Anxiety and Eliquis.......Still....

Hi all! I have had two AFib episodes in the last 18 months....both converted spontaneously after about 2 hours. It’s been 9 months since my last. I am female and 70. Score of 2.

I wrote a number of months ago about not wanting to take Eliquis ....my anxiety about taking the blood thinner still has me in its grip. The regulars here were adamant about the risk I was taking by not starting Eliquis. Let me say ....I understand....I know......I’m really scared that I am not taking it....but scaring myself isn’t helping me get there.


I was thinking the next time I went into AFib.....maybe that would impact me enough to start Eliquis . (I understand the risk of waiting...but better than not starting at all). Quite honestly, I am so sensitive to medications, I dont even know if I could tolerate it. Also, I was hoping to hit Age 75 and qualify for the Watchman, but I have a severe nickel allergy....so that is ruled out.

I read this quote below on a site. Can someone tell me if a Cha2ds2 score is a 2...does that mean that 2 out of 100 people will have a stroke? So my risk of a stroke is 2%?


Your CHA2DS2-VASc score can:

Predict your risk of stroke in the next year. For example, if your total score is 3, it means you have a 3.2% chance of having a stroke in the next year. If your score is 6, the risk jumps up to a nearly 10% chance. Talk to your health care team to ask about your risk over time.

Also, there are tools to help you and your health team estimate your bleeding risk. This information will help determine if you can safely take an anticoagulant, which one might be best, and how often you might need regular follow up. Some people have a higher risk of bleeding due to other health problems or medications they take. “


So, I am in a box......scared to move ahead and scared to stay put. Are there any other options out there? Has anyone out there struggled like this with anxiety abaout taking a blood thinner.
I know I am being foolish and I feel ashamed about it.

Thanks for listening.
Linda

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lds001
I read this quote below on a site. Can someone tell me if a Cha2ds2 score is a 2...does that mean that 2 out of 100 people will have a stroke? So my risk of a stroke is 2%?

It's a bit less than that, more like 1.6%, but it's somewhere in that neighborhood. It does in fact mean that almost 2 out of 100 will have a stroke in the next 12 months.

If you're grasping for straws, it might help that many EPs don't count the 1 point for being female.

Frankly, you're fearing the exact opposite wrong thing, but I guess you know that.

The risks of not taking an anticoagulant for stroke prevention as a result of short periods of AF can be mitigated by diet (including natural anticoagulants) and life style.

“Frankly, you're fearing the exact opposite wrong thing, but I guess you know that.”

Carey,

Boy........dont I know it.....I’m just stuck......

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Joe
The risks of not taking an anticoagulant for stroke prevention as a result of short periods of AF can be mitigated by diet (including natural anticoagulants) and life style.

That makes sense to me. Eliquis has its own risks, besides being expensive.

Linda,

You and I have posted a similar concern about starting Eliquis! See topic below. Many folks have kindly written and some of what they have shared may well be helpful to you too! I understand the struggle! Hope you can find peace in whatever decision you choose!

Karin


Deciding to take Eliquis with infrequent Afib

Karin, in the past I'd never have taken Eliquis for infrequent AF lasting less than a few hours per episode. But after what I've been reading here and elsewhere recently I think I would now. In the past I've always believed the oft-quoted mantra that there's little if any concern about a stroke with episodes of up to 24 or even 48 hours. Now I read that even 5 mins of AF can up one's stroke risk by 5 times. I'm not sure about the extent this applies to younger 'lone' AFrs with no other co-morbitiies, but it's still enough to make one stop and think.

Mike - keep in mind for the short duration AF risk, this directly speaks to the hyperviscosity issue... and the tendency for "thick, sticky blood" to clot quickly. As the old adage quoted in the hemorheology literature.... "churn cream, you get butter, churn blood, you get a clot." So, going back to those tests that identify the risks for hyperviscosity including inflammatory factors, it makes sense to understand that unless one is aware of and managing the factors that allow blood to become hyperviscous, a few minutes of Afib could produce a clot more quickly. This would include fibrinogen levels as well.

Jackie

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mwcf
. Now I read that even 5 mins of AF can up one's stroke risk by 5 times. I'm not sure about the extent this applies to younger 'lone' AFrs with no other co-morbitiies, but it's still enough to make one stop and think.

The five times stroke risk I quoted above as an example was right off the Eliquis (ie, marketing) website. AC's don't dissolve clots, your body does that when you're in rhythm. They just help prevent clots from occurring (although I'm not completely convinced how well with Eliquis). There is no study that determines increased stroke risk after 5 minutes, but I'm guessing it's close to zero. When I was first diagnosed, I had substantial clots that had to be eliminated prior to having an cardioversion, yet never had a stroke. Took months to get rid of (didn't happen with Eliquis, needed warfarin).

Interesting that no doctor ever mentioned drinking more fluids during this period. You have educate yourself and have people like Jackie around.



Edited 2 time(s). Last edit at 09/26/2018 09:59AM by jpeters.

I will definitely ask my EP about this 5 minute issue and report back to the group. Seems so unlikely except for Jackie's reasoning about thick blood. So why not make sure blood isn't thick?!

Thanks
Karin

I would like to see where 5 min. of AF can cause a clot also who is putting that out. My Holistic doctor says I am not in AF long enough to cause a clot and I am in AF longer than 5 min.

Liz

Mike - You may not have been reading as much on the forum back when this report on blood viscosity was noted as being published in the Townsend Letter. You probably recognize Dr. Holworth's name as the nattokinase expert who also collaborated with the late Kenneth Kensey, MD on the Hemorheology technology and clot risk.

Measuring Blood Viscosity to Improve Patient Outcomes
by Pushpa Larsen, ND, and Ralph Holsworth, DO

[www.townsendletter.com]
January 2012

plus these:
[holisticprimarycare.net]

[www.rejuvenation-science.com]

[journals.sagepub.com]


Jackie



Edited 1 time(s). Last edit at 09/26/2018 03:27PM by Jackie.

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Elizabeth
I would like to see where 5 min. of AF can cause a clot also who is putting that out. My Holistic doctor says I am not in AF long enough to cause a clot and I am in AF longer than 5 min.

It was the ASSERT trial. (Not that it matters but it was 6 minutes, not 5.)

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Results of the Asymptomatic AF and Stroke Evaluation in Pacemaker Patients and the AF Reduction Atrial Pacing Trial (ASSERT) showed that, in this population of pacemaker patients with hypertension but no history of atrial fibrillation (AF), episodes of device-detected atrial tachycardia greater than six minutes were found in approximately one-third over almost three years of mean follow-up.

Further, these arrhythmias were associated with a 2.5-fold increase in the risk of ischemic stroke and systemic embolism. Among the subgroup of patients with a CHADS2 score >2, device-detected atrial tachyarrhythmias increased the absolute risk of stroke to 2.1% per year.

A single trial doesn't make fact, but I would be very reluctant to declare a safe amount of time before afib can lead to stroke when these people didn't even think they had afib and yet suffered a 2.5-fold increases in strokes with only a few minutes of asymptomatic afib.

Carey have you read the ASSERT 2 trial?

Moreover, ASSERT 2 "substantially weakens the case that subclinical AF detected after stroke is linked to causality," he said.

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Elizabeth
Carey have you read the ASSERT 2 trial?

Moreover, ASSERT 2 "substantially weakens the case that subclinical AF detected after stroke is linked to causality," he said.

Yes, I have read it, and you're absolutely right. I was going to wait and see if someone mentioned it and you did. It's not really clear at all how long you have to be in afib to be at risk. How much afib does it take to create clots? With no firm answers, I think the wise person with a CHADS-Vasc >2 would go with anticoagulants. The risks and benefits definitely come down on that side.

As ever to me it seems to be all about co-morbidities. The ASSERT trials seems to be talking about AF detected after stroke rather than AF of whatever duration leading to stroke. Even ASSERT 2 itself "substantially weakens the case that subclinical AF detected after stroke is linked to causality,"

As an alternative viewpoint, 15 years ago this forum used to be pretty much all about 'lone' or idiopathic AF - as in AF NOT in the setting of any other significant co-morbidities, and all discussion seemed to be focused around that. I recall founder and former moderator Hans discussing amongst other things - with references - that folks with 'lone AF' actually had a longer than average life-span - likely mainly because their 'lone' AF motivated them to try to improve their overall health to the point where they on average lived a bit longer than average even with native risks associated with their AF.

In these current forum times of pretty much no such thing as 'lone' AF anymore, I have to wonder whether or not maybe we - as predominantly those in otherwise good general health - are rightly or wrongly 'getting our knickers in a twist' about AF-'related' (not necessarily AF-'caused') stroke risk in a mainly elderly population with other significant health issues.

As for me, I have a CHADs Vasc/ATRIA whatever score of 0 and no other co-morbidities. I'm not saying that AF can ultimately actually be 'lone' but in my case (as is the case with many folks here) it is undoubtedly genetic and that to my eyes does significantly differentiate me from the vast majority of folks looked at in studies out there.

That said; I definitely advocate staying informed and vigilant, but on the other hand I don't see the point in worrying myself to death about every study I read that in general apply to a different population than I don't consider myself to be substantially part of.

I haven't read up on it (and I'm not going to!) but I wouldn't be surprised if generalised anxiety disorder and/or acute anxiety alone doubles one's stroke risk!

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mwcf


I haven't read up on it (and I'm not going to!) but I wouldn't be surprised if generalised anxiety disorder and/or acute anxiety alone doubles one's stroke risk!

"Study participants who suffered the most anxiety had a 33 percent higher risk for stroke compared to those with the lowest anxiety levels, the researchers found."

[www.webmd.com]

Determining a causal relationship is an entirely different matter.



Edited 1 time(s). Last edit at 09/27/2018 12:31PM by jpeters.

Hi Mike - your intuition is correct.. .it's the elevated cortisol levels... lots of reports and studies linking increased stress levels and/or constant stress over time... to heart related deaths including stroke.

Just one out of many: [www.webmd.com]

Jackie

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Jackie
Hi Mike - your intuition is correct.. .it's the elevated cortisol levels... lots of reports and studies linking increased stress levels and/or constant stress over time... to heart related deaths including stroke.

Just one out of many: [www.webmd.com]

Jackie

“These studies reinforce the message that stress is bad for the heart, but we don’t really know if we can reduce stress hormone levels or what impact this would have,” VanUum tells WebMD."

umm....relax, dude

...... " we don’t really know if we can reduce stress hormone levels or what impact this would have,”

Yes - that's what mainstream medicine believes, but for those with anxiety/stress issues and elevated cortisol etc... there are targeted nutritional supplements and herbals that help support adrenal function so that over time, adrenal exhaustion and overproduction of cortisol are reversed by balancing cortisol and catecholamines.

There are specific protocols prescribed by those who have advanced medical training in this area of functional medicine.

I know it works because I had the adrenal exhaustion diagnoses by specific testing and followed the protocols set forth to manage and reverse it over 20 years ago. Today, our world is even more stressful, so being aware of adrenal issues is obviously of critical importance to overall health.

Jackie

What supplements/foods do you mainly use in this regard please Jackie?

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Jackie
Today, our world is even more stressful, so being aware of adrenal issues is obviously of critical importance to overall health.

Jackie

Exercise is the most important thing you can do for your body. Cortisol is highest in the morning, and comes right down once you get moving. Taking more supplements isn't always the answer.

Mike - I have used a variety of supplements for adrenal support and eventually settled on one by Designs for Health to maintain the status quo after I normalized long ago. I'll list the details at the end.

The comment by jpeters about exercising reducing cortisol should be clarified…... as that’s not entirely correct.

Long ago when my afib was just beginning, I was tested for cortisol levels (the stress hormone) which led to more specific lab testing that showed I had adrenal fatigue or exhaustion… also called “burnout.” My FM MD give me a plan to follow that included specifics that included the various types of stress and the effect on cortisol levels. I still follow most of that today even though I was ‘normalized’ after about a year or so.

Included in the adrenal function restoration program and to reduce the elevated cortisol levels, I was given a book to use as my restorative program guide. Title: The Schwarzbein Principle II by Diana Schwarzbein MD (Subtitle: A regeneration process to prevent and reverse accelerated aging). Dr. Schwarzbein founded the Endocrinology Institute of Santa Barbara.

An excerpt from her book on exercise and cortisol should be noted:

Over-exercising leads to the hormonal imbalances that direct your body to use up its functional and structural biochemicals more than rebuild them. You may feel you are doing what is best for you, but in reality, you are aging faster.

Here’s why:
When you over exercise, you raise adrenaline and cortisol levels. If adrenaline is higher than cortisol, you will use up fat, protein and sugar biochemicals. If cortisol is higher than adrenaline, you may use up protein and sugar biochemicals, but store more fat around your midsection because cortisol causes a redistribution of fat from your arms and legs to your middle. Either way, you are destroying your metabolism.

Worth noting…Dr. Schwarzbein calls out the impact of cortisol fluctuations and identifies various stressors and how those affect cortisol.

On Stress and Cortisol, “ Stress can be emotional, nutritional, chemical, physiological or hormonal. Your body responds identically to all these stresses because it cannot distinguish the differences between them. Stress symptoms are like reflexes – you get the same response no matter what the stimulus.

Cortisol was designed for survival stresses, not for self-induced ones caused by poor nutrition and lifestyle choices. If you encounter a life-threatening stress, higher cortisol levels will benefit you and help keep you alive. If the stress is self-induced, however, higher cortisol levels will damage you further. Since you live in the 21st century, you are living long anyway because of cultural and scientific advances. Unfortunately, the stress response of the body are designed more for prehistoric times than for modern ones. Therefore, cortisol’s actions of trying to keep you alive longer from a stressful situation are not as beneficial as they once were.

The following are examples of life-threatening versus self-induced stresses. It is the self-induced stresses you have control over and need to address in order to stay healthy.” pp121-122.

Then she lists and elaborates on the types of stress and the life-threatening or self-induced consequences…. The various Stress topics include: Emotional, Nutritional, Chemical, Physiological, and Hormonal.

The Physiological is relevant to clarify comments about exercise.
Life threatening – Self induced
Overexercising is also a physiological stress. Excessive movement may give you a feeling of well-being, but it uses up functional and structural biochemicals and ages you faster. This is probably why most elite athletes are not long-lived individuals.

In addition, overexercising can lead to insulin resistance.

From another segment, titled The American Lifestyle: A High-Cortisol Lifestyle…

In the 1990’s, Americans already had a high-stress lifestyle that included television, telephone, Fax machines and radio communications. But that stress was nothing compared with the amount of stress we are experiencing today. With the rising popularity of home computers and the ability of video games, email and the Internet, new dimensions have been added to our already busy schedules. We are constantly bombarded with information and we are in instant communication with everyone.

Hormonally, this means that our bodies secrete more cortisol. Our bodies break down as we use up biochemicals in order to process all this information and communication. And to make matters worse, we no longer have the time to take care of ourselves. We do not eat as well, sleep as much or exercise enough. Or, we overexercise. The end result is that we are using up biochemicals more than we are rebuilding them. This leads to a hormonal imbalance that initially causes us to seek comfort behaviors.

Some people relieve their stress by overeating carbohydrates (comfort eating), some by drinking alcohol to relax (comfort drinking), others by excessive cardiovascular exercise and some by doing all of these things.

These behaviors may make you feel better in the short term. But, since they do not lower your cholesterol levels, and in some cases even raise your cortisol levels, you may develop signs and symptoms of high cortisol levels (chart on p. 138). You can have one, two several or all of these conditions.” p. 137

Dr.Schwarzbein outlines each problem area and offers remedies…which constitutes the book. In the segment on Lifestyle Based Cortisol Disorders that Can Lead to Disease… she offers this introduction:

“If you have a high cortisol lifestyle, you will first experience the signs and symptoms of high cortisol levels. Over time, however, you will develop a degenerative disease of aging. The degenerative diseases most commonly associated with prolonged cortisol levels are Type II diabetes, hypertension, stroke, osteoporosis, cholesterol abnormalities, depression and heart attacks. “

She notes that it is possible to change lifestyle habits before you develop degenerative diseases of aging… if you act soon enough.


The Schwarzbein Principle II - The Transition
Diana Schwarzbein, MD
©2002
[www.amazon.com]


OK – Mike - The nutritional complex I have used for many years is Adrenotone by Designs for Health.
You can view the ingredients at this weblink. [www.rockwellnutrition.com]

This link indicates a UK source… that carries DFH as well.
[www.amritanutrition.co.uk]

Plus, I took various other additional nutrients according to my nutritional evaluation status testing which was done a couple times a year to monitor progress. I’ll send you the product data sheet on Adrenotone by email.

Jackie

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Jackie



The comment by jpeters about exercising reducing cortisol should be clarified…... as that’s not entirely correct.

True. "Balanced" exercise might be clearer. Becoming an Adrenalin junkie isn't a great solution. And definitely leave the cellphone at home. Going to the gym twice a week won't compensate for sitting in front of computer all day except for trips to Starbucks.



Edited 1 time(s). Last edit at 09/29/2018 08:03PM by jpeters.

Thank you Jackie. Very interesting. And I carry all my excess fat around my middle! A violently abusive childhood definitely didn’t give me the best of starts! Look forward to speaking with further about this. Best, Mike.

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mwcf
A violently abusive childhood definitely didn’t give me the best of starts!

No, in fact it remaps the brain as you probably know.

This should make you even more concerned about taking Eliquis:

[ethicalnag.org]