I started having a fibs in 2007 after having Lyme disease and also possibly too much thyroid medication. I’ve managed it all these years and after I turned 65 2 1/2 years ago, the doctor started pressuring me to go on blood thinner because of stroke risk. my score is only a two and it’s a gray area for anticoagulation. I am very sensitive to medications, and I recently started on Eliquis and I have multiple health issues going on at the same time and I’ve been very anxious. I read that you cannot go on SSRIs with Eliquis because it can raise your bleed out risk. Has anyone found anything that doesn’t interact that’s helpful? I read about the amino acid L-the anine but my doctor wasn’t familiar with it.
Would love to hear your experience.
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A Chadsvasc score of 2 is not a grey area at all so I'm so glad you decided to take your anticoagulant which is much more important than many other medications.
I was given a choice by my cardiologist re thinners when I was a CHADS2.
He drew a line down the middle of a chalk board. On one side was the risk with thinners. The other side the risk without. The risk with thinners was less, but the overall risk was very low. Based on my active lifestyle and overall health, he said either choice was reasonable, but if it were him, he would hold off the thinners. He was a senior cardiologist at a top 10 ranked cardiac hospital in the US.
Don't let anyone here scare you about thinners, one way of the other. Whether they are on thiners, orif I am on thiners, or if anyone else takes or doesn't take thinners is not the point. It's a risk/reward analysis, best left to a trusted doctor who knows YOUR complete medical history. And if you're unhappy with the recommendation, you can always seek a second opinion.
The doctor practices in one of the top 10 rated cardiac hospitals in the US. He is both a medical conservative and an advocate of shared medical decision making where patients are treated as adults and not like children. So instead of telling me what to do, we actually had a discussion using the actual stroke statistics with and without thinners. It turned out we were both in agreement how to proceed. Unfortunately, such doctors are still in the minority.
I agree with Bob that anticoagulant is important. I sympathise with your situation regarding your sensitivity to meds: I have the same problem, and no one has yet found a beta blocker or a calcium channel inhibitor that agrees with me.
However, I’ve been on an anticoagulant for six years, since I was first diagnosed with permanent AF. Have had no problems with it at all, and feel content and confident that it is protecting me.
I, too, have hypothyroidism. AF and the thyroid is a minefield, isn’t it? Sorry, but I can’t comment on SSRIs.
I am always curious as to why there is SUCH a big difference in opinion of recommendation as to when anticoagulation is appropriate between US and Europe regarding anticoagulants as a prophylactic to lower stroke risk in AF. It has entered my thoughts that cost could be an influencing factor? Medication in Europe is generally subsidised but not always covered by insurance in US?
My understanding was that CHADSVASC score is international - 0 is optional, 1 - recommended but a choice, 2 = I think perhaps you are the wrong side of MrJames’s line as 2 in my book is a high score.
I have multiple medical issues and no problems with Apixaban (Eliquis).
The revised guidelines from the European Society of Cardiologists advise that if your 2 points are for female sex and age ie no comorbities then anticoagulation is not mandatory. This is I think because there is some controversy over whether a point should be given for being female. It has been my experience here that some follow the new guidelines of mandatory at 3 points and others stick to the old ones. Or perhaps they look at you as an individual rather than treating by algorithm. It has always seemed absurd to me that a healthy woman with no comorbities should have to go on an anticoagulant on her 65 th birthday whereas an unfit man of 64 with diabetes or high blood pressure doesn't.
Do you have a link for this please? As an active (more so before I went on thinner) power walking, always doing ,female of 69, you echo my thoughts. WHY is a woman penalized with a point , does anyone know?
I am always curious as to why there is SUCH a big difference in opinion of recommendation as to when anticoagulation is appropriate between US and Europe
There really isn't a difference except possibly in exceptional, individual circumstances. I was prescribed Eliquis with a score of 2. Cost is not a factor in a doctor's recommendation. If an afib patient suffers a stroke a close review of all factors would be made if he was not anticoagulated.
You wouldn’t get a score of 2 if you are male with no co- morbidities you would score 1 but if you are female you would score 2. This is an algorithm based on statistics- it’s not foolproof- it’s a guide.
What you say doesn't match the following calculation, which gives 2 if you are 75 or older, both male and female ... so you would be 3 if you were also a female, and without comorbidities ... I am still 2, as I said ... mdcalc.com/calc/801/cha2ds2...
Thanks for correction! It's interesting though that no significant account seems to have been taken in my ChadsVasc2 score of my unexplained chronic bilateral subdural haematomas, nor in my HAS-BLED score. Apixaban still recommended. Confusing for me and my score of 2.
Just over two years ago I had massive heart attack which has left me with PAF ( had cardio version 3 months after heart attack as was left in persistent AFib from cardiac arrest), NSVT and bit of SVT. on all heart medications.
I developed some anxiety about 12 months ago and was seeing my electrophysiologist. We discussed medications. I was already having counselling. He went away and looked into the safest options to treat anxiety. As anxiety can make your heart arrhythmia’s worse.
He came back and suggested sertraline which is an SSRI. I was concerned about this with being on riveroxaban so got in touch with the pharmacist who said they are at times prescribed together if the benefits outweigh the risks and you’re stable with no other bleeding risks. I also then re discussed it with my EP who said he was happy for me to go on it as I’m otherwise a low bleeding risk.
Going on sertraline has given me my life back. I think at times I could do with a higher dose but do other things to help with anxiety when that happens. So I’m keeping on the lowest treatment dose of 50mg. I’ve not experienced any problems.
Good luck anxiety is a horrible thing. Life’s too short anyway not to be able to enjoy it and
I realize this has been up for 7 days now but hope you see this question. My situation is somewhat similar to yours, in that I have Afib (now only occasional episodes after an ablation 4 years ago), take Elliquis, and have anxiety which I know makes things worse at times. My GP recommended Sertraline, and said the potential drug interaction would not be a problem in my case. He also said there were some potential side effects when you started treatment. Well, I was correct. I started on half a dose (25 mg) for a week, but the first day, I had rather severe diarhyia and some anxiety…and since I was about to embark on a trip, I simply stopped. I am now back, and plan to start with another trial. But my question is, did you have this when you started? And if so, how long did it last before it subsided? I realize we all different but your experience might help me decide how to handle things. I am also curious as to how this medication actually helps your anxiety…how does it make you feel?
I think you are replying to ewloe who talked about being on the same anti anxiety drug. I am not on that so I can’t help. Maybe he or she can. Hope you can tolerate something that brings peace.
yes I had some diarrhoea to begin with and my anxiety got worse which apparently it can do for the first few weeks. Mine lasted only about 7 days it wasn’t pleasant but I’m really glad I stuck with it as after that things definitely improved. I’m reluctant to increase it as again increasing it can make your anxiety worse for a short time and I feel i can manage things. I really do feel it’s given me my life back. Its allowed me to see the old me again. If you do start it accept your likely to have a few initial side effects but that they won’t last. Good luck.
There is some controversy as regards CHADSVASC scores according to sex . If you are female and your 2 points are for sex and age ie no comorbities then anticoagulation might not be recommended automatically. This is according to the revised guidelines from the European Society of Cardiologists. I live in France and there seems to be some difference between cardiologists in this - some following the new guidelines and others sticking to the old. I tried both Préviscan ( a Warfarin like drug ) and Pradaxa before these new guidelines came in and did not get on with either so stopped with the acquiescence of my own cardiologist( put on them by hospital cardiolgists). When my score went up to 3 my own cardiologist put me on Apixaban which I have been taking for over 4 years.
No- if I kept links to everything I read my tablet would have ran out of storage space long ago! You could put in a search. As for the point for being female I think it is to do with the stats they used for the algorithm. I vaguely remember reading that the Danish population was used- the Scandinavians have had national computerised medical records for awhile. But other populations might not be the same. Again I remember reading that the Japanese do not give a point for being female.
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