BMJ 2018 Study Report

Research
Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies
BMJ 2018; 361 doi: [doi.org] (Published 09 May 2018)

[www.bmj.com]

Comments?

To put it in prospective, we're talking about only 12.1 and 16.7 per 1000 person years in patients with resolved and unresolved atrial fibrillation, respectively. In the study, only 1.2% of the sample with resolved afib had any record of ablation.

(vs 7.4 per 1000 person years for people with no atrial fibrillation.)



Edited 1 time(s). Last edit at 06/21/2018 08:01PM by jpeters.

Interesting link,Jackie!

Quote

The crude incidence of stroke or TIA in patients with resolved atrial fibrillation and a current prescription for an anticoagulant was 11.4 per 1000 person years, compared with 12.2 per 1000 person years in patients without. The adjusted incidence of stroke or TIA was 14% lower in patients with a current prescription for an anticoagulant compared with those without, but this result was not statistically significant: adjusted incidence rate ratio 0.86 (95% confidence interval 0.62 to 1.18).

My bold. I'm interested in this because i don't take anti-coagulants while my AF seems resolved. Still have some ectopic beats occasionally and a 5/10 min AF the other day.



Edited 1 time(s). Last edit at 06/22/2018 04:35AM by Joe.

Conclusion: Not having afib beats having resolved afib, which beats having unresolved afib.

Not surprising results, but not surprising results are important too.

Interesting.

I’m going to say this may underline the need for sort of a “middle-ground” approach to thrombosis risk, such as the various other threads that address nattokinase or serrapeptase. Certainly putting ALL afibbers, “cured” or not, on anticoagulation therapy will increase mortality due to bleeds. The statistics cited in the report are weak at best. I think that changes in already low probabilities are insignificant until they become greater than 100% at a minimum. Think of it this way - if I buy a lottery ticket I have, say, a 1 in 100 million chance of winning a jackpot. If I buy two lottery tickets, then my “risk” of winning the jackpot has DOUBLED. Should I start spending the money already, even before the draw? Of course not! Double bad odds are still bad odds. Things really have move a bunch before they become significant.

Quote
wolfpack
Interesting.

Certainly putting ALL afibbers, “cured” or not, on anticoagulation therapy will increase mortality due to bleeds.

Hans Larsen (the founder of this site) used to go into this in great detail and addresses it in his book: <[www.amazon.com] Thrombosis and Stroke Prevention 3rd. Edition: The Afibber's Guide to Stroke Prevention.

Just a quick hit on what Wolfpack is talking about <[www.thennt.com]
Oral anticoagulants in non-valvular atrial fibrillation for primary stroke prevention (no prior stroke)
Benefits in NNT
1 in 25 were helped (preventing stroke*)
1 in 42 were helped (preventing death from any cause)
Harms in NNT
1 in 25 were harmed (having bleeding)
1 in 384 were harmed (intracranial hemorrhage)

I take a lot of fish oil as prescribed by my Doc Steven Gundry. This was not for afib purposes. I was also taking 83 mg/day of aspirin, again prescribed by him to "activate the anti-inflammatory properties of the fish oil". After reading Hans' book with all the aspirin studies, I decided I should revisit taking the aspirin. Also I'd noticed the backs of my hands and \forearms looked like someone on warfarin with an INR too high. Of course, I'm not sedentary it is common for me to have a lot of impacts to my limbs rock climbing, slackining & skiing. I finally decided to ditch the aspirin and keep the fish oil, and my hands and arms resolved quickly.

Those numbers are misleading. For example, "1 in 25 were harmed (having bleeding)". It's natural for people to compare that to the other number "1 in 25 were helped (preventing stroke)". The natural conclusion is they are equal risks and benefits, but that's not at all the case. What matters with bleeding is where the bleeding is. Bleeding in your GI tract is generally easily treated and you will survive, and that's where most bleeds occur. Bleeding in your brain is a very different matter and that's where the numbers diverge hugely. The numbers to be compared aren't 1-in-25 vs. 1-in-25, they are 1-in-25 vs. 1-in-384.

And this study wasn't about anticoagulants anyway. Not sure how that became a focus.

Quote
Carey
1-in-25 vs. 1-in-384.

And this study wasn't about anticoagulants anyway. Not sure how that became a focus.

Conclusion (final sentence):

"Guidelines should be updated to advocate continued use of anticoagulants in patients with resolved atrial fibrillation."

For me the whole piece is pretty much totally undermined by the fact that 'resolved AF' includes paroxysmal AF terminated by whatever means - either spontaneously, by AAD or cardioversion. It is surely a given that most of these folks with 'resolved' AF are going to have further episodes during any significant follow-up period.

SFAIAC a successful ablation (and I'm absolutely certain I'd know if I had any recurrence since my AF has never been anything like approaching 'silent'!) will surely pretty much (post blanking period at least) put one's stroke risk back to the same as folks who've never (so far as they are aware) had AF. CHADS score has to count heavily here regardless.

Whew, that was long and an uneventful conclusion for me. I will still be refusing all meds including anti coags and continuing with Phos Serine, Natto and Serrapetase for my security blanket. It doesnt take a fancy machine with bells and whistles worth $billions for me to detect AF.

Dividing the people hours of those without afib who got strokes with chance (.01), I conclude that people who don't take thinners are 740 times as likely to get strokes, so everyone should be on anti-coagulants.

Could someone tell us in simple terms what it all means please, because to me it sounds like another reason to push thinners.

Collin,

In the study, you'll also note the results were correlated with CHADS or a variant of that score. The unresolved had a higher CHADS score than the resolved. Hence risk is also proportional to CHADS score.

George

Does CHADS score come into play if you've had a successful (Dr. Natale) LAA isolation ablation and have had no Afib for 5 years? Is there a reason for this score?

When I googled it, it always came up as being tied to Afib...so if you don't have it anymore, is it relevant?

Barb

Quote
tobherd
Does CHADS score come into play if you've had a successful (Dr. Natale) LAA isolation ablation and have had no Afib for 5 years? Is there a reason for this score?

When I googled it, it always came up as being tied to Afib...so if you don't have it anymore, is it relevant?

Barb

You get a point for being a woman, then more points for being older (>64 =1, <74 =2) . Vascular disease, diabetes, hypertension, history of strokes, congestive heart failure ads points. All you need is two points (one for male) to be eligible for an anti-coagulant.



Edited 1 time(s). Last edit at 06/28/2018 06:54PM by jpeters.

Quote
tobherd
so if you don't have it anymore, is it relevant?

Yes.

Although eliminating the afib reduces your stroke risk considerably, the remaining risk factors measured by CHADS-Vasc still apply. But it does change the equation. For example, if you're a CHADS 2 with afib, without question you should be on an anticoagulant, but without the afib now you're a judgement call and many EPs would say it's okay to stop them. As your score goes higher, the risk factors increase regardless of your afib status. In fact, if I had a CHADS-Vasc over 3, I would take anticoagulants even if I'd never had afib. I've seen what strokes do. No thank you. I'll take risk of bleeds over risk of stroke any day. Bleeds can usually be stopped and that beats hell out of spending the rest of my life wheelchair-bound in a nursing home drooling onto a bib.