Blood thinners from the first diagnosis or?

[NewOne2023]

Is it standard practice to put you on thinners from the start or only if you develop permanent afib? Because I didn't get blood thinners. Just bisoprolol and propafenone. Mind you, my episodes are pretty short. Never more than 45min, and vast majority under few minutes. 40 days since diagnosis.

[jeanjeannie50]

I believe anticoagulants are recommended for people aged 65 and over. I would feel happier to have them from age 60 though.

While in atrial fibrillation blood can pool and cause the formation of clots, these can cause a stroke.

I know of people in their early 60's who have had serious strokes caused by AF.

Jean

[Hidden]

Not normally necessary for a 41 yr old male in good health……

[BenHall1]

I was first diagnosed in Jan 2010 with paroxysmal AF .... aged 65. I was automatically put on Warfarin. Been on it ever since. Have elected not to switch to the NOAC's. Mind you in 2010 the NOAC's were still at testing stage, Warfarin was the only A/c commonly available back in the day.

[CDreamer]

It depends on your assessment of stroke risk - there are several algorithms to calculate stroke risk and measure that against bleed risk. If you are under 65 with no other risk factors eg: - high BP, diabetes, CVD etc - then you would score 0-1 and that is usually optional. As soon as your score rises - anticoagulants would be recommended. Whether or not AF is paroxysmal or persistent is not considered a factor - it’s the company AF keeps which increases risk.

[NewOne2023 in reply to CDreamer]

Well, by CHA2DS2-VASc scoring my number is 0. The only risk I presume (but that scoring option is not in the cha2ds2) is obesity. I do fall into obese category but my bmi is getting lower by the day (almost under 30 now) since I already lost 10 kg in the last 40 days since my diagnose. And it keeps dropping due to lifestyle changes (no alchohol, no sodas, and mainly helathy food with almost everyday of walking or some basketball). Another potential thing which also isn't in Cha2ds2 is sleep apnea. Altough I'm still not sure if I have apnea. I do snore especially on my back but as far as I know I do not choke or gasp for air during night which would be obstructive apnea, the worst kind. I'm still considering doing a test privately for that.

[JOY2THEWORLD49 in reply to NewOne2023]

hi

A 24-hr heart monitor should show if you have it.

cheri JOY 74. (nz)

[NewOne2023 in reply to JOY2THEWORLD49]

I had a holter for 24 hours during my first chek ups. My cardiologist told me the results are normal and didnt mentioned anything about apnea or over night issues. And in those days I had no afib episodes so there was nothing recorded. Only thing was I had three isolated SVES moments which are normal occurance even in healthy people as she told me. But I did get the feeling she was kinda uninterested with my check up and like she wanted to finishcit as soon as possible. Maybe I expected too much from the meeting, I dont know. I have my first EP meeting in 2 weeks. And there is an option to do sleep apnea test just after NYear. Will see.

[JOY2THEWORLD49 in reply to NewOne2023]

hi

excellent weight loss, you should be pleased with yourself.

i lost 7kg since last NOVEMBER 2022.

I found that /H/R had dropped to 60s. Great which gave my energy a boost.

So weight loss is a plus. Also I think it stops the snoring.

I found that sour dough bread and A2 milk helped reduce my weight.

Keep it up NEW12023.

cheers joy

[CDreamer in reply to NewOne2023]

Sleep apnea is worth seeing evaluation as it can be easily treated, however, to the best of my knowledge neither weight nor sleep are factors in assessing your risk of stroke, they may increase the frequency and intensity of your AF though.

If your score is 0 there is very mixed opinions on the benefits of anticoagulants but talk to your specialist. If you would feel reassured by taking one, as some are, it’s worth considering but also look at the risks of taking them.

[TopBiscuit in reply to NewOne2023]

Well done you for losing the weight! This is the single most effective thing you can do for your health in general but very specifically for AFib.

[Vonnegut]

I was told by an EP that unless an episode went on for a long time with a very high heart rate I was not at risk of stroke but I stayed on the anticoagulants until I found the side effects of constipation or diarrhoea were too much to cope with and taking Flecainide regularly put an end to AF episodes anyway!

[Cos56]

mine was paroxysmal, but, the episodes, which sound like yours of short duration, started to come closer together. I am a nurse. I really didn’t want the Eliquis, but I wanted a stroke even less. I haven’t had an episode for two years since the start of Flecainide, but I’m not taking any chances … I’m not poking the bear😉

[RoyMacDonald]

If you have AF you can have a stroke is my understanding of the risk. So yes you should be on anticoagulants if you have AF regardless of how long the episodes last. I'm not a Doctor though.

All the best.

Roy

[Hidden in reply to RoyMacDonald]

Obviously a personal decision but anticoagulants are not risk free, otherwise they would be prescribed to everyone with AF and the CHADs system of scoring would be redundant. Whilst they apparently do not cause spontaneous bleeding, and the risk of excessive bleeding for those with normal blood pressure is relatively low, the increased risk needs to be considered, particularly for those who enjoy an active lifestyle.

[RoyMacDonald in reply to Hidden]

I can only say I was diagnosed with AF, prescribed Apixaban but did not take it and had a stroke 4 years ago. Fortunately it had no effect on my active lifestyle although my GP is not happy that I continue to race, and do weights now, but I'm 80 soon and enjoy it so what's the point in worrying about doing something that you enjoy at that age? Something will kill me sooner or later anyway.

All the best.

Roy

[Hidden in reply to RoyMacDonald]

Not disagreeing with but from what he told us in an earlier post he is only 41 which is why anticoagulants are not normally necessary for healthy individuals. At the tender age of 76’ish you sadly paid the price for not following normal advice but you seem quite pragmatic having almost reached 80 so the best of good fortune👍

[babs1234 in reply to RoyMacDonald]

Ditto Roy. I’m 70 and play numerous sports. Sometimes over exertion put me into AF bit bit one to give in, I carry on. Not sure whether it’s a good thing or bad but I enjoy it too much to give up

[Keswickman in reply to Hidden]

Hi. I spoke with my GP yesterday regarding anti coagulation and referral to a cardiologist for their assessment on whether I should be considered for medication.

GP said he would not refer me to an EP or cardiologist unless my circumstances change; furthermore he wouldn’t prescribe any medication as I have a 0 Chads score. I am 60, good health, good BMI, no contributing factors. He did say that in my case, the benefits of anticoagulants do not necessarily outweigh the risks of problems from the medication which itself can contribute to having a stroke.

He will only consider prescribing medication if my health changes or when I reach 65.

All the best

Nick

[RoyMacDonald in reply to Keswickman]

My understanding is that even with a 0 Chads score there is still a risk of a stroke as it never falls to 0% regardless of age. (even babies can have a stroke) But I'm not a statistician or Doctor.

All the best.

Roy

[TopBiscuit in reply to RoyMacDonald]

They are not recommended unless they have a CHADS2 score of 2 or over. Despite any claims to the contrary anticoagulents are considered a 'high risk' medication, as Flapjack says.

Oral anticoagulants have been classified as high alert medications according to the Institute of Safe Medication Practices (ISMP) because they have the potential for harm when used clinically.

[Speed in reply to TopBiscuit]

Note that high alert medications are ones that IF TAKEN INCORRECTLY can cause significant harm - ie overdose and include insulin, opiates and narcotics. This is different from being “high risk” when taken correctly. The main concern is that in the event of a trauma, resulting in bleeding, the consequences could be far worse. This could include a bang to the head and a brain bleed which could be fatal. This is why the simple CHADSVasc type scores are used to flag up suitability yet not over prescribe if bleed risk more than offsets stroke risk, but clinicians should also consider other relevant patient circumstances. And although obesity itself is not one of the parameters, hypertension, diabetes and cardiac events are often a consequence of obesity and so is effectively taken into account.

And well done NewOne for biting the bullet and loosing weight. It is probably the single most effective thing you can do to minimise future health issues. Yes there may be a lot of factors that encourage us to over eat or eat poorly and for a small minority there is very little they can do, but for the majority of us, being over weight is a choice, be it a very difficult one to say no to. Take responsibility rather than comfort in believing you are a victim. I know, I can, and have, put half a stone on in a 2 weeks on all inclusive holiday. Those puddings, that wine, the fried breakfast, all topped off by a lack of will (or won’t) power!

[Nightmare2 in reply to TopBiscuit]

I do not know where or who told you Anti coagulants are high risk, my Cardiologist states the opposite, in fact there is more High Risk to an AF sufferer by NOT taking these, stroke risk really is too high.

[TopBiscuit in reply to Nightmare2]

Well, in this instance I was quoting the Institute of Safe Medication Practices:

"Oral anticoagulants have been classified as high alert medications according to the Institute of Safe Medication Practices (ISMP) because they have the potential for harm when used clinically. "

But I should add that I wrongly called them 'high risk' rather than the more correct 'high alert'. My point was simply that they - like all medications - have pros and cons and the 'cons' of oral anticoagulants are potentially significant and when prescribed the potential harm is being weighed against the potential good.

As far as the stroke risk for AF sufferers goes, the risk factors are those included in the CHADS2 questions, so for example, an AF sufferer aged 50 without any of those other risk factors will not be prescribed anticoagulants. In that instance the risk of taking anticoagulants is considered to outweigh the (low) risk of stroke, despite their AFib.

[Shell2023 in reply to TopBiscuit]

so if you have afib without being high risk what would they normally do to help control your heartbead

[TopBiscuit in reply to Shell2023]

My post was specifically referring to anticoagulants, which don't do anything to control the symptoms of AFib, but to reduce the risk of stroke.

Treatment, using either rate control drugs or arrhythmia control drugs, or both, are prescribed for any AFib sufferer whatever their age or CHADS2 score, dependinng on what is agreed with their cardiologist or GP.

[FSsimmer]

Hi,

I have had my Afib now for almost 3 years ( its been diagnosed as long standing and persistent ). I first was diagnosed one evening when I went to A&E as I was not feeling too well and my heart rate was all over the place...

Strange for me as my HR resting was about 45bpm as I was a keen runner!!...I was put immediately on beta blockers AND and anticoagulant by the A&E doc and made an appointment to see the cardiologist /EP...

Now one thing they should do is your CHAD score for stroke risk etc. I was over 65 and mine came out at 2....To be honest I am glad they medicated me stright away, as it reduced my stroke risk which is so important...I am still on them after an ablation which has not worked!!, but the medications do not bother me and I have no side effects and inimal Afib symptoms...Keep in there, and all the best

[Nightmare2]

From the day my parosysmal AF came on the Cardiologist insisted i take Apixaban twice daily, although i rarely have an episode now not drinking at all alcohol, he told me this is the most important tablets anyone with AF can take as the risks of blood pooling and causing stroke is much higher than they like.

[Bikica1234]

Sorry,what dose of bisoprolol and propafenone are you taking?

[NewOne2023 in reply to Bikica1234]

Bisoprolol 1.25mg once in the morning. Rytmonorm (propafenone) 150mg 2 times daily, once in the morning and once in the evening.

I was taking propafenone 3 times a day but I lowered my dose to 2 times a day more than 20 days ago and it seems it didn't make any difference. The less of these medications I take, the better. I don't want to stuff myself with meds if it's not necassary. I'm doubting my bisoprolol also, since I never had any problems with my blood pressure, and I do feel some side effects from it. Low heart rate, feeling dizzy sometimes when I get up and overall not feeling like 100% in my head. I do believe it's all because of my meds so I really want to limit the intake as much as I can.

Currently Im waiting for an ablation date and I didn't have afib since early December.

[Bikica1234]

I had an ablation in 2020 for atrial tachycardia. The ablation was successful, I no longer have tachycardia, but I have SVES and VES and for that I drink Bisoprolol of 2.5 mg, but it does not help me. They suspect that I have asthma because I have shortness of breath, I am going to a pulmonologist for tests. However I don't think I have asthma and I believe that the shortness of breath is from the heart, although cardiologists say that according to all the cardiological findings I shouldn't have shortness of breath. However, I have them because when I get SVES and VES then I feel shortness of breath and it's like I'm going to die. It lasts for a second, two and later it will be OK. This is driving me crazy because bisoprolol therapy is not helping me.