My cardiologist/EP (a Professor) is of the opinion that automatically giving a female a 1 score is outdated and after my ablation three weeks ago, he said when I see you in six weeks time, we will probably be able to take you off anticoagulants. On stating that I was a 2 score because I’m a female and over 65, he poopooed the need for a female score, saying that that was not necessary anymore in his opinion.
Would like feedback from you please!
This is a growing modern opinion. Mind you I have always been told that even successful ablation does not remove stroke risk. I haven't knowingly had AF for ten yeasr or more but have no intention of stopping warfarin.
If an ablation is successful, how would it not remove stroke risk, or at least make it equivalent to someone who never had AFIB?
Two reasons. First It is not necessarily the AF that gives the stroke risk but the company it keeps and two the process of ablating can create surface changes in the atrium which can allow eddies and subsequently clots to form.
"he poopooed the need for a female score, saying that that was not necessary anymore in his opinion."
I don't think it is just his opinion. The following is one of many examples of guidance that effectively ignores the impact of the 1 point scored for being female.
"When the CHA2DS2-VASc is used, the AHA/ACC/HRS guidelines recommend OAC prophylaxis for men whose score is ≥2 and for women whose score is ≥3, which is equivalent to an estimated thromboembolic risk of ≥2% per year. For men with a score of 1 and women with a score of 2, whose estimated thromboembolic risk is ≥1% but < 2% per year, the AHA/ACC/HRS guidelines consider anticoagulation reasonable, but note that in some cases this may require additional discussion with the patient."
AHA/ACC/HRS = American Heart Association/American College of Cardiology/Heart Rhythm Society
My view of CHA2DS2-VASc and the like is that they are tools to assist decision making i.e. something to be taken into consideration when making a decision rather than something that decides what you do. Ultimately the decision should be yours to make - hopefully after you've weighed up the pros and cons for your specific circumstances, in consultation with your relevant medical professional(s).
What you've quoted concurs with the idea that women get an extra point surely? Regardless of whether the outcome is anti-coag (after discussion as you say)
Yes, they get an extra point for being female but then it's effectively ignored.
In the example provided they get an extra point for being female but when assessed they are allowed an extra point for the same outcome as a male. So the net result effectively ignores the additional point scored for being female.
I think there is an evolving view in cardiology that automatically assigning every woman a score of 1 in the CHA2DS2-VASc score is being reconsidered, with increasing recognition of the risk of over-treatment in women without additional risk factors. And as bean_counter mentioned, to emphasize shared decision-making (doctor and patient) considering other co-morbidities to definitely avoid underestimating stroke risk.
I stopped anticoagulant 12 months following successful ablation with no AF for 12 months and then had a TIA a few months later with a score of 1 for female. There are no certainties and whatever happens statistically, we cannot eliminate risk either way so you need to weigh up how you feel about it and then talk to your doctor. With a score of 1 for being over 65 - I would be taking anticoagulants but that’s just my personal opinion.
Whatever happens a doctor should not be poo pooing your concerns, you need reassurance and help to make the choice. Perhaps research a little yourself?
What’s a TIA?
A transient ischemic attack -it’s a a short period of symptoms similar to those of a stroke caused by a brief blockage of blood flow to the brain. It’s usually last a few minutes.
Considering the potential life altering effects of a stroke vs the minimal risk of Anticoagulants I would error on the safe side and take them.
Those of us who get side effects which impact our QOL cannot look at this so simply. Balancing the risk of a stroke that might never happen against living every day with increased skeletal pain and digestive issues is not easy.
Would you get digestive issues with Edoxoban eg?
Probably. The bans are all very similar . I'm not sure it is available here in France. I was offered Apixaban or Rivaroxaban. I had already tried Pradaxa - even worse digestive issues . My doctor will not prescribe Warfarin.
I agree.
Oops. I was agreeing with Auriculaire. Sorry.
I agree! One of the reasons I wanted, and got, a Watchman was QOL without drugs that had a negative effect on my enjoyment of each day.
Ooh, tell me more about watchman please!
More than 90% of all blood clots form in your heart’s left atrial appendage (LAA). Some research puts the number at 95%+.
With Afib, blood can get stalled in the LAA because of the uneven flow. The Watchman closes off the LAA so that the elements in your blood that form clots don’t have a place to hang out together to create a clot.
The procedure is called LAAO: Left Atrial Appendage Occlusion.
When the place where almost all blood clots form is eliminated, one can get off anticoagulants and switch to baby aspirin.
Just look up Watchman in your browser and you’ll find all you need to know.
I love having a Watchman. It lowers my stroke risk to as close to nil as possible. Complete “nil” is impossible. But I’ll take as close to nil as possible, especially given that we afib folks have a 5 times higher risk of stroke than those without afib. The Watchman puts me on a more even playing field with people who have healthy hearts without our electrical problems.
Hi,
Just picking up on a few thoughts on TIA ... although not strictly related certainly fits the phrase of 'a cerebal event '.
About 10 years ago had a weird experience. I stepped out of the morning shower and suddenly became totally confused as to where I was and what I was doing ....... YET I knew I was safe ( at home ) and was able to navigate my way around rooms and knew my wife was in the same room. ( At this time I was 2 years into my life with paroxysmal AF ). As I walked into the lounge my wife looked at me and asked if I was okay ... she claimed my face was a light grey and I looked quite confused. It gave me a period of brief concern as my mother died from Alzheimers.
Long story short, saw a Cardiac Consultant who after head scans and other tests diagnosed TGA - Transient Global Amnesia. One of the features is described as ............
"The underlying cause of TGA remains enigmatic. The leading hypotheses are some form of epileptic event, a problem with blood circulation around, to or from the brain, or some kind of migraine-like phenomenon.[8][15][16][17] The differences are sufficiently meaningful that transient amnesia may be considered a heterogeneous clinical syndrome[2] with multiple etiologies, corresponding mechanisms, and differing prognoses".
I made a decision at that time there was no way I was gonna mess around ....... the experience confirmed my original decision that I was gonna stay on meds for life .. ESPECIALLY .. ANTICOAGULANTS. No way was I gonna fool around with ablations or any other fancy invasive stuff. Now at 80 years, no return of TGA, but happily jogging along with my meds and my anticoagulant of choice, WARFARIN, ( despite the best efforts of my GP to get me onto the new stuff ).
John
Are you aware that TGA can be a side effect of statins?
I wouldn't say an ablation was 'fancy invasive stuff', in my opinion it's a skilled procedure that has given me a better quality of life
it is just what I said when compared to the mundane task of swallowing pills every evening. Hope the success lasts for you, statistically it may not.
I hope so too!! My EP says I have a chance of 85% as I had paroxysmal AF. My last episode was January 2024 and I had the ablation at the end of March
my chads score would be 3 in November and I would need blood thinners. I said so my body knows when I’m 65 ? lol so I started at 64. I don’t want the risk. Whether chads is outdated or not I would rather. Same as having any sort of insurance .dont have it you will need it..have it and you won’t
Good luck whatever you decide
He's a professor for a reason and sounds like he knows his stuff. I was told once AF occurs, then it's "blood thinners" for life, myself (by another professor!).
No one knows why the clots form, It seems to be more to do with the shape and size of the small atrial cavity in which they start their life (the LAD, left atrial appendage). I would be guided by the specialist every time, but press him for a better explanation of his stance.
Steve
If you have no comorbidities & take no other drugs daily, lead an active life with improved lifestyle choices to compensate for your 'over 65' age and are under 75, I totally agree with your EP.
The medics tried to put me on ACs 10 yrs ago at age 60 and I declined the offer, only starting this year because AF has restarted with a changed 'flutter/pause' pattern. All medics have a different approach and I understand in Europe they have an approach more like your EP.
I've heard the same.
Thanks everyone for your input! I’m in the UK. I am slim & very active - regular gym classes, golf, long walks - no other medication. Very rarely had any afib occurrences before my ablation - max heart rate 120 for about 20 minutes. Mostly bradycardia. After ablation get daily flutters, ectopics. HATE the thought of any medication going forward. Will discuss further with my EP when I have my follow up appointment in 3 weeks.
Why did yo have an ablation if your afib burden was so slight?
The EP suggested it and because my heart rate was so low normally (bradycardia) it was not going to be easy to give me something like Bisoprolol (which I would not like to have taken anyway!).
I have had paroxysmal AF for some 15 years, for which I take propranolol which suits me. I have had some interruptions a couple of times when I’ve tried the newer drugs and flecainide which don’t agree with me. I had a funny episode last year, which, after brain scans and extensive tests was deemed to be a migraine. However, I had reached a score of 2 being female and over 65. I have always fought not to have AC but having seen a neurologist who seemed to make sense by what he was saying, his opinion was that despite what any cardiologist tells me he sees so many 100’s of cases that could have been prevented by AC’s so I decided to start last December when I was having a particularly troublesome bout of AF after Covid. The final decision is yours but I know how quickly a stroke can devastate a life and feel ok on the AC’s now I’m on them (68 now).
Wishing you all the best.
What AC and any side effects?
I stoped taking anticoagulants when I virtually stopped having episodes of AF and I’m still here at 80 (and two thirds!) The EP who prescribed the Flecainide told me I was not at risk of stroke unless I had a long period in AF and mine never were.
That’s interesting! But are you on flecainide still?
Yes. I take 50mg am and 100 mg before I go to sleep- 12 hours apart approximately. I used to take 100mg twice a day but a doc I’d never met agreed to the reduction that I suggested after I had been fine when I had forgotten to take the first pill of the day!
I understood the 1 point for being female was only applicable if you had co morbidities.
I had an ablation last October for persistent AF and was told I would always be on an anticoagulant and that was before I knew the ablation was only partly a success and NSR maintained with the help of daily flecainide (flecainide didn't work before the ablation) and I am happy with that. I am 75 and previously had high blood pressure and I also have asthma .
A 'successful ' ablation is not a cure and there is no guarantee AF will not return sometimes maybe in the silent form so unnoticed , I would be reluctant to stop my Apixaban .
The exact same thing happened to me. My EP feels the same way. I have an RX for Apixaban to keep on hand in the event that I do get an afib episode (which then I would take for a couple of weeks), but I had my ablation March of 2021 and have been episode free since. I am female, age 70 now. He did say that at age 75, I WILL go on anticoagulants from that point on.
That’s sounds sensible! Did you get severe episodes of a fib? I didn’t.
Mine was paroxysmal, and to me any episode would feel severe just out of fear
the score of 1 for female makes perfect sense. I work within the field of family planning and any history of or family history of venothrombo embolism is an absolute no for giving any pills that contain oestrogen. Whether it’s out of fashion or not to score 1 for being female the fact remains it is a naturally occurring female hormone, maybe it declines post menopausal but then HRT can increase levels again but I’m happy to pop an edoxaban every day for being female for my PAF if it means reducing risk of a stroke. 🦊x
Interesting, I had an ablation end of February performed by a well known professor, seems successful, however when we spoke about the Apixaban he said he’d rather deal with too much bleeding than a stroke!
Which professor are you under? I am with Professor Ng at Glenfield and shared the same views, saying I would be on anticoagulants for life despite a successful ablation in March this year
Professor Schilling
I was in the same situation as you with a Chad vasc 2 for the same reasons being female and over 65, and I am on Eliquis half dose because I’m a very sensitive person and react to medication‘s poorly. I regret starting anticoagulants.
be aware that as bean counter pointed out, your stroke riskis about 2%, but did you know that going off anticoagulants has a 3% risk of forming a blood clot and causing a possible stroke or heart attack in the first 30 days or so when you go off?
Also if you don’t like taking risks and that’s why you going on the anticoagulant, a serious bleed risk at 3% is higher than your stroke risk right now.
I’m working with an alternative cardiologist now to go off and go on a natural blood thinning protocol if I can tolerate that. Doctors don’t tell us when they take us off for various procedures and off after ablation about our risk and they don’t give us any protocol to safely get off after ablation. To me that’s dangerous.
it is mind-boggling that a lot of doctors don’t know about that black box warning in regard to this. Many of them think it means because of our condition of a fib we could have a clatter stroke, but it’s the drug itself that can cause that by going off. they only know about the other black box warning that talks about the risk of needing a spinal and possibly becoming paralyzed if on anticoagulants
we don’t have any 100 percent guarantees in life so do what you feel comfortable with and what doctors you trust recommend.
I was told by some doctors to take it and buy some that I’m in a gray area with a Chad vasc 2 as far as anticoagulation
do your research on your own because most doctors are very busy and they don’t read a lot of what’s out there now.
Unfortunately for us patients there’s no one right course. I went to three EP‘s to discuss ablation. One of them says that it doesn’t prevent stroke and you will not go off the blood thinners after having it. One of them said he puts in a loop recoder and if you don’t have a fibs for three months, he takes you off blood thinner, and the other one goes by the patient Checking their own burden and if they don’t have a fib for a few months, he takes you right off the blood thinner.
One thing I neglected to say is that our burden matters too and that’s another thing with very differing opinions. Some doctors say six minutes is when we can form a clot there have been newer research that it’s 5 1/2 hours and then some doctors still say 24 hours More you should be anticoagulated. So I don’t know how your episodes are
all the best on your journey with this I wish us all good health and a wonderful quality of life. Learning as I go.
That’s very interesting !
I had a pulsed field ablation in May, am female and 65 years old. In my follow up appointment this month my EP said that in 6 months time, if I have remained AF free I will wear a 7 day holter . If it shows no arrythmia I can come off Edoxapan. I went on it 6 weeks before the ablation. I will be happy to come off it as I have a horse and really can’t fall off and bang my head.
my EP decided I was 0 after cardiology suggested 1 for female.
Other factors include your health, cholesterol, diabetes, obesity etc and also your age .
As we get older our risks naturally increase so in my humble opinion if your blood pressure and all other health markers are good then you should be guided by your EP .
As a 58 year old female in generally good health, my doctor just monitors my AF issues and will decide if coagulation is necessary. My AF is currently well controlled after an ablation, but ablations are not a cure, just an improvement in the quality of life. As I get older I know that this could change. Also know that with today's fitness watch and cardia technology, studies are being done where anticoagulant use may one day be provide as a pill in pocket based on what your doctor views from your current heart scans from this technology. This will allow for proper medical intervention and a reduction in the cost that daily anticoagulants can cost patients and insurance companies. See "Pocket in pocket anticoagulation for stroke prevention for AF"-Peigh-2023- journal of Cardiovascular Electrophysiology.
Fingers and toes crossed please my friends.
RF ablation or Cryo ablation? 
QRISK2 cardiovascular disease 10 year risk score
Chad score of zero; no more anticoagulants?
3 months, 2 weeks post ablation review with EP. Swap notes ?
