One Atrial Fibrillation episode and the subsequent need for anti coagulants (Apixaban)

[Zeusy512]

3 days ago I had a resting heart rate of 166 bpm and my Kardia app told me I was having an AF episode. I went to A&E where my heart corrected itself after 2.5 hours but the A&E consultant told me I should ask my GP to be put on Apixaban to reduce the risk of clots and stroke. My GP said I scored low on the need to have this drug and low on the potential for bleeding if I did take it. He suggested maybe I take it until I see a cardiac specialist but who knows how long it will take to be referred and consequently I’m unsure what to do. The GP was fairly non committal tbh. Consequently any advice would be appreciated and is really needed. Thanks ☺️

[PadThaiNoodles]

Was the A&E consultant a cardiologist or a stroke specialist? If so I’d go with their advice in the meantime.

Even if not, I imagine they see a lot more stroke in A&E than in a GP surgery, so I’d still probably go with them. Particularly as your GP appears to be somewhat on the fence.

I presented to A&E about 2 weeks post OHS after a transient retinal occlusion (that had already resolved, possibly because I was already on warfarin for my new mechanical valve). The stroke specialists ran a battery of tests all which showed clear, and then after discussion with my cardio-thoracic surgeon they added aspirin to my thinning regimen.

[bluemoon572]

Some clinicians, but not all, feel that there's no worry about blood clots forming in the atria if the A Fib reverts to normal rhythm before 48 hours. However this isn't a reliable practice unless the patient knows exactly when he/she is in A Fib. In some cases it's asymptomatic & such patients may not know when they are having A Fib episodes. My wife has had 3 episodes of paroxsysmal A Fib during the last 3 years with each episode converting within 45 minutes of taking metoprolol. Accordingly, she has been spared taking daily anticoagulants for these 3 years since she feels very confiden that she would know if A Fib occurs. She also monitors her pulse and BP three times a day.

[SlothOnSpeed]

The problem is that afib can be silent. You may have been in afib before and not have known. If your bleeding risk is low, I would personally take it.

It seems that some guidelines now are more sceptical about the need for anticoagulants.

[ASD46]

Hi Zeusy. I had a similar incident in the summer, though my heart took about 16 hours before it self reverted. GP wasn’t too fussed about anti coagulants but the first cardiologist I saw was adamant. Assuming you don’t yet know if there were any other factors, would it be a problem taking them for a bit while you wait for the specialist?

[Zeusy512 in reply to ASD46]

I think this is probably the safest way forward until I get to see a cardiology specialist. Just to minimise the risk. I had a quadruple heart bypass 2.5 years ago and things had been going really well and I felt good. It feels like a backward step but this is the first ‘episode’ I’ve had in that time. I’ve had some benign ectopic beats on occasions but monitor myself with my Kardia app when I feel any changes. I had two initial bouts of AF post my opp in the hospital but was told this was quite normal following OH surgery. Thanks for the response

[ASD46]

Good luck! I hope the appointment is fairly quick, sounds like you’ve been through quite a bit already.

[Anothernewbie]

I have had two episodes of paroxsymal AFib., and went to A&E both times. First was March 2023, 3 hours, after which I was put on bisoprolol 1.25mg. The second was in September 2024, 22 hours. This time the cardiologist put me on apixaban and doubled the bisoprolol.

As others have said, go with the hospital, and if necessry get them to contact your GP to confirm the apixaban.