A question to throw out there - if being over 65 and female gives you a Chads of 2 and deems you high risk for a stroke, and being, say, 59 and male gives you a Chads of 0 and deems you very low risk for a stroke, what is happening in the heart for both these scenarios? Assuming that both have ongoing afib, with no comorbidities, why would one be at less risk than the other? Surely the risk of clotting is still the same, as it is the erratic behaviour of afib that affects the blood flow that can cause the blood to pool and possibly clot. Is it the case that the risk is just as high for both, but age is the factor that increases the risk more, simply because, as we age, our stroke risk goes up anyway. I hope you can see where I'm going with this and would be interested to know your thoughts.....
Stroke risk: A question to throw out... - Atrial Fibrillati...
Stroke risk
Good question, don’t have the answer but my guess is arithmetic = purely statistics.
I am guessing that the afib, alone, will always carry the risk of clotting and the other factors taken into account simply add to the risk. That said, my train of thought has made me question why AC isn't considered necessary for everyone with afib, as the risk of clotting is there anyway.
My friends husband aged fifty, slim, fit, no co morbidities had a stroke while driving and crashed into a tree. Turns out he was in continuous AF but unaware of it which would support your point . He made a full recovery btw
Yes it is an interesting question and one that was raised a few times at our support group meetings. If I remember correctly, it was something to do with the change of hormones during and after the menopause, particularly oestrogen.
Being a newbie, I haven't yet attended a support group meeting. I do remember, from when I was going through the menopause, that the lack of oestrogen has a bearing on heart health. However, I still don't think that is likely to have any bearing on the clotting risk 🤔
I don’t know, but others here may have more information......
Thank you flapjack. Any info greatly appreciated
I guess the menopause is a significant difference between male and female and there may be a connection with periods but it’s way outside my sphere of knowledge....
Yes, I can see that that difference could well affect heart health but still maintain that it would not make a difference to the clotting risk.
We are not researchers into clotting! Surely anything that may affect the heart (including menopause/ hormone changes) will affect clotting. The flow can be disrupted, and disruption affects flow and flow irregularities allow blood to clot.
Just as an aside, I have had an arrhythmia problem in excess of 30 years but the afib is a bit of a newcomer for me. So, have had a lot of irregularities over the years but I guess that Afib's unpredictability and the general chaos it causes in the heart makes it affect the flow more and is therefore more of a risk.
I have just delved into Dr Google and it says that women’s risk of stroke roughly doubled in the ten years post menopause. Didn’t elaborate on why or whether that took our risk to being on a par with men’s or above that . More digging would be required to elicit that
I’ve just checked your history here on the forum and can see you are strongly averse to taking anticoagulants and you have had hundreds of responses explaining why they are so important to patients with AF. At the end of the day, it is your choice whether you continue to take them or not, but no amount of discussion at our level is going to change the views expressed by experts.
The situation is simple, if you decide to stop, you will be exposing yourself to an increased risk of having a life changing stroke that will not only affect you, but could have a devastating impact on your family. Having worked with stroke victims, that is something I would not wish on anybody.
Apologies for being so blunt, whilst there is absolutely nothing wrong in exploring and challenging all the evidence, no responsible person here is likely to support an argument not to take anticoagulants if they have been recommended and prescribed.
I am sorry to be blunt too but I am fully aware of the risk of a stroke - goodness knows, I have been told enough times, both on this forum and by medical practitioners. I do not dispute those risks at all and would never suggest that anyone should not take anticoagulants, given that risk.It is about personal choices and I have my own reasons for those choices - believe me when I say that it has put me in a difficult place and not one where anyone would choose to be. I have delved into many whys and wherefores, done lots of research and reading and will continue to do so.
My post today really was not to do with whether to anticoagulate, or not - I get the general consensus on here and am not seeking anymore reassurance or dispute on that. I posed that question out of sheer interest, that is all.
Then I apologise profusely, it was your last sentence in the post which seemed to be suggesting that there should be no difference in the results between male and female scoring which would bring you down to borderline levels and possibly not needing an anticoagulant.
Those of us who are perhaps more exposed to the views expressed by specialist AF medics than others are very aware that when necessary, anticoagulants are considered to be the most important medication AF patients should take. This is why I and some others, get twitchy when we feel this is being challenged.
I hope I am forgiven....🌹
Of course you are forgiven! I joined this forum to get help and support and hope that I can give that to others too. You are right to say that I am looking for a way to bring my Chads down but I know that, realistically, I cannot - I am a 67 year old female and those two things are written in stone (I don't think I'm up for a sex change at my age and stage 😂) That said, I am genuinely interested in the whole issue aroun the pooling and clotting for gender and age. I can only imagine that that risk remains the same for ANYONE with afib but the age and gender are treated as a bit of a comorbidity. If that really is the case then surely everyone with afib should be offered it. Someone in this thread did point out that it could be too high a risk to give it to everyone, as some would be considered lower risk - it is there that my argument comes full circle, in that the real risk of pooling and clotting does not change, unless, of course age, gender etc add to that risk. Hope this all makes sense! 🥴
I can see what you mean but these bodies of ours are pretty complex already so having a sex change might help, but assuming you have one, your ‘ole man might not be too happy with that option. I also saw that there have been other issues which had added to your worries so I can see things have not been easy for you.......apart from all that, I like feisty wimmin! Take care and stay well!
I believe oestrogen does have effects upon clotting.
In that case risk should kick in much earlier than 65 as most women have completed their menopause before 55.
I think it’s more to do with women who have been through the menopause and the effect that it has on their body, but trust me, I’m no expert on this!!
My understanding is that stats say that after about 65 the risk of stroke from AF outweighs the risk of a bleed from anticoagulants but comorbities such as high BP tip the balance further. No idea what the physical changes are that lead to that.
I have a HAS-BLED score of 1,so Chads outweighs with a score of 2. I have had a number of bleeding issues (ongoing), which makes me very concerned about ACs. The HAS-BLED score has, obviously, taken these issues into account, but I am still very concerned that my propensity to an internal bleed is greater than for those who do not have those issues. So difficult! I know that some might argue that a stroke is more fearful but that doesn't hold so much with something like a bleed on the brain. Choices would be somewhat easier with a crystal ball - if I knew that a stroke of a bleed would be mild, or, at least manageable, we could all make those choices far more easily. Has anyone got one handy! 😂😂
Under your circumstances I would toss a coin and go with the result, having first vowed not to agonise over it any more. Whichever way you go, be alert to symptoms of a bad outcome - brain bleed or stroke - and get help ASAP.
To make it even more difficult for you, BobD recently said that 80% of AF induced strokes were the serious kind. I agree it's difficult, but generally bleeding can be managed, and stroke is a lottery. There are exceptions, if you have bleeding problems, mind you don't ever bang your head. The older you are, the more your brain shrinks and there's more room in the skull for the brain to move and also more exposed (stretched!) blood vessels open to damage in an impact. Give up martial arts, and especially boxing!
😜
Yes, I was already aware of the risk of a more serious stroke risk, but thank you for pointing it out. Yes, agreed that many bleeding incidents can be managed, but some not so easily, especially intercranial ones. Decisions like this are always tough and I know that there are not any easy answers. Damn you AF!
I just have an enquiring mind, so am interested to know why. Like you say, we are all different 😉
Interesting how none of you mention diet when it is one of the biggest risk factors for heart disease & stroke. Diets high in sat & trans fats clog your arteries.
Yes, I don't think enough emphasis is put on diet and lifestyle - there is a lot out there about it when you look into it. I have cut back on sugars and fats, stopped drinking alcohol and walk 3 miles every day. I am not suggesting it will stop the afib, or that it should replace the medication one has been prescribed but it is another string to the bow in trying to get this wretched thing under greater control and who knows......
Yes, I agree it does appear a big divergence of the CHADS between genders over just a few years.
All I can think of that might affect the statistics is if physically the average male heart components are bigger (only physically!!) & maybe as a consequence there is less opportunity to pool/clot? Also the menopause was mentioned and oestrogen, which reminded me I think I read somewhere that as the genders get older men develop more oestrogen and women more testosterone. Apologies if this makes no sense.
I had a phone call from my surgery, probably over a year ago now, advising her that the person who devised the CHAD scoring system had revised the criteria and my score was now zero and I no longer needed to take anti coagulants. They said they were obliged by law to let the patients affected know. When I reminded the caller (a nurse practitioner of many years experience) that I had a history of a TIA and I was in anti coagulants for atrial fibrillation and asked if it was a good , safe recommendation for me to come off warfarin (at the time) she said no it wasn’t. If I had taken the call at face value and not questioned... well, I am sure I don’t need to explain the figures re increased stroke risk with AF! So, in my opinion, whether It brings womens CHADS scores level with men’s is not relevant, it’s the risk your health issues contribute to. My CHAD score is now 0 on medical records, but the risk of stroke from AF hasn’t gone away ......
This underpins my argument to some extent. I have to say that I am really surprised that you were put at 0 as a tia would be at least one point, surely 🤔
You would think so, maybe it depends on the severity? I was lucky, it passed very quickly and they only really investigated it because I took a photo of my face while it was happening!!!
A TIA is one point .
According to my limited research oestrogen doesn’t cause blood clots but increases the risk several fold which is why I guess females score 1 just for being female. Then come 65 we get another point raising our score to 2. Stay safe
Frances x
I am 64 with PAF and my cardiologist put me on Pradaxa. The EP said no need as no co morbidities. So I shall wait for the mythic 65 !! 😊
I’m 63 and not on anticoagulant, Consultant said my CHADvasc score is 0, he said I’m more at rush from the anticoagulant. He said I will have to have it when I’m 65. I’ve had a CT Angiogram, which was fine.
My cardiologist said it’s 1 point for being a woman and another for being 65
Interesting. My score was 2, on the old system, according to the nurse practitioner, and she said the new system took me down to 0, and that was why I could stop the anti coagulant. I will have to check with them to see what they have put on my records. Thank you for pointing this out to me, ectopic1.
I will ring them tomorrow, because she definitely told me i no longer needed to take warfarin due to my lowered score. But looking at the link you gave me, I am at least a 3. All is well, because I am taking an anticoagulant, but I would like to make sure it’s the right score on my records. I am lucky, I don’t often get AF episodes, They are triggered by Chinese takeaway, getting too hot, too tired and not drinking enough water! There are probably other things, but the main triggers. I have a Kardia which is really helpful . 🥰
Good question. It seems that there is a difference in how men and women hearts react, as you may recall that Tropin test thresholds were modified, as damage occured at a lower level than men. The figures are derived from case histories. In my case I had a low chance of a stroke, but it didn't stop me having one!
Yes, women are different, we present heart attacks in a different way. I’m currently reading a book that says a lot of drugs are not tested on women and when they are, to few to show a difference!
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