In a recent study, 99% of subjects aged 65 years or older presented evidence of microbreweries; and closer examination of cranial MRI images revealed an increased number of detectable micro-bloods (i.e., the closer they looked, the more they were found).
Micro-blood in the brain is thought to be a precursor to hemorrhagic stroke.
Cerebral microbes (CMB) are small chronic cerebral hemorrhages of small vessels in the brain.
If the microblocks cause a hemorrhagic stroke, should I be on a blood thinner?
The fact that almost everyone aged 65 or over has germs is amazing and worrying, especially if you have A-Fib and need to take anticoagulants. Anticoagulants cause or increase bleeding. That's how it works.
Simply put, this study indicates that brain microbes lead to or cause hemorrhagic stroke. Then it is not surprising that some doctors are reluctant to prescribe high-capacity anticoagulants for older A-Fib patients.
Being older and already having micro-blood makes the administration of anticoagulants all the more worrying.
Risks of anticoagulants (anticoagulants)
Taking almost any prescription drug has advantages. Older patients with A-Fib find themselves between a rock and a hard place.
In the case of anticoagulants, on the one hand, you will benefit from protection against A-Fib stroke (which often leads to death or severe disability), but on the other hand, you have an increased risk of bleeding.
For those over 65 who already have micro-blood, there is a substantial disadvantage in the administration of anticoagulants: an increased risk of hemorrhagic stroke, dementia and other problems.
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Pearipile-55
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Much as I might enjoy having a micro brewery in my head, this is predictive text causing mischief. Think micro bleeds, a genuine concern for many. I hope Pearipile-55 won’t mind me reminding members she is from Romania. I have sent brief messages to her in the past using Google translate, not that that is necessary.
This is why I myself don't use prescription anticoagulants and am pursuing other methods for managing and reducing my afib. I posted something on this topic a month ago: healthunlocked.com/afassoci...
Good morning Pearipile-55
This is a question of huge importance for many of us, thank you for asking it. I have taken anticoagulants (ACs) for 12 years since I was 60, at the same time that I was diagnosed with AF. I had a CT head scan 4 years ago which showed a small number of micro infarcts.
In an ideal world, a cranial MRI scan before starting ACs would be valuable in determining bleed risk alongside HASBLED.
As at 72, I become more forgetful, I do wonder about cerebral micro bleeds, but on balance I don’t want to know what an MRI would show. I don’t want to have to choose between infarct and bleed. Neither do I want to know if I have evidence of early AZ.
The best available evidence favours ACs in AF in most people over 75 and the under 75s with raised CHADs2Vasc.
Unless I start falling regularly and banging my head, I will continue to take my AC.
think many take AC unnecessarily. There have been many questions about anticoagulants for short and rare episodes of paroxysmal fibrillation. My opinion is that only those with permanent-persistent AF should take them, or those with more many associated diseases. Reading the leaflet of several anticoagulants. I did not find recommendations for their use when AF is episodic, or when you are in NSR.
Good points! I should have added that I have been permanent for 3 years, and that my left atrium (LA) is enlarged because of decades of overdoing the exercise. And that my LA endocardium is basically b*******d because of lifelong hypertension, anxiety and arguable malfeasance by various electricians.
The recipe is always the same - if you want them to buy drugs, scare them to death and than sell what you want. An ideal product is such product, where there is no concrete result to be guarantied, but life-long (sometimes unnecessary) protection is offered (vaccines, anticoagulants, BP medication,...). It is a nasty world, we are living in!
Recently, there have been recalled some of the medication for high BP (a lot about it in the Internet), which have been in use for decades, because it was realized that they are causing cancer. Of course, nobody will admit that it was the medication itself, but pharma companies are hiding behind the impurities, present in traces, which have got into the drugs during their production.
I do not take and never will take any of the mentioned drugs, so intend to die on natural causes, whenever it may be...
Good post P. My EP was not a fan of AC, he said, and a year after my ablation when he asked for them to be stopped even though my gp resisted but he insisted and I've been off them a year now . He indicated that some research had shown a higher risk taking them in some cohorts as your link displays, and I agree with what looks like quite in depth research ..Its a hard choice I think and difficult subject as stroke is such a debilitating and savage condition. For some i think it's necessary and others maybe not, balance of probability must be used and I'd still rather take them if it meant not having a stroke or worse, but as everything we take there are risks involved..
There is always risk, however, you need to assess your own risk of bleeds - including micro bleeds - and balance that against the risk of NOT taking them ie:- AF induced stroke.
As with any medicine, benefit:risk is only something you and your doctors can decide and whilst the tools to make that assessement - CHADSVASC score : HASBLED are rather blunt ones, along with your personal history, it is possible to come to a reasoned decision as to what is best for you.
Eg:- Under 65, low AF burden, no other risk factors such as Hypertension, Diebetes, previous Cardio = CHADS score of 0 - low risk so it would be a personal decision.
In my case - I had high AF burden, 2/3 times week, over 65, female and already had TIA - CHADSVASC score = 4. The risk of having AF induced stroke completely outweighs the small risk of vascular bleeds.
You might also want to research the work being done on the human Biome - so many people are now suddenly interested because of it’s huge importance to our health. Keep your gut healthy to prevent Leaky Gut and keep your AF burden low, your risk will diminish which is the approach that PlanetaryKim is taking, who I believe but she will correct me if I got this wrong, has very low CHADS score?
It’s impossible to take much from a study like this, which is meant more for research and learning than for guidance for AF patients. (Although as your link didn’t work we couldn’t read the original). All I can say is from my research, Wafarin has a higher risk of brain bleeds than any of the newer anticoagulants.
posted the correct link, at the bottom of the page for "similar articles" you will find those about anticoagulation. It makes no difference between NOAC and warfarin. What I noticed is that you can't avoid stroke by taking anticoagulants you risk cerebral hemorrhage which is deadly unlike a stroke caused by other causes you get rid of, you recover. It is best to cure AF by ablation or implanted device in the heart which prevents clotting..
Had both and no currently no AF. Iwill always be on anticoagulants as the stroke risk doesn’t decrease if you have no AF, but stopping anticoagulants is riskier once you have taken them.
Having a pacemaker - means you have to take anticoagulants.
And all the studies I have read say there IS a difference in cranial bleed risk between Wafarin & DOACs.
Couldn't access the report you refer to Pearipile but I had read some time back about microbleeds in certain people with reference to dementia and anticoagulation.
The problem for all of us is that medication, whether it be pharmaceutical or natural, will have effects in doing its job. In the case of anticoagulants, for me the risk of stroke with my CHADs score of 3 far outweighs the risk of taking Apixaban. My cardiologist told me on starting Apixaban that it has the lowest bleed factor of any AC (Edoxaban didn't exist then).
The problem with new anticoagulants is that they have no antidote. So if you bleed from an accident, what do you do to stop the bleeding? are you waiting for hours?.
I think in the case of a life-threatening bleed, most hospitals would use their existing emergency procedures and protocols - they may not even have supplies of the reversal agents which are available. If you cannot get taken to a hospital in life-threatening circumstances - the reversal agent is fairly unimportant in the scheme of things.
Less serious bleeding does stop with pressure, elevation and normal first aid procedures. In my case, with a full flow nasty bleed, the hospital staff monitored my misery and followed what the doctor called 'our protocol'. Above all, for me is the idea that bleeding can be reversed - a serious, life-impairing or life-threatening stroke cannot.
Forgot to say, I think there are reversal agents available for 2 of the DOAC's with more in the pipeline.
Read the article, It says 90+% of people over 65 have microbleeds. It gives one instance of a person taking an anticoagulant having a bleed.It gives no percentage of people with microbleeds on anticoagulants having a hemorrhagic stroke While interesting reading, It does not refute the fact that people with afib are 5x more likely to have a stroke if not taking AC.
Have just read the report, it’s rather difficult to make an informed decision from a single report from 2018, so personally , I’d rather trust taking the advice from my trusted EP from the Royal Brompton Hospital ,a well known centre of excellence . We all need to ask questions , that’s where this site is invaluable , helping share information .
It's bad to take anticoagulant and not to take them. How to choose the less bad option? hard question. Why in the link indicated by you only talk about nonvalvular AF? isn't the valve one dangerous? thanks!.
It's not the case that there are no antidotes to NOACS. Most bleeding can be stopped without antidotes- also I believe Vit K is only given in a very small percentage of bleeds in people on warfarin as other methods are used. It's hard to know what has caused micro bleeds. Hypertension is closely connected with AF and is likely to be a culprit! Having seen the devastating effect of stroke while working in the NHS I will continue to take Apixaban!!
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Anticoagulants- the risk of stroke v risk of bleeding caused by falls.
Vaccine and anticoagulants
dentist and anticoagulants 
PAF no anticoagulant!
