I was wondering if anyone is using the pill in the pocket/apple watch method for taking anticoagulants as apposed to taking them on a daily basis which I know is UK NHS guideline. I have read some stuff on the REACT-AF trial being done in the states which I know is not yet completed.
After reaching 65 my Chads score is now such that the GP is saying I need anticoags, but I have averaged one episode of AF every 2 years and it seems to be managed ok with Flecainide/Bisoprolol. To me it appears to be an over kill to take a life changing anticoagulant when the condition is managed so well. In addition to this the GP is also talking about Statins which I have resisted up to know.
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SteM
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You are indeed correct, but, AF is all things to all people and often educating one another isn't or rather doesn't cover the whole thingy. I think you'll find somewhere on this AFA website are a wide range of recommendations - in document form - which cover many issues including the relationship between statins - beta blockers and anticoagulants.
When I kicked off in 2010 life was simple, there was only one anticoagulant - Warfarin ( Coumadin ). Now there are 5 and its a lottery as to which one you are prescribed. My GP has prescribed me Edoxaban, one of the 4 newer ones and the side effects were horrible, I told her, in no uncertain terms I'd stay with Warfarin. Sorted !
The two drugs you mention - Flecainide/Bisoprolol do nothing for anticoagulation and will not prevent an AF origin stroke. Only anticoagulation will do that - or - go someway to easing that burden.
Now to send you into the depths of despair - it is a fact that even running the odds at 1 AF event every 2 years might seem bloody great - BUT - what if in that 2 years your heart condition has changed .... AND SAY - you are asymptomatic ..... you might be having AF events and not feel anything or be aware ......... any 1 could hit you with a stroke. A great many AF origin strokes are fatal. Goodnight Vienna.
If in that 2 years your heart condition has changed ..... what if you don't know it ? Usually only an ECG or a heart scan will pick up oddities.
By the way, anticoagulants are not life changing - other than to help preserve your life.
I see you have met lovely John who is a very valid member and has helped many of us. John says it like it is, and he is exactly right in his way of putting it! It could save your life.
It is difficult for you with just having AF every two years, which is a low burden, but the thing with AF is that it is so unpredictable and could rear its ugly head at anytime. I didn’t have an episode for 18 months, then it came back with a vengeance, together with ectopics and regularly once a month, so nothing is absolute with AF. It is a progressive monster. Also, you can have it in your sleep.
During an AF episode the blood pools in the atria and a devastating clot could form in as little time as 30 minutes. This is the importance of being anticoagulated.
Yes, there is a trial going on in the States regarding an anticoagulant being used as a PIP., but nothing is confirmed or guaranteed to date. I think we would all welcome that treatment, but until then l feel much safer taking it everyday, which we are all advised to do.
There is nothing else we can do but strive to have the best quality of life as possible and not let it define who we are. Wishing you well.
Hi, No just internet browsing, mainly with Google. There has been another member mention it in their post some time ago, but can’t send you a link as forgotten.
I looked this up to confirm after the post and that is what l read in black and white. I like to do my own research before l trust any medical advice. I have heard of too many people having a stroke because of no anticoagulant. I am fearful of being a guinea pig with this new approach of pip etc. Not enough evidence yet for me.
When you look at what happens during an AF episode, how the blood pools and curdles, it is scary. I feel some seem to be in denial that this is real. We all detest taking an anticoagulant, but the risk is too high not to.
This is my opinion and as already said, we have a choice, so it’s a personal decision, Take care.
Your middle two paragraphs should be thought provoking ..... at 80 , and having escaped death by misfortune several times ( usually wrong place, wrong time ) most notably Farnborough Airshow Sept 1952, there isn't much I fear in life now .... apart from Starmer and a Stroke.
Having had two ECG's, in Nov 2020 and Nov 2022 and seen how my left Atria has changed in its dimensions compared to a normal Atria in a healthy person there is no way in the universe would I consider coming off my Warfarin.
Blood pooling and curdling is excactly spot on and that's just what frightens me to bits and pieces - with this PIP approach.
I haven't knowingly had AF since 2009 but would rather cut off my (insert whatever) with a rusty penknife than stop anticoagulants. As has been said , it is not the AF that does it but the company it keeps.
To me it appears to be an over kill to take a life changing anticoagulant when the condition is managed so well.
And that is the thinking behind the REACT-AF trial. And several here, including myself, have previously posted of using one form or another of PIP anticoagulation.
In the US, ep's are already going beyond CHADS and factoring afib burden into the thinner decision, based some promising current trial data.
In the end, I think it's a decision we all have to make for ourselves, along with the advice of a trusted doctor.
I take mine daily, as prescribed and recommended by my EP but if you prefer to trust the 'stuff' you're reading over advise given by the medics treating you, then don't. It's as simple as that! I just wish that coronary matters were just as simple.
I sympathise as my episodes are two years apart also . I am sticking with the anticoagulants as I am on the waiting list for an ablation which could be up to two years but there is always the possibility of a cancellation so here we are . My EP intends to stop the anticoagulants a couple of months after the ablation if successful .
Opinions change and many doctors are moving away from the anti coagulate everyone for life position because anticoagulants do come with very real risks as well as benefits , and like yourself I question taking a risk every day for a benefit every two years . I personally wouldn’t take advice from a GP on this issue or the statin ( their mission is to get everyone over 50 on a statin .) If I were you I would find out who is the top EP in your region , or an experienced one at least, and pay £200 to see them privately and talk through your concerns if you can afford it .
The majority on here seem very hostile to the idea of intermittent anti coagulation but opinion changes. 20 years ago everyone was advised to take aspirin everyday to prevent heart attacks, now they say it’s not useful for primary prevention and the risks outweigh the benefits .
If I were not waiting for an ablation I would be where you are , and I suggest getting some proper advice and then making your own mind up
I haven't had an AF episode since the end of the blanking period following my Ablation over 2.5 years ago. I carry both Apixaban and Flecainide for use as PIP as agreed with my EP. My AF has so far always been very symptomatic, but I also wear an Apple watch just in case. I'm 66 year old male, non-smoker, in good health.
"overkill to take a life changing anticoagulant". In what way is it life changing? You need to take a little more care relating to injury but for most of us that is all.
I will tell you what is 'life changing'. It is having a stroke. And there is NO warning when that happens.
I agree 💯 my brother didn't know he was having an afib episode as some don't feel it....until ...he had a life changing stroke, he was driving when he hit 2 stationary cars and lost his left periferal vision and subsequently his driving licence, he is now mentally ill as well. The decline is life changing don't take the risk. I have AF (I had a successful ablation in March last year), notice I said 'I have' because there's no cure even though I have had no episodes that I am AWARE of since. I would not stop my anticoagulants as advised by me EP
You identify the real risk of these things. None of us think that it will happen to us and a diagnosis of AF is just 'one of those things'. I had AF for decades and at the time of the stroke I believed I was very fit, ate healthily, and took lots of exercise. I took aspirin every day and thought I was fully protected.
So sorry and I hope you have recovered from the stroke ❤️My brother will never be the same and can't accept his vision is impaired, he sits all day with my elderly mum and won't do anything or go out. He used to visit a health centre and swim, it's very sad how it changes you. I wouldn't wish it on anyone. I understand the bleed risk, my father had AF along with other heart related issues and was put on warfarin, he fell, banged his head and passed away suddenly before Christmas 37 years ago, he was only 60. It's one of those things we need to be careful but I wouldn't personally stop taking them
So sorry to hear about your brother and the permanent effects on his vision. I was very lucky in terms of only suffering the loss of normal speech for a couple of weeks and paralysis in my right hand and arm, which again recovered relatively quickly. However there are always long remaining problems with things like aphasia, loss of vocabulary and the partial facial paralysis took several years to recover. I have never recovered all my previous speed of reaction and energy levels, but I am truly grateful that I got immediate treatment within two hours of my stroke which made all the difference.
Please give my best wishes to your brother. I spent two years not going out at all except for medical appointments but I had a great psychological therapist who managed over more than a year to get me back to a more normal life. Depression and anxiety is the other thing you rarely read about with stroke victims. I hope your brother can be encouraged to return to more of a normal social life too.
That's sad to read about your dad. I have had many falls due to a leg length difference after a hip replacement. Three of the falls were head injuries. The last one was a broken wrist which led me to be in shock and subsequently have AF diagnosed before the wrist operation. I've had one trop fall since being on Apixaban but i hit my knees on the floor. ..I dread to think if I had a head injury from a fall.
I think you are asking a very valid question. If I was you assuming no comorbidities, daily active lifestyle, good diet including liquids and assurance that you weren't getting any AF during the night I would (and have) postponed ACs at your age.
Firstly you have to talk to a trusted medic who is not wedded to any mantra (my cardiologist did not issue any dire warnings with my decision) and secondly be aware nobody can say you are right or wrong with your decision as a stroke or a brain bleed can occur for different reasons not just AF or ACs.
Most here swear by ACs and to be clear I am not saying they are wrong because I am not a medic, don't know their circumstances and respect their decision anyway.
My decision to postpone ACs for 10 years until age 70 was based on the above. I also took into account reading that in random tests around 10% of the Public have AF and don't know. If ACs were critical they would be dropping like flies.
I was offered statins and declined 20 years ago because of cholesterol of around 7; my body has kept it at that level since I started keeping a record (30yrs) and scans since have not detected any artery issues.
Nobody wants to take extra medication but a stroke is infinitely more life changing than a tablet twice per day.I'm very symptomatic when I have AF so don't need a watch to tell me but I have several friends and patients (foot health practitioner) who are not symptomatic and only discovered they had AF when attending hospital for something else or a pre-op prior to surgery.
I, personally, in that situation, would not want to rely on a watch to alert me to an episode, by which point the damage could be done. Having seen the effects of a stroke in others, it's not something I'd want to risk.
It really is personal choice and that's absolutely your decision but just make sure it's a well informed one.
I totally agree. A friend of mine only found out about her afib when the doctor was trying to figure out why she kept having little strokes. Thankfully for her, the strokes were somewhat minor, though they did mean she couldn't keep doing her job. I have no side effects from my Eliquis and I would scare me to stop taking it; I could still have a stroke, but it's less likely to be caused by whatever the heck it is my heart has been doing lately.
Hi Stem, i am 65 in may this year, i didnt want meds of any kind, but af has changed my mind in particular relation to anti-coagulants, i shall soon be ringing my gp to organise with ep to be put on them hopefully asap.
Hello and thank you for your post. Having AF affects everyone in different ways, many experience daily / painful episodes, many experience very few sporadic episodes, and some do not have any symptoms at all.
AF has no cure, and as it stands alone can greatly increase your risk of having an AF-related stroke, anticoagulants are an important part of treatment in lowering that risk. It is advisable to follow advice from your doctor regarding medication as they have access to your medical records and can advise the best treatment for you personally.
If you have any questions, or would like further advice or information, our Patient Services Team are always here to help, either by our Patient Helpline or via email: heartrhythmalliance.org/afa...
Alternatively, please download the 'Preventing an AF-related stroke booklet' for reference: api.heartrhythmalliance.org...
Think hard about taking a statin, which is aimed at lowering cholesterol and thereby helping avoid the formation of clots in the coronary arteries or small vessels of the brain, possibly in conjunction with an antiplatelet like low dose aspirin. I personally can’t see any downsides, but it depends on your cholesterol levels and eating habits.
The point of anticoagulants for AF sufferers is primarily to avoid the formation of a clot in the atrium (thence travelling to the brain and causing an ischaemic stroke). Only you can balance the bleeding risk of the anticoagulant against the stroke risk of a clot forming in the heart. I don’t think the frequency of AF episodes is as relevant as their duration if and when they occur (ie do they last long enough for blood to pool and a clot to form). That’s no doubt why trials of anticoagulants as PIP are being done, but as others have commented, for that strategy to work in stroke prevention someone would need to know that a PAF episode is under way and take the PIP as soon as it starts.
I have noticed there are a small cohort of Forum members, in USA, Canada, Australia, UK and various parts of Europe, who have reported using a PIP approach to anticoagulation, usually with the support of their cardiologist/EP. You might find such previous reports if you use the HU Search 🔍 option at the top of any HU page.
My concerns re daily anticoagulation (I am 78 but currently take no daily anticoagulation) surround previous spontaneous (ie. unexplained) chronic bilateral subdural haematomas, but I am hopeful the REACT-AF trial will endorse this PIP approach, as it seems a viable option for me. Unfortunately, final results are not expected till mid 2029.🤔
Changing views on anticoagulation for shorter duration, atrial fibrillation episodes based on two recent studies reported by Dr. John Mandrola. Exerpt below:
"For an older patient with stroke risk factors and 3 hours of AF on a cardiac device, pre-2023 thinking would have us leaning toward anticoagulation. The results of the ARTESIA and NOAH-AFNET 6 trials strongly question that idea.
NOAH-AFNET randomly assigned about 2500 older patients with short-duration device-detected AF (median duration, 2.8 hours) to edoxaban vs placebo. The trial was stopped early at 21 months for perceived futility and excess bleeding in the edoxaban arm. Edoxaban reduced the primary endpoint of stroke, systemic embolism, and cardiovascular death by 19% (HR, 0.81; 95% CI, 0.60-1.08; P = .15) but increased bleeding by 31% (HR, 1.31; 95% CI, 1.02-1.67; P = .03).
ARTESIA randomly assigned about 4000 older patients with short-duration AF (median duration, 1.5 hours) to apixaban vs aspirin. More patients and longer follow-up of 3.5 years translated to more events. Apixaban reduced the primary endpoint of stroke or systemic embolism by 37% (HR, 0.63; 95% CI, 0.45- 0.88; P = .007). This was countered by an 80% increase in major bleeding (HR, 1.80; 95% CI, 1.26- 2.57; P = .001).
The results of both trials were consistent: Direct-acting oral anticoagulants reduce thrombotic events but increase bleeding rates. The biggest discovery — and reason for debate about net benefit — was the low stroke rates (< 1% per patient-year) in both trials. What clinicians need, and is probably forthcoming, is an analysis correlating duration of AF and net benefit. Right now, anticoagulation decisions with device-detected short-duration AF require high doses of judgement and patient preference."
obviously the decision is yours to make, however, in one of my previous posts a friend of mine messed around with her anticoagulants, sometimes she would take them sometimes she wouldn’t. Unfortunately for her she had a massive stroke. The Doctors and Consultants have said it was probably the non taking of the anticoagulants. Her life now is bed to chair, chair to bed. Completely paralysed down one side, has very limited speech with cognitive impairment. She has a young family, I visit her as much as I can, she was a vibrant woman.
I have permanent AF, agreed between myself and my Consultant, I’m lucky it’s a nuisance, however, I try not to let it interfere with my QIL, I take my life saver anticoagulant, never miss unless medically told to stop for a short time, a very short time.
I am nearly 1 year post ablation, in NSR. Apart from being a little chubby I'm pretty healthy. I saw my EP f or a 1 year review last week. We have agreed to stop edoxaban (I'm 63). I monitor my AF via a smart watch which I wear pretty much 24/7. If I have AF I must start anticoagulants with 24hr and take for 1 month after the end of the episode. If AF returns I am to make contact with my EP and he'll review my drugs. He says that I don't need to see him again but will leave me as an open referral in case I need him.
I'm the same boat as you, SteM. I was having a couple of episodes a week, then I went vegan, gave up sugar, lost a lot of weight, went off most of my meds, so my afib episodes are quite rare now, like once every few years.
Anyway, I don't worry about not taking strong anti-coagulants (which caused intense itching for me), though I do take baby aspirin. I did read the study mrames1 cited above, and was reassured. I support you using anti-coagulants as a PIP, the fewer meds you take, the better, I think, though I do still take some too.
I was on warfarin for some years with no side effects but they are a bit of a pain keeping inr in check and getting tested. Was swapped to Edoxaban so side effects and easy to maintain I’ve never considered it to be a life changing drug. Would not consider taking as prescribed
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