This is a post particularly for newly diagnosed members who maybe concerned at some of things they may have read recently about the increased risk of bleeding due to taking anticoagulants. I’m not medically trained, nor (as far as I know) are any of the contributors featured in the links below but what they say will hopefully improve your understanding of what is an extremely complex and important subject.
AF and other Arrhythmias tend to be complex conditions which can affect people in so many different ways. It’s therefore impossible to come up with any simple solutions for anything and everything the condition can throw at you. In other words, there are no “one size fits all” solutions to treating any Arrhythmia. In addition, because this is an international forum, different countries have their own methods of delivering medical care which often creates differences in opinions and advice offered by members and this can further complicate treatment considerations because not all treatments are easily accessible everywhere.
Generally, in the UK when an Arrhythmia patient is diagnosed, the Doctor has 4 main objectives to consider:
1. Heart rate control - If the heart rate remains too fast for too long it can ultimately result in heart failure. Whilst that sounds bad, it is treatable but obviously best avoided. Similarly, but not so common, slow heart rates also need treatment but for different reasons. Treatment (normally medication) is prescribed to get the heart rate into normal range, ie 60/100 bpm.
2. Assessing the risk of stroke - it is a well known fact that AF will increase the risk of having a serious stroke. The degree by which this risk increases is determined for each patient using a system known as CHADsVASC. For those not familiar with this process, there is plenty of information on the AF website or alternatively, using Google. The system provides every patient with a score and depending on that score, a decision needs to be made as to whether or not the patient should be anti-coagulated. Whilst ideally the patient should participate in the decision process, this is normally assessed almost immediately after diagnosis therefore it is unlikely that the patient will be in a position to contribute much to the process. Unless anticoagulants are prescribed for short term use, i.e. to support a procedure such as a cardioversion or an ablation, they should normally be taken for life regardless of any treatment which might and hopefully will at some stage, control symptoms. It is generally understood that there is no finite cure for AF so symptoms can return at anytime. If symptoms return after treatments such as an ablation, they are often significantly less obvious and a patient may even be unaware that AF has returned, so always discuss this with your doctor and follow the advice given. Unfortunately, a stroke will occur with little or no warning and needs immediate medical attention to minimise any long term effects. If you live within close vicinity to an A&E facility, if it’s possible it might be better to be taken to the hospital by car rather than risk waiting for an ambulance if you are told there could be a delay.
3. Assessing the risk of bleeding - if anticoagulants are prescribed they will increase the risk of bleeding. As far as we know, they do not, in themselves cause a spontaneous bleed, but if a patient experiences ANY form of trauma or internal bleeding perhaps caused by an ulcer, it is likely to take longer to stem the bleeding. The system for assessing this risk is known as HAS-BLED and is a similar process to CHADsVASC. Unless an AF patient, or a close family relative has a history of bleeding, medics suggest the risk of stroke outweighs the risk of bleeding. Unlike the risk of stroke, you normally have to actually experience “something” to cause it to happen. This is why it is important to take sensible precautions to minimise the risk but as the majority of patients prescribed anticoagulants are 65+, I guess this is no bad thing anyway. If you have recently been prescribed an anticoagulant, it is likely to be one of the DOACs ie Apixaban, Edoxaban, Rivaroxaban or Dabigatran. These operate in a different way to Warfarin which was more commonly prescribed pre-pandemic. All anticoagulants are good at what they do, but as I understand it, DOACs tend to offer very slightly better protection against bleeds than Warfarin and Apixaban is very marginally deemed as being the better DOAC but that is all very speculative. Personally, I take Apixaban and have done for several years and had no problems. Normal cuts and scrapes really do not take much longer to heal than before. Bruises caused by knocks seem to fade as normal and I have had no unaccountable bruises. I am a fairly active 76 year old and continue to do all the things I have always done but more carefully and using protective clothing when necessary. Whilst I don’t partake in contact sports, ride horses or ski, I feel comfortable doing the things I want to do but patients should always follow guidance from your medics. Read the links below, you should find the comments helpful and interesting and will hopefully help to allay your concerns regarding the risk of bleeding.
4. Symptom control - often, but not always, AF brings with it a number of different symptoms and if you have been recently diagnosed, you will no doubt be familiar with some or all of the more normal ones. In the UK, under the NHS, doctors will follow a set of procedures which are laid down and monitored by NICE. This is a very complex process which often involves a combination of tests, procedures and medications which are designed to help control AF symptoms in order that over time, the patient can lead a near normal life. None of this is easy or quick and more specific information is available on the AF Associations website.
I hope you find this helpful, no doubt it will encourage other members to add their thoughts and experiences but it is always important to follow the advice of your doctor. Here in the UK, doctors will follow the NHS guidelines for treatment as defined by NICE. I have know idea how treatments are determined in other countries. Please read the comments in the links below and normally, there should be a list of related posts featured on this page, so take a look at those too as they can only add to your knowledge and understanding.
healthunlocked.com/afassoci...
Please be aware that as is often the case when dealing difficult issues, admin decided that access to this post was best stopped but the comments regarding anticoagulation are still worth considering
healthunlocked.com/afassoci...
Finally, nobody wants to take medication but most of us accept that where AF is concerned, taking prescribed medication is almost always better than the alternative. There is always research into new modified treatments and of course, the advances in technology have been and will continue to be incredible. There will soon be trials in the US to explore the possibilities of reducing the need for some AF patients to take anticoagulants on a regular basis but this will take at least 5 years to complete. If, as we all hope this research is successful in its findings, it will probably take even longer before any changes occur in the UK because the Medicines and Healthcare Products and Regulatory Agency (MHRA) exists to make sure that medicines and medical devices work properly and meet the required standards of safety, quality and efficacy. It also assesses all new medicines before they can be sold in the UK and continues to monitor the safety of medicines once licensed. I think we can all be assured that the AF Association will be quick to make members aware of any developments in this important area, as and when they occur.
I hope that all you newly diagnosed members will find this information helpful and encourage you to ask questions because members are always willing to share their experiences in order that you can begin your AF journey with more confidence and understanding than we did. Once knowledge and a better understanding of anticoagulation has been acquired, newly diagnosed patients are better placed to discuss their concerns directly with their doctors
Of course in time, patients conditions will change and hopefully improve as will their knowledge and understanding as their treatment plans evolve but the principles referred to in this post are unlikely to change significantly anytime soon in the UK due to the reasons mentioned above. Most are happy to follow the advice given by their medics but there is nothing to stop any patient from ignoring this advice but I assume that they are then responsible for the outcome of their actions.
Also remember, the AF Association’s Patient Services Team are always able to offer help and assistance regarding this important subject…….
Article on anticoagulation in today's Daily Telegraph
Blood-thinning drugs 'can reduce risk of dementia by up to 48%' 
Incidence of Stroke for those with AF taking an Anticoagulant
