Stroke risk?

[John3333333]

My CHA2Ds2-VASC score is 0, but I think I'd prefer to take an anticoagulant (probably Apixaban). I'm meeting with my cardiologist at the end of the month, and plan on asking him about starting anticoagulant medication.I've had 4 short episodes of AF this year (the longest was about 2 minutes), but I get bombarded with various ectopics, including the occasional short atrial salvo (3 - 5 seconds long), on a regular basis. Am I really a stroke risk with such short episodes, or am I worrying about something that is unlikely to happen to me?

[BobD Volunteer]

Your AF burden is apparently low as is your stroke risk. always assuming that you have been totally honest regarding any co morbidities. I think the short answer is it is your choice.#

Personally, even with no AF the past few years after three ablations I still take my warfarin but then my Chadsvasc score does say yes.

[Jalia]

This is your personal decision. Although my situation is f different to yours I would never want to stop anticoagulation even if I was told it was unnecessary. Like many with AF , my biggest fear is stroke which can't be undone.

[Hidden]

I've had no recent assessment of my risk ............ the fact is though I'm paroxysmal AF and asymptomatic. With diet and meds if it kicks in its very highly controlled and this year has been my best year ever with only one minor and one major ( which put me off work for a couple of days) AF event. No way would I stop my Bisoprolol or Warfarin ........... just no way. 65 when I was diagnosed in 2010, 78 now. Be bloody stupid now wouldn't I to even try it.

[bayonnejoe1]

Have you had a heart monitor, a Zio is considered by many to be the best, to determine exactly how many AF episodes you're having? Many can be totally silent and produce no discernable symptoms.

[secondtry]

CHADS score O, QOL very good, no comorbidities......why rock the boat?

[MarkS in reply to secondtry]

So were all my scores and I still had a TIA in my 50's. I would suggest everyone in their 50's with AF should consider starting anticoags.

[secondtry in reply to MarkS]

Shame we don't have reliable stats and so we have to fall back on subjective individual decisions. I will certainly be considering them carefully again next year when I reach 70.

[Hidden]

Taking an anticoagulant is not without risk. More general cuts and scrapes are not generally a problem but more serious injuries caused by lifestyle activities, accidents etc can be. Similarly, if there is any close family history of internal bleeds then this also needs to be considered. I’m sure this will be properly considered by your cardiologist and he may well be reluctant or unwilling to prescribe but it’s your choice to ask……..

[Ppiman]

I have read that there is some evidence that the AF itself might not be what leads to the clots but the shape of a little pouch in the atrium called the atrial appendage. I shall do some more reading around this now your post has reminded me as it sounded very interesting. I have read that ectopic beats do not increase stroke risk unless the burden is very heavy, but, again, that sounds like more research is needed. If I were you. I'd have the conversation you are planning to with the cardiologist, but I don;t think I would rush into taking an anticoagulant since they do, themselves, carry some level of risk, especially if surgery is required.

Steve

[2learn in reply to Ppiman]

Hi Steve. I had a mitrial valve repair Dec 21 and part of that was to seal the appendage. Surgeon said it has no practical use (like appendix) but causes and stores bloodclots so better out than in.

[Ppiman in reply to 2learn]

I think your surgeon did you a favour!

Steve

[Speed]

I’m not medically trained but my understanding is that there is a trade off between a blood clot and a brain bleed (both classed as strokes). Anticoagulants reduce the chance of a clot but increase the risk of a bleed. A score of 0 suggests the PROBABILITIES of increased risk of a bleed does not justify the small reduction in the chance of a clot. This could be particularly relevant if you partake in risky activities that might increase the risk of a blow to the head (cycling / climbing / boxing!!!). It has been suggested that if I’m going mountain biking, then if a dose is scheduled for just before, then I delay my dose until after. And now a timely reminder for anyone on anticoagulants to get checked out urgently at hospital if the bang their head.

Of course this is guidance and best discussed with your consultant and any strong anxieties left after discussion should be taken into account.

[Leechg]

Hi, my consultant said I was at low risk of stroke and to wait till 65 as that age increases your risk. So I waited seven years or so and still had to ask GP to go on them. If the rest of your health is fine I would wait.

[MisterMagoo]

I had a score of 0 and generally well controlled afib but then had a TIA out of the blue aged 57. It was scary and I think myself lucky that I was given the warning. As a road and mountain biker I am concerned about the risks involved but I try and manage this by reducing or postponing my Edoxaban dose until after my ride. I always take my pill before bed as my TIA was early in the morning and I understand that many strokes happen at this time so I take half a pill before bedtime if riding the next day.

[LaceyLady]

check the side effects. Medication has to be filtered by kidneys and liver!

[Jetcat]

Hi John. I was eventually taken off anticoagulants after 3 ablations and a zero chads score. I asked the EP on two separate appointments if I could stay on them but he was very certain I came off them because of my score.!! I also still get short bouts of afib now and again and get ectopics. It bothered me for quite a while but at the end of the day Iv got to think that they are the specialists not me so I will do what they say.👍

[John3333333 in reply to Jetcat]

Hi. It sounds like our hearts are causing us fairly similar issues. Providing my AF episodes are short, not too fast and infrequent, my cardiologist isn't overly concerned. However, the erratic, weak beats and unusual pauses I experience during an episode never fail to make me think a stroke is on the cards.

[Jetcat in reply to John3333333]

yes I know what you mean John. I think the same sometimes.!!

Although The risk of taking them must outweigh the benefits for us or we would be on them I think.?

[jd2004]

During a recent cardio appointment I was told the main aim for medics is to reduce risk of stroke in all af patients. I’m on Apixaban- I bruise easily so when I dropped a radio on my foot it was quite spectacular! Personally I would have refused Warfarin which my mother took and she was covered in bruises from the least knock. However Apixaban is pretty non invasive so I’m a fan.

[Foxey2]

I’m 51 and had an ablation in October 2021, 1 year later everything seems ok other than lots of etopics, I have opted to stay on my Rivaroxaban and my consultant is happy with this

[Jumper]

My CHA2Ds2-VASC score is 2, I take Edoxaban. I followed the advice of my Consultant and only took Edoxaban when the score was indicative of necessity.

Some info I took on board in my decision process.

1.Some 20 % of strokes are related to non AF causes. eg most people over 50 have some restrictions due to plaque in the carotid artery that can flake off and cause a stroke

2. A further 15 - 20% are caused by a haemorrhage in the brain. This figure rises if one takes an anti coagulant.

You are left with around 60% of strokes that are likely to be have an AF component and to a degree are mitigated by taking an anti coagulant. An anticoagulant will reduce the likelihood of a stroke by 60%

AF strokes are likely to be severe .

It was a shock to me when after taking an anticoagulant for 2 years I had a mini stroke totally unrelated to my AF but after some examination was informed that my right carotid was very restricted and was the cause of the stroke and an immediate intervention by a Carotid endarterectomy was required. To add to this my cholesterol was only 4.5 ( using dietary control) and it was never considered that I needed to take statins.

Life can bring some odd curved balls and although I was careful with my weight, diet, cholesterol as a result of AF concerns I still had a stroke from something I had never considered. ie There were no markers that I was likely to have a stroke other than an AF one.

it is a question of balancing risks. Best of luck with your decision.

[Silky57]

Hi John, would be interested in an update on what your cardiologist suggested. I’m in a similar position CHAD 0 (or 1 due to being female) but with only one single short AF run leading to my diagnosis. I’m however in the opposite camp in that I’ve been prescribed an anticoagulant but am unconvinced of the risk/benefit ratio. Would you be happy to share your cardiologists take on this?

[John3333333]

My cardiologist advised against anticoagulation. My 48 hour tape showed no AF, but did pick up atrial triplets and two short bouts of bigeminy. None of the activity captured on the tape would suggest anticoagulation is necessary, according to my cardiologist.

From what I'm led to believe, short, infrequent bursts of most atrial arrhythmias/ectopics are unlikely to lead to a clot, especially for someone with a CHADS score of 0.

[Silky57]

Thanks John, that’s really helpful to know. Best wishes.

[Stevecat1]

My mother has had short Afib episodes and she got a stroke. She was an active lady. It best to be proactive on your doctor visit, eat and stay healthy.