CHAD VASc

[SteM]

Last year on a visit to my EP he informed me that at the age of 64 and with a CHAD VASc score of 1 that anti coagulants were not necessary. However as I turn 65 then my score would go to 0 which then does require Anti-c . I am taking Flecainide, bisoprolol along with Magnesium and I am in good health with only 1 episode in the last 12 months which self corrected in around 6 hours. I would appreciate any comments.

[BobD Volunteer]

in fact with a score of 1 anticoagulants are optional, not unecessary. With a score of two which you now have, (not 0) they are recommended. The number and severity of any AF events are irrelevant particularly since many people are unaware of many of their events.

As has been said many times, you can always stop taking then but you can never undo a stroke.

[jeanjeannie50 in reply to BobD]

I totally agree with Bob. Having worked in a nursing home and seen the results of strokes, it's pitiful and never ever would I risk the chance of having one. We had people who couldn't move, speak, eat (fed through a tube in their stomach). Having to wear incontinence pads through having no control over their bladder or bowels. Their eyes looked out bewildered on a world they couldn't understand. Yes several patients had all these things, others just had a few of them.

Anticoagulants can protect against strokes, so other tablets you may have, yes discontinue if you feel better without them, but never ever go without an anticoagulant.

Jean

[mjames1]

I think what you meant to say is that when you turn 65 you're score will be "2". When my score was "2" , my cardiologist sat me down and he drew a line down a chalk board. On one side he put my stroke risk on AC's and on the other side, my stroke risk without AC's.

The stroke risk without AC's was higher, but the absolute stroke risk was quite low. Then we talked about my lifestyle, which included sports with a higher than normal bleed risk. We also discussed the fact that one of my risk factors (blood pressure) was now controlled. We also factored in the fact that my episodes were very infrequent. And he also asked me my personal preference.

We then came to a shared medical decision that I would be better off without AC's then on them.

Everyone should have this type of discussion with their doctor, because we are not cookies and should not follow cookie cutter formulas. The revised CHADS score is an excellent starting point, but not an end point.

Today, I'm on AC's, because my situation changed. I'm older so now my score is a "3" and I'm also in the blanking period following an ablation. If the ablation is successful I hope to be able to stop AC's again and go on what is termed PIP Anti-coagulation. That means just taking an AC at the onset of an afib episode and only continuing for 30 days. For more information, you can "google" Dr. Rod Passman, PIP Anticoagulation". He has already completed some promising pilot studies and is now enrolling in a multi-center trial in the US.

Important to note that PIP AC's is not part of either the US or UK guidelines, however my ep in the US supported the concept. I have been told that it is not being done in the UK, although I stand to be corrected on that if anyone in the UK has done this under their doctor's guidance. In any event no one should stop taking statins, or any other meds for that matter, without their doctors approval.

Jim

[Cavalierrubie in reply to mjames1]

l would never go without an anticoagulant and would not feel fully covered with an anticoagulant used as a pip. It is possible to have AF in your sleep, as is a heart attack (my father had one and didn’t know.). . Despite a doctor sitting down and discussing what he thought was ok and, would work, l would not be 100per cent convinced that l would be safe. Sorry to burst your bubble but l feel you would be playing Russian roulette with your life. I have never heard of this theory before.

[healingharpist in reply to Cavalierrubie]

Hi Cavalierrubie, Yes, this approach has been discussed for years amongst cardiologists. One reason is that almost 7 million people in the world suffer from serious bowel bleeding diseases (such as myself) and are NOT good candidates for AC's, which can and do often trigger life-threatening bleeding in those patients. Some of us also have very low risk profiles so the absolute risk percentage for stroke is extremely low. (The AC drug reps make it sound like everyone w/ AF will have a stroke, but that's not the truth, and they never mention that AC's are not 100% effective.) The decision has to be all about our individual medical histories.

[Cavalierrubie in reply to healingharpist]

Thanks for your reply. I appreciate that there are always exception to the rule. I think that is the case with most medical conditions when the risks outweigh the treatment. In such cases it is the individuals choice. However, for such as myself and, the majority of AF sufferers here in the UK, anticoagulants are the most important treatment of all. No drugs/anticoagulants are 100 per cent guaranteed as we are all unique, but they are highly effective in giving protection against a more serious illness, which has been proven to happen with AF. With an AF attack the blood pools and forms clots. For this reason l choose to take an anticoagulant

[Hidden in reply to mjames1]

I thought the administrator from the AF Association had recently clarified how anticoagulants are prescribed in the UK.

[OzJames in reply to mjames1]

hi Jim, my cardiologist said now that I’m 65 my score is 1 and I have no other issues and reasonably fit and healthy. He suggested at last check up to use AC as PIP if I go into AF. He explained that a clot can start forming 3-4 days from on set of AF. He advised to do the low dose aspirin which I know is not an AC. I’m ok with that and wear Apple Watch for alerts plus when I exercise I can review hearts rate after session to see any anomalies from previous sessions. It’s frustrating that there are different views on what is right or wrong. I’ve always been aware when I’m in AF but as some people have suggested when your asleep you don’t always pick up a short AF episode. My score all going well will go to 2 when I turn 75 and will most likely go on AC

[Sixtyslidogirl in reply to mjames1]

I have got PIP apixaban as AC with score of 1 due to being female. Private sport’s cardiologist in UK. I am 62 , so when I get to 65 there will have to be another discussion. I have got my NHS appt in a few weeks so will be interesting to hear what they think.

[secondtry in reply to mjames1]

I agree and you had a good EP. As you say it is a balanced decision and not one to opt out of by using the CHADS score as gospel. I have not taken any ACs for 10+ years as on CHADS1 (with virtually no AF episodes) but that was only the starting point with my cardiologist chat.It is not an easy decision and subjective, best taken after you have done extensive homework.

[Singwell in reply to mjames1]

Very informative response. Thanks Jim!

[Ppiman]

I was told by the cardiologist after my ablation for atrial flutter in 2019, at the age of 66, that the single episode of AF that I experienced a few days after it meant lifelong anticoagulation. I was amazed.

Steve

[Omniscient1]

Patently Chads2vasc is based on statistics, which means that some (most) people will glide through life never having needed ACs. I see this as insurance, I take out policies with the intention of never claiming. My C2V score is 0, when it gets to 1 I'll be in the queue at the pharmacy.

[Jetcat in reply to Omniscient1]

me too.👍

[wilsond]

I had a so called score of 1 at age 53 fir being female. GP forgot or didn't know that hypertension is also a score. With a high family history of AF too. I wanted to be ACd. It took a mini stroke to convince.

[SeanJax]

it is a perennial question. All the comments here have their points and merits. People make their decisions according to their understanding and preferences and it is their brain cells. One we have a stroke we cannot undo it. Also anticoagulants can cause brain bleed if you have high blood pressure or arterio malformation in the brain . And it can cause 4 major site bleedings in the eyes , joints, brain, digestive system. It is your own call. Think over it and make a shared decision with your ep. Best wishes .

[Jetcat]

hi steM, I wouldn’t say your a zero chads given your age now mate. I’d Go back to GP and ask for another evaluation just for peace of mind.👍

[gorpo59]

6hrs too long in my opinion. I’m same age and had two minor but permanent strokes 7 years ago after af overnight. Been on apixaban since. Zero side effects but it will save you if you go into af.

[SCCDL]

I have forgotten what my CHADS score is, but I know it is not good. So, I am on Eliquis, which I tolerate well. What puzzles me is the number of my friends who have or have had bouts of afib, yet their docs have not put them on an anticoagulant. I wonder why? I have a family member who suffered a bad stroke that has left him in bad shape. His wife now has become an almost full time caregiver to him, despite her own health challenges.

[healingharpist in reply to SCCDL]

Hi SCCDL, One answer to your question is, almost 7 million people in the world suffer from inflammatory bowel diseases (which include bowel bleeding); and anticoagulants, even the new ones like Eliquis, have definite risks of causing bowel & other bleeding if you have that history. I'm one of those. My 2 cardiologists (1 is an EP) say NO to AC's for me, because the absolute risk of stroke is still quite low for me. There is no "one size fits all." It all depends on our medical history.