Anticoagulation and again

Looks like us low risk afibbers are damned if we do and damned if we don't...........

[www.sciencedaily.com]

So what the are saying is if we go on anticoagulation therapy we are swapping a low risk of ischemic stroke for a considerably higher risk of hemorrhagic stroke and bleeding to death?

Dean

This Study shows a double risk of Stroke for "low Risk AF's" and a large increased risk of bleeding by taking the Anti-Coagulant Drugs. According to this study we are actually more at risk for Stroke by taking the AC Drugs. The swap you are talking about is the current dilemma we normally go through in making this decision. The site originator, Hans Larson cautioned against the risk of AC drugs outweighing the benefits like 15 years ago.

I still can't figure for life (pun intended) of me how time in Afib does not factor into these scores. How can someone with a CHADS score of 1 in AFIB for 15 minutes a day versus someone with a CHADS score of 1 in AFIB almost all the time share the same risk profile? Does not seem logical.



Edited 1 time(s). Last edit at 08/15/2017 10:16PM by Fibrillator.

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Fibrillator
I still can't figure for life (pun intended) of me how time in Afib does not factor into these scores. How can someone with a CHADS score of 1 in AFIB for 15 minutes a day versus someone with a CHADS score of 1 in AFIB almost all the time share the same risk profile? Does not seem logical.

They don't.

Broad-based statistics are almost always misleading. Instead, if possible, one should asses one's own risk by assessing such factors as blood viscosity. I'm not an expert by any means, but there have been several posts regarding the subject. To a first order, simply thinning the blood by sufficient water intake may help.

In a second though someone will be along to say don't drink too much water to deplete electrolytes Can't win for losing with this condition!

Read the actual paper and could not determine if aspirin dosage was 325 mg or 81 mg.

Hi Dean - on this topic, it's important to remember the contributing factors to sources and causes of hyperviscosity which then brings about the concerns and risk factors. Many influences cause systemic, silent inflammation which ultimately affects the lining of blood vessels... endothelium, the thin membrane lining the blood vessels and heart. In blood vessels, when the endothelium becomes inflamed, plaque forms as part of the body's protective mechanism... although that doesn't do much for protection..rather contributes to the risk of soft plaques breaking loose and causing blockages - risk of stroke and MI.

So, as is typical, the source cause of a problem (such as hyperviscosity and resultant risk of clots) isn't really addressed by warfarin and the new oral anticoagulants... rather those help to thin the blood but do not address the inflammation, the soft plaques or the eventual hard stenosis of blood vessels.

So for afibbers who are deemed 'low risk,' the focus or target concern should always be to monitor the markers of inflammation and that which contributes to the formation of soft plaques and ultimate blockages.

Cardiac or High Sensitivity (HS) C-reactive protein - blood test is one evaluation of inflammation. There are many more that those doctors who practice functional medicine typically include in an assessment of inflammatory markers that need to be addressed by the patient - most often, dietary influences that cause inflammation, often environmental impurities including that in food, inadequate hydration for that individual, and so on. The recent post titled Clot Risk references more detail on the tests and previous posts on the hyperviscosity topic. [www.afibbers.org]

But -also important to remember are the contributing factors including poor circulation due to age, overweight, diabetes, and dietary factors unique to that person or generally known to be inflammatory.... it's a broad topic.

I'm 'stuck' on half-dose Eliquis at least for now... and but my doctor continues to test and we are very aware of the other inflammatory makers as a preventive measure... and I continue to use much smaller doses of the natural remedies to keep aging vessels and tissues inflammation free and healthy as possible.

Because of the downsides of aspirin and similar, I have never relied on those chemicals.

Jackie

so Jackie what is the actual dosage of Eliquis you are on? After reading the above report from science daily I am now very concerned as I agreed to go on 2.5 mg Eliquis 2xday last month per my cardiologist after several a-fib incidences (altho now on 25mg exteneded release Metoprolol daily) as I was told I am now CHADS2 due to my age. At this point I have had no more a-fib. I was taking my nattokinase/garlic/fishoil/etc over the past couple years as I rarely had a-fib episodes until recently. After reading the above report I am not sure what to do anne h

Hello Anne... Because I had the LAA isolation ablation and undoubtedly because of my age, it's recommended that I continue with Eliquis even though my clearance velocity is or was at the time of the TEE.... considered in the normal range. I take half dose - 2.5 mg twice a day. I much prefer the nattokinase/fish oil/ginkgo/serrapeptase etc routine that kept me clot free for most of my AF 'career.' However I understand the medico/legal liability issue for physicians regarding the risk factor element. For me, Eliquis has too many side effects but for now, I'm just coping and waiting.

Jackie

I was hoping that ablation made it possible not to have to use any of the meds including blood thinners Perhaps after awhile you will be able to completely eliminate the Eliquis and go back to the safe routine. I am also on the 2.5mg Eliquis 2xday but was wondering if it would be bad to just take 1 dose once a day while not having any a-fib?

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anneh
I am also on the 2.5mg Eliquis 2xday but was wondering if it would be bad to just take 1 dose once a day while not having any a-fib?

Eliquis has a half-life of 12 hours, so once-a-day dosing means you'll spend half of each day with inadequate coverage. That doesn't accomplish anything positive.

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I was hoping that ablation made it possible not to have to use any of the meds including blood thinners

It does -- sometimes. If you really are completely free of afib (as proven by a monitor) and your CHA2DS2-VASc score is less than 2, the risk-benefit ratio of anticoagulants reverses in favor of stopping the AC. The problem is people can have afib they're unaware of, so wearing some type of monitor for a long period (weeks) is essential before stopping them. As Jackie notes above, if your LAA was isolated during your ablation that's a whole different matter and you might have to continue them even if you're afib free.



Edited 1 time(s). Last edit at 08/27/2017 06:48PM by Carey.

Anneh,
I want to underscore what Carey just said for added emphasis! Do NOT use Eliquis as a once a day dosing protocol, regardless of dose! That is not a safe way to 'cut down' your overall dosage. Plus, that should not be done, in any event, without the express agreement with your EP/Cardio.

Going from a normal 5mg BID (twice a day) to 2.5mg BID is the only option for reducing the daily dose of Eliquis and is usually mean't for folks with renal dysfunction, but can be an option for some LAA isolation folks that almost pass their 6 month TEE LAA mechanical function test, but might be just slightly shy of earning a passing grade on any one of the three required metrics measured within the 6th month post ablation TEE scan that one must pass all three of to possibly be eligible for stopping all OAC drugs altogether.

Shannon

Your recommendations re Eliquis dosing is what my Cardiologist said as well when i told him that i take 5mg only evenings (have for the last year or so). While the 1/2 life is 12 hours i would have 2.5mg left reducing after that. At the next intake i would have 1.25mg + 5mg etc. My CHADS is 1.5 to 2.
Asking him at my recent visit about discontinuing with my 'poisons' (taking 40mg of Sotalol evenings only) he told me that i could but the risk of AF goes up and it will return sooner or later anyway (he seems to be in the habit of giving nocebos)
I don't feel that i have been AF free for 2 years but do have occasional double beats and sometimes delayed beats. When i feel a double beat(s) i take deep slow breath and all seems well again.