Understandably, there is a lot of concern amongst AF patients about the risk of having a stroke compared with the risk of bleeding when taking an anticoagulant. This was raised at a recent Support Group meeting and the speaker, a specialist GP responsible for training GP’s and other NHS staff on anticoagulation, said that there was a study which came up with some interesting statistics. The paper was produced back in 1999, when I believe the only anticoagulant available was Warfarin and it refers to bleeds caused by falls. I think medics now seem to agree that DOAC’s have an even slightly lower risk of bleeding than Warfarin. I have attached a link to the study and in the section headed “Comments” towards the end of page 7, it says a patient taking Warfarin would need to fall about 295 times in one year for Warfarin not to be the optimal therapy.
The stroke risk is well documented on the AF Association website.
Hope some of you find it reassuring. Hopefully, there are others here who are aware of similar studies on internal and intracranial bleeds.
P.S, When I posted this, in the “Related Posts” section to the right of this page there was a 7 year old post asking if they were statistically more at risk of a stroke than a bleed. If it’s still there, it’s well worth reading!
Some years ago (More recently than 1999) I represented AFA at a talk given by Prof Gregory Lip who some may know is a leading expert on anticoagulation and actually formulated the CHADS2VASC2 system. The talk was for medical people from GPs , through nurses to paramedics ,
His thrust was similar to yours but he also bemoaned the fact that so many GPs were averse to prescribing anticoagulants. He explained that one person with say a gastrointestinal bleed often meant that for the next year or more that GP would avoid prescribing anticoagulants yet tha same GP could have three people suffer strokes and it would not change his mindset.
Our own Dr Matt Fay up in Bradford has proved that changing this mindset can greatly reduce the number of strokes as his area has the lowest AF relate stroke ratio in Britain.
remember also that aspirin causes more intestinal bleeding than anticoagulants.
I think we can see this from some of the other replies already. The other point possibly worth making that this was produced well before the advent of DOAC’s, so with warfarin being as cheap as chips, it’s unlikely that their conclusions were influenced in any way by the so called “big pharma” argument.
At the end of the day, we make our decisions based on evidence rather than opinions and I just hope others do much the same.
Are we back on the. What you agree with you classify as evidence, and what you disagree with is just opinion, as opposed to evidence for a different point of view Flapjack ?
Do you know Buff, I really don’t care. I made my decision back in 2014 based on informed advice. Most of us here just try to do what the forum was formed for, it’s as simple as that.......
Hello, just trying to be helpful as I realise you are getting increasingly frustrated with the discussions over anti coagulation decisions. This is a very interesting article, particularly the part about the heart’s nervous system so I shal post separately.
It ought to be obvious that the issue is whether Dr Fay has the lowest AF-related mortality rate in Britain, if you just prioritise minimising strokes regardless of overall mortality rate the simplest way to achieve that would be suicide.
You miss out an important factor. The % are per year so each year multplies the risk so after 20 years you are 20% likely . Your choice obviously but do the maths correctly please.
So, after 120 years we come to 120%...?! Are you an engineer, BobD?
in reply to
Neither of you are calculating probability correctly.
If the probability of an event occurring in one year were 1%, then the probability of it not occurring would be 99% (0.99), and the probability of it not occurring in three years:
0.99x0.99x0.99 = 0.99^3 = 0.970299 = 97.0299%
Therefore the probability of it occurring once or more is:
1-0.970299 = 0.029701 = 2.9701%
Similarly, the risk over 120 years would be:
0.99^120 = 0.2994 = 29.94% of not occurring, and 70.06% of it occurring.
in reply to
If I had one, my brain would hurt......😉. That said, have you included leap years?
I don't think any of us can look more than 10yrs ahead re changes and I struggle with 5 years, so for me multiplying the risk factor to 20% is stretching your case a tad.
I think it's all a lot more complicated than that. At my age without AF I have a 10% chance of having a stroke in the next ten years, with AF, it's 14%. Younger people have a much lower risk.
Other things can increase the risk, high blood pressure up to another 10%, diabetes +2, cigarettes +3, cardiovascular disease +4, left ventricular hypertrophy +5%.
20% of strokes are haemorrhagic. For bleeds into the brain the main risk factor is high blood pressure. For bleeds between the brain and the covering membranes the extra risks are anticoagulants.
The CHADS2VASC2 system seems far too simple for me. Maybe we should take other things into account like platelet count, etc.
Also as I have migraine with aura, I am much more likely to have a clot based stroke so I really must take the anticoagulant and be grateful for it. Apart from a brief spell after my ablation Eliquis has completely stopped my attacks of migraine for three years.
Not quite sure what the above proves. It's all on the internet.
Well, in some ways I agree with you. I would much rather have an ablation than take drugs for the rest of my life.
However, you may be relatively young and so your risk of a stroke is lower than mine but it won't be close to zero because your calculations are based on the whole population. AF tends to be a problem in the 50% of the population who are older. That is the age group which also has more strokes.
Of all the drugs that the members of this forum take, I think anticoagulants give the fewest problems. When I first took it I noticed no difference at all. If there is a problem it is likely to be with severe internal bleeding but the action can now be reversed.
I agree with you about deaths from car accidents. We take risks and nobody thinks twice about driving.
It's a bit like Covid, we have 100,000 deaths and they are thinking of putting up a memorial. We have 20,000 deaths a year from flu and nobody worries about it at all.
''Anticoagulants- the risk of stroke v risk of bleeding caused by falls.''
Looking at this logically, how often do we fall (which to some extent is age related) and when we do fall how often are we get badly hurt.
I have had occasional falls the worst being about 5years ago , I have episodes of P-AF all the time with blood flow behaving erratically as it passes through my heart increasing me risk of a blood clot and a stroke . Added to this risk , I have co-morbidities giving a CHADS score of 3.
So common sense tells me taking any anticoagulant, Warfarin or NOAC is the wises choice for me giving daily protection from a daily risk rather than not taking an AC because of something that might occasionally happen.
Added, I may be wrong and feel free to correct me, but my understanding from extensive research is the time AFers are at their most vulnerable to stroke when they go in and out of episode. As some episodes are 'silent' and people are unaware of them they may not fully appreciate their extent of their risk .
This I think is one reason anticoagulation is recommended for many with comorbidities even after an ablation because the person may still have occasional asymptomatic episode of which they are unaware the ablation having removed the symptoms.
I think the study related to falls because newly diagnosed folk often believed they would immediately have a major bleed problem as soon as they took an anticoagulant and it’s not unreasonable to consider that a fall as the most likely cause as you say, for those who may be older. In reality, most of us experience hardly any difference from minor cuts etc, but falls are generally associated with banging your head which is obviously more complex because you have no way of knowing how much damage could be done. Again, most of us try to be a bit more careful but the reality seems to be that life goes on......
The statistics won't change my mind regarding taking anticoagulants - with a CHADs score of 3, I'm at risk of something which I dread - stroke.
Falling as we age is a concern which is why I walk the mountain armed with a Nordic pole, two-way bleeper and mobile phone. The only time I had a fall was in snow fortunately but my collie thought it was a great game and kept jumping on me - I laughed so much I had trouble getting up.
"if it is wise to take chemicals into your body "just for the case". Some of the people, diagnosed in their 50-ties, will have to take drugs for decades. Can you imagine the consequences for the liver, kidneys and the rest of the body? And these consequences are coming for sure... (probability = 100%)."
This is meaningless nonsense. What chemicals, what consequences, what calculation = 100%?
Ain’t given up yet, but it’s not looking good......🙁
This paper is much quoted in articles promoting the use of anticoagulation in the very elderly with AF. As far as I could see, it didn’t mention chronic subdural haematoma. This is an easily overlooked complication of anticoagulation in older people, often presenting with dementia.
xxxxxxxxxx
Now we meet a 95 year old woman called Mrs Brown who develops AFib. She has had 295 falls in the previous 12 months. She lives with her two cats called Plato and Socrates , has macular degeneration and enjoys a small glass of Tio Pepe most evenings.
Guidelines including CHADS2-VASC, HASBLED and NICE suggest her GP Dr Black, who Is 60 and very experienced, should start her on a DOAC.
She explains the pros and cons of anticoagulants (ACs). Mrs Smith asks Dr Black to decide. Dr Black does not prescribe ACs.
Mrs Brown enjoys a good quality of life until the age of 106, when she has a disabling stroke at home, while shouting at Nick Robinson on the Today programme. She dies the following day at home having received an excellent emergency care package.
The family, who have not visited for 5 years, sue Dr Black for failing to follow guidelines. The judge awards the family £1
Dr Black is admonished by the GMC, and ordered to undergo relevant retraining, in order to retain her licence. Dr Black, much loved by her patients, resigns her post and studies for a B.A. in Ancient Greek.
xxxxxxx
The word guide in guidelines is indicative of why many senior hospital consultants often ignore them. Evidence based medicine is firmly entrenched. Personalised medicine seems more appropriate for the individual and is coming to the fore.
Mrs Brown sounds exactly like my mother except it was my mother who refused them. Died aged 98 of old age .
Sorry Badger, haven’t got a clue what you are on about. I can only assume you are disputing the message the report proffers which if so, implies that you believe anticoagulation causes a greater risk of causing a bleed than it does helping to protect AF patients against the risk of stroke......
Well my response, having nursed stroke patients over a number of years, I’d rather take the medicine thank you than the risk.
I’m aware of the early issues regarding Pradaxa but as I understand it, the deaths, whilst tragic, were no where near the levels you suggest. The fact that you have taken a figure (which I have seen as a total number) and just multiplied it out in the way that you have is concerning and may be inaccurate. I have therefore reported your post to admin because if it is inaccurate, it will create concern to members taking this medication. If it’s accurate, then it might encourage them to consider an alternative in which case, your post will be very helpful.......
Knock yourself out Flapjack . I quoted directly from Dr Carolyn Dean from The Magnesium Miracle a well known published book which would have been fact checked before it went to print. I wasn’t “suggesting “ anything I was quoting evidence none of the figures are mine . You are determined to muzzle any alternative view . It’s ok for you to frighten people regarding strokes but not for balance regarding side effects of drugs they may be taking . You are pathetic the way you resort to the report button if anyone disagrees with you . And checked against source everything I said is accurate. Am done with this forum you can keep it as your own personal fiefdom . Go forth and multiply
And don’t say you think it’s a shame. You try to silence anyone who puts an alternative view to your own . In the end it becomes too much like hard work . You didn’t even ask me for my source before reaching for the report button
Just add my two pennorth. The quote about putting drugs into your system for years, what damage does it do to other organs? Tell that to one of my sons who has TI diabetes from his twenties and me with no thyroid for over 30 years! I had a stroke that came out of the blue (thrombolised) and put on anti coagulants. After having seen my grandfather and an aunt having life changing strokes I'll keep on with the edoxoban thank you
My observation of bleed victims on the stroke ward are that the stroke specialists can do nothing for them and the victims are completely f***ed up and in my fathers case death came three months later. Stroke victims are pretty well cured with only minor disabilities now and in my case after a major stroke because I refused to take ant-coagulants I was back on my feet after three days and discharged from hospital in ten days. Most people don't know I've had a major stroke until I tell them. I still have some slight difficulties with some right side coordination and hesitant speech when I get agitated but I think that will resolve itself in time.
I did not take the Apixaban for two and a half year after I was diagnosed with SVT so was I just unlucky given the statistics quoted? I'm 77 and now take the Apixaban all the time. I have fallen of my bike many times without experiencing a bleed of any description. So as a precaution I now only ride trikes. The one in my avatar picture is my favourite.
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