Sanjay Gupta and anticoagulants

[Swimsyroke]

I just watched Sanjay Gupta's YouTube video on anticoagulants. He said it is not the Afib but the company it keeps that is responsible for a stroke therefore anticoagulation is only advised if you have other factors i.e high blood pressure, diabetes, heart failure etc.

If that is the case why are all women over the age of 75 with a base score of 2 on the ChadVasc index, (i.e. because of their age alone, even if they have no other risk factors and not even suffering from Afib), not on anticoagulants!!!

[CDreamer]

1. Dr Sanjay is expressing an opinion -based on experience and studies he has read - not a fact. He may well be correct but it’s not proven. He always lists the studies he bases his opinions on so worth reading the original studies.

2. You have always scored 1 for being female & 1 for being over 65 on the CHADSVASC scoring system - which most of us on this forum have been assessed on - simply because that’s a statistical algorithm which has shown that more women than men suffer AF induced strokes & being over 65 increases your risk.

I for instance score 4 - 1= being Female, 1=65+, 2=previous TIA. I have no other co-morbidities that are relevant.

The fact that you have AF is a factor for assessing your risk in the first place.

[Swimsyroke in reply to CDreamer]

Thanks for that CDreamer. It explains the situation. So should I ask my doc for anticoagulant as I score 2 but have never had a TIA and have paroxysmal pill in the pocket atrial fibrillation and am usually very fit and healthy except when in Afib. By the way I NEVER get a check up for my condition.

[BobD Volunteer in reply to Swimsyroke]

A score of 2 makes antcoagulation advisable. You are not being well looked after in your condition to my mind. I have annual checkups (blood tests discussion etc) in normal circumstances. This year I had telephone consultation with local hospital cardiology consultant.

[Swimsyroke in reply to BobD]

Lucky you. Am waiting for a consultant appointment after some bad episodes in September but haven't heard a thing so just trying to manage myself.

[BobD Volunteer in reply to Swimsyroke]

I did stress "in normal circumstances". You know who to blame.

In fairness they did try to temporarily kill me during cardioversion and left me with broken ribs from CPR so I think they feel guilty.

[Hidden in reply to Swimsyroke]

A friend says: "I never go to see a doctor. They always find something".😀 In my opinion, the AC mantra should be reexamined. Have PAF with no symptoms, 77 years old, no comorbidities, do not take any pills (except magnesium, vitamin C and D, zinc). Saw two cardiologists in the previous year, since I discovered my AF by chance, both of them recommended radical measures, Flecanaide, ablation, conversion,...Luckily, I did not listen to them. Of course, if one has serious symptoms than it is another matter.

[wilsond in reply to Hidden]

HmmSerious symptoms are not the only reason to take measures of protection against AF activity.

Thousands of strokes per year are AF related, many of which are only identifiedcas AF caused on post mortem.

I don't call that lucky!

[Hidden in reply to wilsond]

One can be certain these strokes are AF related only if there are comorbidities.

[Hidden in reply to Hidden]

correction: if there are no comorbidities.

[CDreamer in reply to Swimsyroke]

I have an annual Healthy Heart Check up by my GP - usually done by practice nurse + bloods every 12 weeks. Nowadays, review with hospital every 2 years. I have a pacemaker hooked up to an app which sends regular reports ditto on CPAP machine so am very well monitored. Hardly ever see a doctor but am reassured that I am well monitored.

I agree with Bob - your GP practice could be a lot more proactive to support you.

[Swimsyroke in reply to CDreamer]

Thanks. I think it is because I have no co- morbidities and my heart when last checked a few years ago was fine and I only have paroxysmal atrial fibrillation that I am overlooked. Will see what the consultant says when I eventually get to see him. If no joy will go back to my GP. We are short of doctors in this area so it seems to be a case of call us as we won't call you.

[Auriculaire in reply to Swimsyroke]

The point for being female is not accepted universally. Also the latest guidelines from the European Society of Cardiologists say that if the two points are for age and being female ie no comorbidities then anticoagulation is not necessarily advisable.

[Hidden in reply to Auriculaire]

Only in 7% of the patients the clot was actually found before TEE. No difference between coagulated and non coagulated. pubmed.ncbi.nlm.nih.gov/162...

[wilsond in reply to Swimsyroke]

All I can say is that my GP mistakenly scored me as a 1 for being female. He didn't include my longstanding ,albeit,med.controlled high blood pressure.I asked about AC specifically as I was worried due to strong history on both side if stroke etc.

I went on to have a TIA .

Then was promptly put on Apixaban!

I still think I dodged a bullet.

Xx

[LaceyLady in reply to CDreamer]

So I get 1 for T2 diabetes? I’m 64 and slapped on Apixaban in hospital without consultation. Making me lose my hair.

I’m also a ‘bleeder’ also found out my younger sister is too.

[Auriculaire in reply to LaceyLady]

No you get another just for being a woman ! And next birthday you go up to 3 though your health is probably no different the day after your birthday than the day before it. Welcome to the wonderful world of algorithms where being an individual doesn't matter.

[LaceyLady in reply to Auriculaire]

Think they already class me as having 3 😳 My BP and cholesterol is fine.

[doodle68]

That is now how I interpreted the video and Dr Gupta has made a number on the subject if you search his YT playlist . As CDreamer says SG is putting forward a hypothesis based on some studies and he is surmising 'Just who is the Daddy of AF' and leaving it as an open question but not drawing any real conclusions.

[Kaz747]

Hi Swimsyroke

I’m a 57 yo female so I get one point for being female and 1 point for having a history of hypertension, even though it is perfect now. When I was about to have an ablation three years ago, they found a blood clot in my heart so couldn’t proceed. That made the risk of having a stroke seem very real. My EP recommends me staying on the anticoagulants for life. Having seen my grandmother and my father-in-law suffer a number of strokes I’m happy to keep taking the pills.

[JudiHalf]

I have PAF and was put on anti coag straightaway, I was over 65, I managed to get an ecg done while in afib, after years of me telling doctors about my heart problems, it is difficult to get afib diagnosed sometimes.

[ramblerbaz3 in reply to JudiHalf]

HiSame here, although the way I had my PAF confirmed, was by buying a Kardia & sending results to my GP when I had an episode.

Am being treated with Flecainide & Apixaban, plus on waiting list for an ablation.

All the best.

[secondtry]

PAF is still a serious condition and I would pay (if affordable) for an annual visit to the same cardiologist. I have done this for 7 years despite only having 2 short episodes in that time and you build up a useful relationship and mutual judgement over taking medication including ACs. I am 68 now and still not taking ACs, I don't regard this as reckless as I continue to build my knowledge, although in the end it is an individual subjective decision based not least on the quality of your lifestyle. Maybe post 70 I will change my view!

[plopper]

My afib is asymptomatic and was diagnosed after the stroke. I don't reccomend that method!

[wilsond in reply to plopper]

Exactly my point too! Xx

[Nerja2012]

I score 3 on Chad's. 1 for being female and 2 for being 76, No health problems at all. PAF episodes average 1 year. I fought with myself about taking anticoags but finally gave in 6 months ago. Fear of the unknown I guess.