Hello,
Anticoagulant was prescribed. We hesitated. Got a kardia device and started to daily monitor the heart rhythm. This morning it hit: "possible atrial fibrillation".
Note that apixaban, pradaxa and coumarin were prescribed (different doctors, different drugs).
Hope has died. Afib doesn't seem to go away.
Should we take the antigoaculant now or we should wait for the afib episode to finish ?
Thank you
You have AF then you should be taking anticoagaulants all the time to protect you from the five times increased risk of a stroke. Please for your future's sake do not mess about waiting for anything. These are not drugs you can chose to take at odd times when you think.
As Bob says, you take them to prevent clots forming in your heart and possibly causing a stroke, they are essential with A fib so take them daily as prescribed and do not miss a dose unless instructed prior to some surgical procedure. I have symptomless AF and my biggest fear is that the pharmacy might be out of stock of my ant-coagulant !
We are not medically trained on this forum.
You must talk to the medical practitioner who prescribed the anticoagulant.
I am surprised you were not told clearly what to do in the first place.
I have taken Warfarin as an anticoagulant for more than 15 years. There is nothing to worry about just follow your doctor’s advice.
Pete
If you have AF and your Doctor has prescribed Apixaban to help prevent you from having a life changing stroke then you need to take it exactly as prescribed…..simples!
I wish it was that simple. Let me breakdown what doctors prescribed:
3 cardiologists prescribed Apixaban
2 cardiologists said not to take Apixaban and instead prescribed Dabigatran
3 cardiologists said not to take anticoagulant at all (one of them said that anticoagulant is prescribed too easily nowadays, another said we should wait and the other one said he doesn't see AFib on the ECG, just some strange PVCs - it was afib btw, confirmed later by many others)
1 cardiologist prescribed Coumarin before surgery and switch to Apixaban after surgery (GP confirmed it's a good plan)
1 cardiologist said to take any anticoagulant (doesn't matter which one)
Looking at the numbers, Apixaban seems to be the winner by a small margin but not every doctor visit weighs the same.
For example 2 cardiologists that prescribed Apixaban have been very rude and disrespectful during the visit: insulting and screaming at us, for no reason trust me (he was doing that with his own staff as well not just patients). How can I follow a treatment plan given by someone who treats patients like animals ?
Other doctors opinion weighs more, like the doctor who said to wait for the moment. That's a famous cardiologist, with a good reputation and record who I know for a long time and he cares for his patients and I respect him a lot. Now looking back I think he was wrong: would he have said to take anticoagulant right away, this dilemma would have been over months ago.
So I wish it was as simple as take this pill and that's it.
Totally agree its not simply just take the pill (ACs) and get on with life, if only! I suggest you try and find (probably paying privately) the right cardiologist who looks at you as an individual and reviews your position annually reaching a joint decision.
I have done this for 8 years (Lone PAF in remission, previously symptomatic) and at 68yo male & active my cardio wrote to my GP this year:
'He now has a CHAD's Vac score of 1 so we have discussed whether he would want to start on oral anticoagulation. At this point in time, as he is not having any episodes of atrial fibrillation and has not had lengthy episodes for many years, I have agreed that it is reasonable that he remains off a DOAC.'
I stress I am not complacent and have made many lifestyle changes to reduce my risk of a stroke and will probably take ACs post 70yo. Its not you should or you shouldn't, it is whats right for you, which includes your personal beliefs. Many people take them and relax as a result, which is an anti-stroke benefit in itself but that would exclude me.
I think in general more research (unlikely) is needed and in the meantimeI draw some comfort from the fact that because so much AF is undetected (incl myself for many years) if the risk of stroke was indeed very high they would be dropping like flies in the street.
Your last point is one that I must say puzzles me too, Secondtry. On the one hand is the oft- quoted figure of 5 times more likely to have a stroke if you have AF ( still haven’t found where that comes from) and on the other, the large numbers of folk who are running around with undiagnosed AF and not, it seems,“dropping like flies” with strokes. As you say, more research is needed but unlikely.
A couple things here, First, I'm wondering why so many cardiologists?
I would never put up with a doc who was insulting and screaming, highly unprofessional. I think it is as simple as if you're having an episode of afib, you treat it.
If medication works for you, then take it. It's never worked for me. Every afib episode I've had resulted in being reversed with a cardioversion. I would have been glad a med would have worked and even more glad not to have to spend a day or two in the hospital to revere the afib.
Why so many cardiologists ? Because I couldn't find a good one for us. I've been to so many that I lost count. Most of them have been privately and the consultation cost a lot. Cardiologist#1. Unprepared.Failed to recognize AFib. Didn't pay attention at all. Entire consultation which lasted less than 10 minutes was a rush to get us out so he can see the next patient (you could see the $$$ in his eyes) He only gave little advice regarding the high blood pressure. And even that turned out to be wrong.
Cardiologist#2 Is a pro but he is a heart surgeon. He is not keen on taking patients who don't need surgery.
Cardiologist#3 was kind, understanding and did a proper consultation. He said that AFib meds are not pleasant and because there were only 2-3 AFib episodes, to postpone any meds (including anticoagulant) and see in 6 months how the situation is.
Cardiologist#4 She was a bit more meticulous but she was crazy. Started to scream at my mom and to insult her. At the nurse too. My mom started to cry. This doctor then got even more mad because a fly entered through the open window and started to buzz around the office. She did prescribed anticoagulant though, it's just that I didn't trust her judgment because she wasn't mentally healthy (a sane person doesn't behave like that).
Cardiologist#5 Famous EP, very quiet and weird. You couldn't hear a word coming out his month. I was struggling to get some answers. No mention about AFib. He noticed from an ecg holter monitor report that pulse sometimes dropped to 50 BPM. He was more focused on possibility of implanting a pacemaker. No mention about AFib even though I explicitly asked him about it. He just stood there without saying anything and looking at the horizon, like he was in a state of trance. It was very awkward.
Cardiologist#6 Nice doctor. Took time to explain us things. But failed to recognize AFib and said she doesn't prescribe anticoagulant so easily. When I nicely asked her to check again she said to send her the ecg on WhatsApp and that she will take a second look. But by that time I lost confidence in her and decided to keep looking.
Cardiologist#7 Worst person I've seen. Totally unprofessional. Rude. She insulted us the entire visit. I can't explain here how awful this person was (because she can't be called a doctor). We didn't do anything and she just exploded. Insult after insult after insult. I started to secretly record the meeting as evidence. Mom went into depression after that consultation. I filed a complaint against her but I got no feedback yet. First complaint I filled so far and hope to be the last. And guess what. It was a paid consultation. Not cheap at all.
Someone wise told me that a doctor either saves patients or kills them. This one falls into the latter category.
Cardiologist#8 Nice doctor, took his time to listen and imediatley acknowledge that this is AFib. He said to go on anticoagulant immediately. He explained us that AFib is no joke. He requested more investigations but his office is not equipped at all and he send us to find another cardiologist who has the necessary equipment to run the investigations he gave us. And he couldn't prescribe compensated pills. I find it strange for a cardiologist to send me and find another cardiologist.
Cardiologist#9 He put a 24 hour holter monitor. Report came back with 29min atrial fibrillation. It was a team of 2 cardiologists. They both said that there is no AFib here. I looked at the ecg myself: it was obvious there was AFib because the irregular QRS complex. Came back to ask them about that: they again confirmed that there is no AFib because they both checked it. Incompetent doctors...
Cardiologist#10 did acknowledge AFib. Said to start with Coumarin and then switch to Apixaban.
Have I done something wrong ? What cardiologist would you choose from that list ?
Wow! 🤣 sorry to laugh but that’s a lot of cardiologists.
The first question I would ask is are you sourcing them yourself?
The second question I would ask is what exactly do you want from them? I’m assuming you are looking for a diagnosis of af?
Do you have any evidence of afib? Does your mother have a device to catch it on? Such as an Apple watch? With the money you’ve spent on cardios by now you probably could have bought 3. If not I would suggest getting one, record the episodes yourself and then go to see an electrophysiologist armed with the right tools.
As Bob said cardios are basically plumbers and you need an electrician (electropysiologist) broadly speaking.
Also on a side note please don’t let people scream at you and most definitely not your elderly mother. If people let them do it then they will continue to. If anyone, be it a doctor, policemen or the queen mother screamed in my mums face they would instantly regret it and so they should.
I do have the ECG from the ambulance where it shows AFib and from a holter report.
Cardiologist#3 said to take good care of the ECG from the ambulance because that's the proof. He was my favorite cardio from the bunch, but he didn't prescribed anticoagulant 
Should I continue with him ? Don't know...
Meanwhile, cardiologist#6, not only she failed to recognize AFib from the same ECG, but I had a long debate with her whether that is my mom's ECG...she stated that what if the ambulance staff printed the wrong ECG ? What if the ECG machine has a memory function and that's not my mum's ECG but it belongs to someone else maybe a patient before her and that she needs to be 100% certain that it's her ECG especially before giving any anticoagulant....that debate went for more than 30 minutes (face palm)
EP's are very few and hard to get an appointment. There are so few that I know them all by name: and some of them have a very bad record. Cardiologist#5 appointment took months and he was useless...
I'm thinking to go back to cardiologist#8...he's the only one who took AFib seriously.
What I want is to find a cardiologist who can monitor my moms condition. To know that she is in good hands. That's all I want.
If your convinced it’s afib then you need to see an EP in my opinion. They will tell you straight away. I would get myself a means to record it and after recording a few episodes set up a zoom call with a respected EP and hopefully you can get the ball rolling.
I’m assuming Your from America? Can you not book a consultation with someone like John d day? The author of the afib cure?
Not sure how costly it is over there but I paid £200 for a 90 minute zoom consultation with a very respected EP this side of the water and that was all I needed. He gave me everything I needed and got the ball rolling for me and even allowed me to substantially jump the queue for an ablation.
That’s what I would do as you seem to just be wasting money with your current strategy. Go straight to the top and work your way down if for whatever reason your unable to get the absolute best.
Good luck 👍
Of course you haven't done anything wrong. At a hospital stay last year, I had two cardiologists, both were wonderful, and I picked one to be the doc I'd stay with after being released, but, yes, I forgot I've been to docs that either don't know much or don't care much, or worse, both! I've seen several cardiologists who were truly awful. I guess I lucked out because the one I chosee is the chair of the department at the hospital he's on staff. So I guess that says something. Not only is he very smart, he's really nice and treats people well.
I forgot there are some really crummy docs out there.
While the majority of doctors have prescribed anticoagulant, some of them said it's not necessary. That induced mistrust and mistrust lead to hesitation, at least until eye surgery scheduled for 18th of january.
We are now convinced that going on anticoagulant is the right choice.
Latest doctor said it's ok to start with vitamin k antagonists Coumarin, do the INR blood work until it reaches the 2-3 threshold and later we can switch to a more modern anticoagulant like Apixaban or Dabigatran.
Other doctors said to start with Apixaban from the beginning.
So we want to start the anticoagulant treatment but we don't know which one. I have all of them sitting on the kitchen table.
Please bear in mind, we can only advise on the information provided and as has been said, because we are not medically trained, we can not offer any specific advice on medication. Whether or not you need to or should take an anticoagulant is determined by your CHADSVASC score and this is something you can easily do by googling CHADSVASC and follow the guidance offered. You need to bear in mind that if you take medication to control blood pressure, you must still include high blood pressure when scoring. If your score is 1, then you should consider taking an anticoagulant and very many (including me) do. If you score 2 or more, it is recommended that you take an anticoagulant. Once prescribed, you should remain on them for life regardless of ANY treatment for controlling AF an naturally, that includes having an ablation.
Thousands of people (well millions really around the world) are prescribed DOACS which they take from the outset after being diagnosed. I take Apixaban which some medics say have a slightly better result from some tests but the difference is minuscule. If I were you, I’d just make a decision about which one to take and just get on with it. If you should be anti-coagulated and you delay, you are putting yourself at risk. On YouTube, Dr Sanjay Gupta from York hospital has made several videos about anticoagulants so take a look at those as they may help.
Thank you FlapJack, but as you can see I'm not taking drugs which haven't been prescribed to us by a doctor.I just failed to find a cardiologist who I can trust. Still searching.
In the meantime, I'm confused on which prescribed option to take.
And yes, I can be too analytical sometimes when I should act on it and just do it.
Update:
We started to take anticoagulant Coumarin until eye surgery in January because it has a lower half life and it's easier to stop.
After eye surgery we plan to switch to Apixaban (after another visit to my doctor of course).
Next week will have the first INR blood test.
What is the eye surgery? I take Apixaban and didn’t stop for my cataract surgery.
Yes. It's for cataract surgery but it's a mature cataract which is more difficult to operate. It requires 3 days hospitalization and takes longer to heal. The eye surgeon will decide whether to temporary stop or not the anticoagulant, but from what I hear (from other doctors) because it's not a standard cataract surgery, they usually stop the anticoagulant before this type of intervention.
I agree with Bob, I would go with Apixaban, wears off quickly and takes effect quickly after op.
Puzzled by your cataract description. I had my eyes done privately at a two week interval by the Director of Surgery at Moorfields and he poked a small hollow tube into the lens (which are made of protein) and vacuumed them out completely before replacing them with plastic lenses. Took him about 5 mins each eye, and I could see normally straight away. I no longer need glasses as he corrected my vision at the same time.
I don't understand why you need 3 days in hospital or what a mature cataract is. Nothing I read on the subject made any differentiation between types of cataract.
It was before I was diagnosed with SVT so not on Apixaban at that time.
All the best.
Roy
I'm happy to hear it went well for you and I wish you all the best.
I'm pretty sure you had a standard cataract surgery because you went and got the surgery on time. Unfortunately, if you delay it, the lens can quickly become harder, like cement, making it more difficult to break it in pieces and to remove it. Larger incisions are needed, increasing the risk and the recovery time.
I had an eye surgeon who refused to perform the intervention because he wasn't comfortable performing it and another one in a private clinic who said it's best to do it at the hospital due to the risk factors.
Advice for everyone with cataract here: get the surgery on time!!! Don't delay it.
Simple procedure can transform into a very complicated one even for top surgeons, if not treated on time.
Coumarin is warfarin and the least easy anticoagulant to deal with as it needs regular testing. Unless you have access to blood tests to find the correct dose I think you have seriously misunderstood the problem and made the wrong choice. The half life of wafrain is much greater than that of any of the DOACs.
Hi Bob.I do have access to blood tests. I'm careful with the dosage, vitamin K intake and the INR levels.
Regarding the half life, 2 doctors confirmed (cardiologist on Friday and my GP on Thursday) that Coumarin doesn't stay in the system for too long and is more recommend to take before surgery.
Seems they were wrong. Now do you see why I have issues trusting doctors ?
I know that vitamin K is used as an antitode for warfarin. Maybe they plan to administer a vitamin K IV a day before surgery, I don't know.
The antitode for Apixaban on the other hand is Andexanet alfa (brand name Ondexxya) which costs around $20 000 for a single dose and most hospitals don't have it in stock.
Warfarin degrades gradually and normally one needs to stop five days before surgery and maybe bridge with heparin injections to maintain stroke protection. Starting with INR 2.5 I would expect it to take at least three days to return to 1 whereas DOACs are out in 24 hours . I am still amazed, however, that many surgeons still tell patients to stop DOACs five days before surgery wheras one day is generally enough. Old habbits I guess.
Bob, if there is a degree in atrial fibrillation, you should be awarded. I've seen cardiologists with less knowledge about AFib than you have. Sometimes I get the feeling that some cardiologists don't like treating arrythmias or is it just me ?
Maybe they think it's not their domain and that an EP should handle such cases ? I don't know.
Getting on twenty years at the coal face Snakeyes give you quite a lot of knowledge. Being involved with AF Association since it started in 2007 means I have met a lot of the top people in the field of arrhythmias at a social rather than business level which also helps.
Re cardiologists or plumbers as we call them, you wouldn't ask a plumber to re-wire your house would you.
I'm sorry to hear that your mother has Atrial Fibrillation. I've had AF on and off for the last 26 years. For the last 6-7 I've had permanent AF which is mostly asymptomatic. I can't feel anything, unless I make an effort to feel my pulse, or use a Kardia , although I don't have a Kardia. I don't take any medication for AF except Warfarin, ( what you in the US call Coumarin, which is odd as the Warf in Warfarin stands for Wisconsin Alumni Research Foundation). In the past I've taken other drugs but none work with permanent AF. I have other ailments, including asthma, lymphoedema in my lower legs and right foot drop, and urticaria caused by a beta blocker.I put my orthotic on every day so I can walk fairly normally, I may forget to use my asthma prevention inhalers but I never ever forget to take my anticoagulant. Once someone has had an episode of AF they become Five times more likely to have a stroke than those who don't have AF.
I have never worried about bleeds on the brain. I went into hospital on one occasion with a grumbling appendix and for 12 hours was given intravenous vitamin k to re-coagulate my blood prior to the operation to remove my appendix.
A few years ago I fell accidentally and had a 5" x 2" cut on my leg which meant 2 days in hospital, and a further 3 months of treatment by local nurses,but I took my anticoagulant throughout.
Thank you Thomas.
You know what's frustrating ? She had 3-4 documented cases of AFib.
Because she was overweight, she was now determined more than ever to change her life style.
She started a healthy diet and doing evening walks as exercise. As a result, she lost 30kg.
Her blood sugar dropped significantly (before she was close to diabetes range).
Her stress level went down and she started to get better sleep.
Her biomarkes were in check (potassium, magnesium, c-reactive protein etc)
And for a while AFib episodes stopped.
She was optimistic that AFib is a thing of the past, although I always had a thought in the back of my mind that it could come back.
This morning during a routine check using Kardia, our fears came true: atrial fibrillation.
We are feeling down at the moment but hearing what you and others here have been been through it shows that with the right attitude and level of strength, we should manage this.
I wish to thank everyone for your support and kindness.
That’s great progress, congratulations! AF is manageable for many people and maybe we see more of the people for whom it isn’t manageable on this forum. And the fact that your mother didn’t know she was in AF until the routine check shows that she’s not badly affected as many people don’t need a Kardia to tell them. The most important thing if QOL is not too much of an issue is preventing stroke so it’s good you have made a decision. Best wishes for the operation, it’s a life changer 💜
I had a stroke 4 yrs ago caused by afib. I have been on apixaban since. I don't miss a dose. I've had no side effects that I know of.
Take it, you don’t want to risk a stroke.
Help with understanding strange feeling after my first afib episode
As needed anticoagulants for intermittent Afib
longer episodes of afib
Afib episode after eating 
when to go to hospital with an afib episode 
