegran! I also am female and 71! I'm worried about the side effects of Apixaban, having taken Rivoroxaban with un-liveable with side effects. Also I will have to stop taking turmeric which keeps the arthritis at bay. However, I do take several supplements that are anti coagulant., namely said Turmeric, Gingko biloba and Natto. I do take the stroke risk seriously but ......I have had the script made up too, as my EP (NHS) got me a CT scan 3 weeks ago, with a view to putting me on Flecanaide. I'm not sure about that either! (But would like to know my calcium score and the state of my coronary arteries).I find Taurine and L-Arginine shorten the paroxysmal attacks. (Now 3 a month for 10 + hours instead of 16 hours.). I shall probably have to try it soon!
I was taking nattokinase when I had the TIA. Perhaps not a big enough dose. I was also taking a small dose of curcumin, fish oils and NAC - all supposed to have "thinning" effects.
That's rather concerning. Hope you fully recovered from your TIA Auriculaire? The Ginkgo is supposed to have the strongest anti coag effect and if I take a double dose can get slight nosebleeds, but point taken!
It was very subtle. I was gardening and when I got up from kneeling down felt a slight weakness in my right leg as if it did not want to bear my weight. I did not feel quite "right" but had no facial or arm signs. My speech was not slurred but I felt a slowness between thought and articulation. The leg weakness only lasted minutes. The real give away was the next day when I tried to write a shopping list. My writing was all squiggly. I went to the doc and he sent me for a brain scan. Nothing showed up but he was sure from what I described that it was a TIA. My writing is still a bit off but that is because I don't write much so never practised to get it back to normal. I tried gingko years ago - can't remember why- but it gave me headaches.
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