Cardiologist has recommended that I should start on a low dose of an ACE inhibitor for raised blood pressure, so that has added a point onto my CHA2DS2-VASc score!
Due to strong family history of heart disease, he thinks that my actual risk is more like a CHA2DS2-VASc score of two, so he has recommended starting on apixaban as well.
Can't say I'm overly happy about being on more meds, but he did explain that the benefits of stroke prevention outweighed the risk of bleeding from being on apixaban.
When you start adding points to the CHA2DS2-VASc outside of the formula's criteria, then it's fair game to subtract points for positive lifestyle criteria not covered by the formula and even correctable negative criteria. Remember, if you're unhappy with thinners with a CHA2DS2-VASc of 1, which sounds like you are, it's your choice, not your doctor's. They are just there to advise you. When my CHA2DS2-VASc score was an actual "2" (nothing added for my familial history of heart disease) my cardiologist wrote down on a chalk board two columns. On the left, my chance of a stroke on thinners. On the right, my chance of a stroke with thinners. Yes, less chance on thinners, but the overall risk was quite low. We jointly decided I would not take them, weighing in both benefits and risks.
Thanks, you make good points. I think even with a score of 1 the stroke risk is considered moderate, and with a score of 2 or above it is considered high. I’ll have a look to see what my absolute (rather than relative) stroke and bleeding risks are.
My thoughts are very similar very similar. I currently score 1 on the CHAD2 test and have PAF. My cardiologist suggested an optional 75mg Aspirin which I currently take daily and I also take Nattokinase for its anti thrombotic properties but also has other cardio vascular benefits.
Good! I was begging my gp to put me on Anti coagulants after my diagnosis. With a very strong family history of AF and associated strokes female side I felt it was a matter of time!Scored 1 but still had a TIA,then swiftly put on A/C.
And then factor in the risks of anti-coagulants such as increased brain bleeds, increased risk of bleeds due to accidents, plus other potential side effects that you can easily research.
I had an accident and a resulting brain haemorrhage. I was given the reversal drug. Also I haven’t noticed any particularly heavy bleeding
An online calculator that I’ve plugged my risk factors into suggests that my risk of stroke for a score of 2 is approx. 2% a year, and my risk of a bleed due to anticoagulants is approx. 1% per year,
This is the site I used. You can click on your risk factors and it then calculates the CHA2DS2-VASc and HAS-BLED scores. There are tables showing the stroke risk and bleeding risks for the scores.
hi I can only say I agree I argued the case with my consultant about 2 years ago because my score was low and stayed on aspirin - one year ago I had a stroke - I’m very very lucky was found seen and given drugs to clear the clot very quickly and have made pretty much a full recovery - needless to say I now take apixaban daily - not ideal but better than the alternative- good luck
The medical doctor in my hospital recommended Xarelto. He said, the risk of stroke is 4% or the risk of bleed is 1%. After that it was up to me. I had an ablation in Dec. Had my follow up last Tuesday with EP. No AFib since ablation. Discussed coming off Xarelto with EP. Nope, 1, I'm a woman, 2, I have controlled high blood pressure. On blood thinners for life. Then again my mam wasn't on blood thinners and had a devastating stroke as did my aunt, god rest them both. I've no problems with either my bp meds or blood thinners.
Clearly this is a decision that only you can make. The calculated risk percentages are based on population averages so very difficult to apply to an individual's circumstances.
Two possible individual factors to take into account;-
Your risk of a bleed that has serious consequences, i.e. on the brain, are dependant on your lifestyle. Do you ride a bike or motorbike, participate in a sport with physical contact or other such activities that could result in a head impact?
The effect of a stroke, major or minor, on you and your family. Are you the main breadwinner, do you have caring responsibilities? Any stroke is likely to have a major effect on you and the people around you.
Personally, I took the decision to take Apixaban and have not regretted it at all. At 73 I don't have a risky lifestyle
When I was careless and smashed my finger in a door jam the nurse at the local minor injuries unit treated me as normal, it took a bit longer to stop bleeding but no great problem. When I fainted in hospital and possibly banged my head the doctors requested a scan quickly. Again no problems were found.
The risks of brain bleeds are not just restricted to those in combat or active sports, or from accidental or deliberate blows to the head. For reasons unknown I suffered chronic bilateral subdural haematomas a few years ago before my AF diagnosis. Perhaps a congenital weakness?
So my calculation of stroke vs bleed risks is obviously not an application of the generic formulas so easily proffered. And so for all of us. It's an individual equation.
I battle with this question every day, and remain open to new research throwing novel light onto this area.
In the meantime, I have to live with my current choice not to take the recommended Apixaban.
no worries about apixaban and bleeding. I had an accident and suffered a brain haemorrhage. When I was taken to hospital they gave me the reversal drug and had to stop apixaban for a week
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New 2017 European Afib Stroke Risk Guidline, No Gender Bias
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Apixaban 
Putting off the anticoagulants 
