60% of afibbers may not need blood thinners

It seems 60 % of afibbers taking blood thinners may not need to take it. But who are they? This new test may tell us.

[medicalxpress.com]

Thanks for the article! What is aggravating is the date of this article!!! 10/7/16!!!

My electrophysiologist and I had a LONG discussion about Eliquis last month and no mention of this article! As I was in Afib about 16-20 hours across the ENTIRE year, I am resisting starting this drug, even though I have the risk of being over 65 and a female (which my MD thinks may be related to the fact women clot faster than men because they have had to, given their periods and child birth, which is interesting, but insufficient). Have wondered if there is a difference in people who are fit and getting regular exercise and those who are older and sedentary, or overweight, etc. etc. etc. 65 is just an age, not indicative of anything specific to the individual. He noted that Eliquis will stay in the system for 12 hours, so agreed there is a risk of excessive bleeding from a car accident too and no way to stop this effect. I had a one month monitor and had tachycardia or flutter for 1% of the recorded time and no Afib and that was in the heat of the summer and playing 2 plus hours of competitive tennis.

Thanks again for finding this. Wonder if newer research available. Will google.
Karin

Women get a point on the CHADS score because women suffer more strokes than men. Simple as that. The good news is some EPs don't really consider the female point "real."

Not sure why your EP said that about Eliquis. A reversal agent for Eliquis and Xarelto has been available in the US since last May. Any trauma center in the US should have it.

Interesting - thanks colindo - particularly "Maybe the risk of bleeding is initially small. But after taking medication for 20 or 30 years, it's more and more likely that they'll experience complications."

I'm figuring that prior ablations will only adversely affect blood flow results.

Men have strokes at a younger age than women, also women live longer than men, guess more time in which to have a stroke.

liz

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Elizabeth
Men have strokes at a younger age than women, also women live longer than men, guess more time in which to have a stroke.

Yep, that's the main reason women have more strokes, and it's also why a lot of EPs don't think the CHADS point for being female counts.

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karin
He noted that Eliquis will stay in the system for 12 hours, so agreed there is a risk of excessive bleeding from a car accident too and no way to stop this effect.

This is a common fear, and one that might be a bit irrational as well. I’ve shared it myself and have come to reconsider over time. If you, or anyone, suffers trauma resulting in significant hemorrhage then your chances of survival are not good to begin with. I’m not certain that the anticoagulation is going to be the deciding factor between life and death. The best thing to do, in my opinion, is to carry a medical card indicating one’s AC status. Carey can correct me if I’m wrong, but I’m pretty sure first responders such as EMTs know to look for those things whether the patient is conscious or not.

Do all hospitals carry an antidote for Eliquis? I have my doubts on that.

It probably depends on where. I’d guess major cities, yes. Rural hospitals? Maybe not quite yet. That will change. The bigger deal probably will be cost over availability. DOAC reversal agents will continue to cost tens of thousands of dollars for years to come.

More important to understand is that while warfarin is reversible with vitamin K, that process still take almost a day. Eliquis’ half-life is short. You can be transfused until its effect is gone.



Edited 1 time(s). Last edit at 11/30/2018 10:39PM by wolfpack.

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Elizabeth
Do all hospitals carry an antidote for Eliquis? I have my doubts on that.

No, but large hospitals and trauma centers do. So call 911 instead of driving yourself to the (wrong) hospital in an emergency and you'll end up at the right place.

The fear of bleeding with anticoagulants of all types is irrational. As wolfpack explained, you'd be better off with Eliquis than warfarin in a major bleeding event. But no matter what drug you're taking, most likely they'll be able to keep you going until it's reversed or wears off.

My mother just died in April 5 months short of being 100. She had LAF the last 40 years of her life - the first 20 or more not diagnosed. When she was diagnosed she said she’d had an irregular beat for years. She started with Warfarin and then was put on Pradaxa. When she was 92 she had internal intestinal bleeding and got a $40,000 settlement from Pradaxa. She had a stroke while she was in the hospital for that, but it was minor.

If you read Hans books and old reports you will find studies showing that people with LAF don’t have a higher chance of a stroke than the general population. Having said that, I have LAF and was taking Pradaxa and then Xarelto for several years. I took only Cardiokinase for almost the entire year of 2018 and recently my Dr scared me into going back on Xarelto. I’m still conflicted and will watch upcoming reports. I have a friend who is a radiologist (75 yr old man) and has LAF and does not want to go on an anticoagulant. He has done a lot of research and found reports similar to Hans’.

Obviously, I am not 100 percent sold on Nattokinase/Cardiokinase or I wouldn’t be taking Xarelto. I had some minor surgery and went off it and took Cardiokinase for a few days, so for me it is a good, trusted “backup.” It is a personal decision but I will be watching the upcoming research/reports. It’s very hard for Drs to let go of the brainwashing of medicine (the words my Dr. friend used), so we have to be our own advocates — which is why this Forum is so wonderful to have. Thank you all for your input.

Louise

Louise:

Your mother lived a long time with AF, that is wonderful. My mother died at the age of 92, she got AF in her early 80s, she did go on Coumadin. A few months before her death she had tarry, black stools and was hospitalized, the Coumadin was stopped, they did tests but didn't go too far Re: her intestines because of her age, she died in her sleep a few months later. Of course the Coumadin was responsible for her intestinal problems but as for her death, don't know, just that her heart stopped.

Boluoke is supposed to be a good natural supplement for a blood thinner, Jackie has written about it on this site. It appears that these anticoagulants are harder on older people.

Liz

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Louise
If you read Hans books and old reports you will find studies showing that people with LAF don’t have a higher chance of a stroke than the general population.

That's incorrect.

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Carey

If you read Hans books and old reports you will find studies showing that people with LAF don’t have a higher chance of a stroke than the general population.

That's incorrect.

What is incorrect: That Hans wrote that or what he wrote is incorrect?

L

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Elizabeth
What is incorrect: That Hans wrote that or what he wrote is incorrect?

What he wrote is incorrect. (If he actually said that.)

I greatly respect Hans and have used his research quite a bit in my own afib journey, but that statement is just plain wrong.

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Carey

What is incorrect: That Hans wrote that or what he wrote is incorrect?

What he wrote is incorrect. (If he actually said that.)

I greatly respect Hans and have used his research quite a bit in my own afib journey, but that statement is just plain wrong.

That's your opinion, i and a lot of other forum members believe in what Hans said.

On the fear of bleeding with anticoagulants...

There is an informative post response to CindiO by Shannon from 2012...the fourth post from the beginning... and while this was 6 years ago, and the risk of bleeding while on anticogulants is hopefully considerably less, it's still a concern - most likely more so in the more rural areas where large Urgent Care or ER facilities are not as accessible as in metropolitan areas.

Certainly, risk odds are improved with the reversal agents now available, assuming the smaller facilities have it on hand. But it's worth reading through Shannon's responses about his niece's observations so that if you are taking an anticoagulant, you should always have a plan in case you have a trauma. (as in what Shannon shares about the man with a cut on his ear).

Shannon shares an observation from his niece.... .
BTW, my niece who is chief attending physician in one of the largest Level 1 Trauma Centers in Texas in Houston is just finishing a large report comparing Coumadin and Pradaxa/Xeralto in the trauma setting..

The latest date shows that for people on either Coumadin/Aspirin/Plavix coming to the ER due to a bonefide 'trauma' with significant bleeding approximately 30% die as a result of excess bleeding.

That sounds like a lot, but consider 70% of those same degree of trauma patients who are on Pradaxa wind up dying!!! Mostly from bleeding out or related break down!! That really IS a lot!


and in another response:


Also FYI, my niece isn't a greenhorn resident simply conveying a few local anecdotal experiences, she is Chief Attending Physician at the largest level 1 trauma center in Houston .. runs the whole show there. The report she and a host of her Trauma doc colleagues at many centers across the US have been compiling, and of which she was elected to put it all together for publication, is far from a few anecdotal reports. This data is from the total combined documented clinical experience with these new agents reported from the front lines of every trauma center in the US over the last year and a half or however long it has been since Pradaxa first hit the streets ... by far most of the reports are with Pradaxa which is easily the most dangerous of the two..but also with Xeralto.

Bottomline, its a choice of compromises that fact that 30% of geniune trauma patients on either warfarin/aspirin therapy/plavix die in the ER or hospital after admittance from a significant bleeding trauma from whatever cause, is pause enough! But keep in mind that a good number of those would likely have died from the severity of their injuries regardless if they were on warfarin/aspirin/plavix or not.

However, the relevant stat here from the total combined experience across US ERs and hospitals so far is that 70% of people using Pradaxa/Xeralto that come into the trauma center with a similar grade of traumtic bleeding as those in the warfarin/aspirin/plavix group wound up leaving via the morgue! That is a 40% increase of dead patients using Pradaxa/Xeralto over the warfarin/aspiring/plavix group considering and comparing the same general level of trauma and expected recovery rates.

Coumadin is an issue too as reflected in the fact that up to 30% who are taking either Warfarin (Coumadin), therapeutic aspirin doses or Plavix also dont make it out of the hospital when they show up with a bonefide trauma. However, everyone knows just what to do with Coumadin and every ER in the country has plenty of injectable protamine or Vitamin K on hand, as does every ambulance in the country so they can give it as needed before you ever arrive at the ER which could be the difference between life and death in some cases.

The fast action of the two new anti-coags apparently isn't fast enough to save the extra 40% of patients who never make it home, above and beyond those expected to die from the combination of a therapeutic dose of Coumadin on board when they have the very unfortunate experience of suffering a significant bleeding trauma when on any of these drugs!

She said that major difference in survival is largely due to the relative increased difficulty in reversing the anti-coagulation effect of Pradaxa and Xeralto (without a more practical and faster antidote) compared with Coumadin which every ER doc in the country and every ambulance medic understands and knows how to deal with.

Again not many EPs have gotten the word yet as was obvious in my conversation on Wednesday with my up-to-date and skilled EP here in Arizona. Keep in mind too, that as a group these docs have been under a lot of pressure to get on board with these new agents and promote them and most, if not the vast majority of them have been eagerly wanting them to work out which can have an unintentional subconscious bias effect even when one is trying to be objective. I'm sure one or more of these drugs ultimately will be seen as a big step forward over Coumadin once this 'inconvenient' major wrinkle of the lack of antidote is finally solved.

Alas, these are billion dollar new drugs being released and if the Big Pharma reps can, by any stretch of the imagination, bend over backwards to craft a rationale why its no big deal to approve and use these drugs now before a practical antidote is really ready.. you can be sure they would do so as we have seen in fact they have.

This doesn't mean the other comparisons with Coumadin are not valid! I'm sure these drugs .. at least Xeralto and Eliguis from preliminary reports sound like a positive improvement over the many known hassles and limitations of using Coumadin. But at this stage of the game it's more a case of 'the devil we know seems like a safer bet than the devil we don't know' and can leave you hanging high and dry very quickly. It basically like trading the stroke reduction benefits, which all of the drugs including Coumadin appear to do a decent job of to some degree, for yet another 'Sword of Damocles' with the extremely high odds of serious and even fatal trouble for any kind of real trauma.

One anecdote sticks in mind when my niece recounted this guy on Pradaxa who came in with a small cut in his right ear from a simple fender bender car accident in which he banged the side of his head and ear on the upper door sill of his car. He was strapped in and his front air bag went off and no one else in either car was even injured at all. Not a major crash by any means.

It quickly became a full day life or death struggle for him and the team of trauma docs she was running that day as they had to replace over 60 units of blood, or basically 12 entire body blood volumes!! And still they had to revert to an emergency Dialysis in order to clear enough of the drug effect from his body to save the guys life!! Had he been anywhere but a large and experienced Level 1 trauma center in a major metropolitan area this man would be pushing up daisies now without question.

Anyway, the recount of such experiences helps give a more visual feel for the problem than any number of dry stats might convey.

Jackie

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colindo
That's your opinion

It's not opinion.

Came across this: [nutritionfacts.org]

Joe:

Hope that article is true, I raise a lot of tomatoes, I eat them fresh for about 3 months, I also make juice and sauce and can them. Maybe that is why I have low platelets because of all the tomatoes. A Dr. Gundry, which has been spoken off here as being a wise doctor says not to eat tomatoes, I really don't listen to these gurus anymore. I love my tomatoes can't see where they have harmed me. I appreciate the article Joe

Liz

Millions of Italians can't be wrong?

Hi Folks,

I'll post an update to the now very old NOAC report Jackie refernces above and that I shared here before takingover ownership of this wonderful resource for Afibbers founded by Hans and Judi Larsen from one of the highest volume level one trauma centers in the US from 2010/2011 time frame. This was in the initial roll-out days of Pradaxa and including insights and front line experiences not only this large Texas Level one Trauma Center's very early and rather alarming at the time experience, with mostly Pradaxa, but also includes findings from a good number of other trauma centers across the country at that time.

The larger 'relative' number of fatalities that were noted were ALL in the context of all severe-critical bleeding events at said Trauma centers ... please keep that in mind when weighing these numbers. The 40% greater risk of death relative to Warfarin in this initial year experience with Pradaxa also showed a still high relative mortality risk of just over 30% for Coumadin alone. Taking that into account it is clear this is a key indicator for just how critically injured this cohort of trauma patients were, with a much higher baseline mortality due to such severe bleeding injuries, even without a blood thinner at all on board.

These numbers should absolutely NOT be used to imply anything close to such a mortality risk for typical afibbers using Pradaxa or any other NOAC in this day and age!

The point these trauma docs conducting this now very old observational study were trying to highlight, was the folly of releasing this new class of NOAC drugs before a reliable and approved reversal agent had been developed. Many of those excess bleeding deaths could well have been avoided had a quick-acting reliable reversal agent been available at that time ,,, or even if the now common ad hoc means of using existing drugs (PCC prothrmbin Concentrate, and procedures to greatly lessen excess bleeding with these agents that ER docs developed over the first 5 years of experience with these agents, and had those methods been widely known and utilized back then at the very beginning of Pradaxa use, it is safe to say from our now 8+ years of experience since that report was written from the dawn of Pradaxa treatment, that there would have been a good deal less deaths than were reported in those first two years of experience with NOACs.

At that time, the impact of kidney disfunction when prescribing Pradaxa was not widely appreciated as well, which led to far larger numbers of serious "Pradaxa Bleeding episodes", and that you would expect to occur much less often now in typical modern up-to-date trauma center experience with NOACs.

As such, I need to caution everyone from projecting these very early stage real world bleeding problems highlighted in the initial report that my trauma center doc niece was part of at the time during the initial 1.5 years of Pradaxa ER experience, and extrapolating those scary results as being anything close to similar to the real world risks an average group of Afibbers might experience with these drugs during this day and age. The risks for an Afibber who qualifies as needing an OAC drug, are not anywhere close to as scary as those very early Trauma center observations with critically injured patients who came in during major bleeding events.

It's midnight here and time for me to sleep, but Ill come back this weekend and flesh out some more important points about considering taking any N/OAC drug. No one wants to need a blood thinner, and often they are not required for people with low to zero stroke risk scores and below 65 yers old. But there is also an important discussion with your EP or Cardio each active Afibber needs to have ... preferably with an experienced EP .. and if you have ongoing PAF or persistent AFIB, as many who have a 2.0 stoke score ( or higher) do, it is then almost always usually strongly recommended that you'll be wise to start Warfarin or a NOAC assuming your EP also strongly recommends it and you have no other contraindications for taking these drugs that out-weigh the risks of not taking them.

After all, the stroke scores don't even include having AFIB in their useful, but still limited, stroke score equation protocol.

Plus ... the best remedy for not needing an OAC is regaining durable NSR again for life! That, and insuring your CHADS-VASc risk scores are well under 2, if at all possible at your age.

Stay tuned for more on this issue over this weekend,.

Shannon



Edited 3 time(s). Last edit at 12/08/2018 12:15AM by Shannon.

Kind of makes you think that the doctors are in cahoots with the drug companies to keep us using. I've sent a lot of this sort of information to cardio at the L.A. V.A. hospital and they bluntly told me they weren't interested in it. Sad. The ex-military needs to have the best and the newest approaches to those who put their lives on hold to be there when their country needed them. But that isn't so. The V.A. is at least 30 years behind times in their medical approaches. Believe it or not, I got that last statement from a doctor who worked at the V.A.

I don’t know if they are “in cahoots,” but certainly brainwashed and not willing to look at options. I couldn’t agree more with the military being neglected after going through God knows what for us. Hopefully there will be some younger doctors coming and more aware of latest research.

Sorry, but it is all about money, there is a lot of money that has been behind these new blood thinners. We have fake science just like fake news.

The anti-science, anti-medicine attitude so often found here reduces the value of this forum in a big way. I pity the people new to afib who are scared and confused and don't know what to believe who come here and find stuff like this.

If you think anticoagulants are some big conspiracy theory and the science behind them is fake, then show us your data to back up such extraordinary claims. If you have no credible evidence then I suggest you keep your unfounded opinions to yourself. You're doing actual harm to real people.

I think it is good for this forum to express different points of view for new readers. New readers should do their own research if they have questions about different options. All of these new blood thinner drugs require a doctor's prescription so there is some oversight.

Remember it was just a few years ago that aspirin was considered an acceptable blood thinner by many doctors (and some may continue to think that way). Now the data says that aspirin is not acceptable.

Note that if you are concerned about the money that medicine may be getting by promoting the new blood thinners, you can always request that your doctor prescribe Warfarin (almost free and you may be able to test yourself) and I would bet that most doctors would do that.

Also, the patents for these new blood thinners do not last for ever. See the end dates for Eliquis and Pradaxa at this link. Of course some company still has to manufacture and test the generic version.

You are responsible for your own health.

Actually Carey it is you that is scarcing people, I grant that you are a very knowledgeable man but you believe one way.

This post is one that you posted a few months ago;

It would be nice if that were true but it's not. Strokes are more common among afib patients even when they haven't had an afib episode in months or even years. And actually, there's probably no such thing as lone afib. Current thinking is that afib is a symptom of an underlying disease known as atrial myopathy. I've talked to Shannon about removing the words "lone afib" from the site and he agrees it needs to be changed.

I asked my doctor about having a stroke even if you do not have AF for months or YEARS, now that is a scarce statement, you can get a stroke which has nothing to do with AF, so if that is what you meant you should explain it. My doctor said I wasn't in AF long enough to stroke which is around 3 to 12 hours, yet you said years. I will be seeing my doctor in a couple of months and will expound further on the subject.

liz



Edited 1 time(s). Last edit at 12/09/2018 11:04PM by Elizabeth.

With everyone here doing so much research on their own, we are all lucky to have so much information from so many perspectives based on that and personal experience. Carey, have you read any of Hans Larsens’ books or research in the forum’s archives?

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Louise
Carey, have you read any of Hans Larsens’ books or research in the forum’s archives?

Absolutely. I have copies of many articles from the archives saved, and I used a number of them to formulate my own treatment plan that I used successfully for two years.

However, I don't consider Hans an authority so much as a useful resource. A lot of his articles are speculative, and at this point many are also rather dated. The term "lone afib" that used to be in the banner for this forum is a good example. Shannon removed the word "lone" because lone afib isn't really an accepted concept anymore. It's increasingly recognized that afib is in fact a form of heart disease in itself. Just because you don't have other forms of heart disease doesn't mean you don't have heart disease. You do, and it's called atrial myopathy.

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Elizabeth
Actually Carey it is you that is scarcing people, I grant that you are a very knowledgeable man but you believe one way.

This post is one that you posted a few months ago;

It would be nice if that were true but it's not. Strokes are more common among afib patients even when they haven't had an afib episode in months or even years. And actually, there's probably no such thing as lone afib. Current thinking is that afib is a symptom of an underlying disease known as atrial myopathy. I've talked to Shannon about removing the words "lone afib" from the site and he agrees it needs to be changed.

I asked my doctor about having a stroke even if you do not have AF for months or YEARS, now that is a scarce statement, you can get a stroke which has nothing to do with AF, so if that is what you meant you should explain it. My doctor said I wasn't in AF long enough to stroke which is around 3 to 12 hours, yet you said years. I will be seeing my doctor in a couple of months and will expound further on the subject.

You really need to learn the difference between one doctor's opinions about you and what's true of the population in general. I stand by that statement you quoted above because that's what the science says, not one doctor about one patient. I also don't know where he got that 3-12 hours number but that's not an accepted criteria. The accepted criteria was 48 hours for many years, and in fact some still accept that. But the notion that there are minimum periods of afib that cause strokes has largely been discarded. There are studies showing that stroke risk increases after just minutes of afib.

I stick to evidence-based medicine, not anecdotes and opinions. If I say something like the above, I say it because I know it to be supported by solid scientific evidence. So if that scares someone then that's because sometimes the facts are scary. But it's better to be armed with scary facts than be ignorant of scary facts.

What you won't ever hear from me are ridiculous stories about Pradaxa patients bleeding out from minor external injuries, nor will you hear me accusing doctors of being fraudulent, in it for the money, or practicing fake science unless I have good evidence that it's true. The facts about anticoagulants are readily available, in multiple, large, high-quality studies showing the same thing over and over again. To cast doubt on those studies by casting doubt on science as a whole does real harm and I don't think it should be found here. People come here looking for help and information, not conspiracy theories.

Where are the studies that one can stroke after one min. of AF? I told my doctor that I usually am in AF for about 3 to 12 hours, he got that from me not from the wind.

Carey said; I stick to evidence-based medicine, not anecdotes and opinions. If I say something like the above, I say it because I know it to be supported by solid scientific evidence.

Seems to me Carey you should know that science changes, it is not set in stone.

You should read Dr. Judy Mikovits's book Plague and her fight with the XMRV virus and vacinations she was thrown in jail and had her med license taken away by the Gov. because of her stand. I could say a lot more but I won't, this is your board not mine.

I wonder if each heart is different in terms of it's efficiency when pumping during afib. Meaning - would an athletic heart (pumping more efficiently) be less likely to cause a stoke than an unfit heart? I doubt there are any studies.

I had undiagnosed afib for 5 years (diagnosed as a irregular beat because of mitral valve prolapse) and took no meds. Then finally diagnosed correctly when caught on an ECG, and no prolapse.

After diagnosed, I recorded all my episodes for 6 years (while on meds) averaging 33 per year. I don't know how many episodes I had during the first 5 years - maybe 100+. I have always been in excellent physical condition and was a competitive swimmer at the highest level for many years, so I likely would be considered to have an "athletic" heart. Does that corollate to better protection from stroke? Plus, because of my activities and greater risk of bleeding, I was on Plavix for my 6 years of afib. After the ablation, nothing except one month of warfarin.

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Ken
I wonder if each heart is different in terms of it's efficiency when pumping during afib. Meaning - would an athletic heart (pumping more efficiently) be less likely to cause a stoke than an unfit heart? I doubt there are any studies.

Maybe, maybe not. I think you're right that no study has ever looked at that particular question.

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Ken
I wonder if each heart is different in terms of it's efficiency when pumping during afib. Meaning - would an athletic heart (pumping more efficiently) be less likely to cause a stoke than an unfit heart?

It could be as much as 60% are less likely to get a stroke.
I think Doctors and some hospital assistant are in their own world, and can't see things in the real world.
They can't see the forest for the trees.
Laymen are not dumb. They know that if you have a stroke after being in afib for a couple of minutes (which is very rare) then there must be a contributing factor. So afib is not the problem. The solution is to fix the contributing factor not stuff them with a blood thinner which will eventually kill them one way or the other.

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colindo
The solution is to fix the contributing factor not stuff them with a blood thinner which will eventually kill them one way or the other.

That is flatly false and you're not doing anyone any favors scaremongering.

As for fixing the contributing factors, the reason why people with afib are more likely to experience strokes despite not being actively in afib isn't fully understood. You can't criticize doctors for not fixing underlying cause when those causes haven't even been identified.

Please read some of the science behind afib, strokes and anticoagulants before you go around criticizing doctors and declaring anticoagulants death sentences.

Carey said:

That is flatly false and you're not doing anyone any favors scaremongering.

How is Colindo scaremongering? Isn't this a board that is open to discussion about AF, Carey anything you don't like you call it criticizing doctors, scaremongering and false. People get strokes even while they are on bloodthinners, Shannon has written about his after he had his watchman implanted, there have been a couple of people on this board that have written about their strokes while being on a blood thinner. It is a big problem and a worrisome one, I can't take blood thinners and it does worry me, I can't even take some of these natural blood thinners because they seem to give me aura migraines. I believe as we get older we cannot take a lot of these meds or even some supplements. I would like to see more open discussion about what do people do, does everybody take blood thinners or perhaps they take some natural means, I know that Dean eats Natto and it works for him.

By the way Carey, tell me when I get an episode of AF, why does it stop and I go into NSR, which I have been doing for almost 20 years, I am extremely thankful that I do, but what changes?

Unfortunately Carey is right. AFIB causes aren't fully understood. I take that to be the case from listening 2.5 days to an AF conference, reading other stuff and being fobbed off by the Cardiologist and EP when i asked about fixing the cause of the problem.
They usually say: 'All that is very interesting, i don't know, we do what we know now' or some version of this.

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Elizabeth
Isn't this a board that is open to discussion about AF

Absolutely. And that means when I see someone post false information, I will challenge it.

Ok Carey, show us the solid scientific evidence that one can have stroke after one min. of Afib. Isn't that scaremongering?

Carey is correct in his statement (note he said minutes not one minute). The ASSERT trial showed even 6 minutes of AF resulted in 2.5 times increased stroke risk. Other studies have disputed this, and the trend seems to be moving away from short duration risk. In fact, there is evidence that neither the timing nor patterning nor perception of AF is predictive of stroke risk. Consequently risk assessment and anticoagulant therapy continues to be based on other risk factors using for example CHA2DS2-VASc, without stratification within the AF group. Unfortunately, many of the opinions expressed by MDs and echoed here are not current with the literature. My own EP indicated to me that his criteria for anticoagulation assuming it was not indicated by CHA2DS2-VASc was whether one fell asleep with AF and it was still present on waking. He actually said that this was based on his own experience, even though he was aware it was not aligned with current recommendations.

Safib:

Carey also said the following:

quote=Carey]

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.[/quote]

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Elizabeth
Safib:

Carey also said the following:

quote=Carey]

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.

Carey is correct again about the evidence, with the caveat that the long term risk is really unknown. To extrapolate from a short term risk to a long term risk requires a model, and there is no validation of the Bernoulli model which he uses.

Safib:

Carey is correct again about the evidence, with the caveat that the long term risk is really unknown. To extrapolate from a short term risk to a long term risk requires a model, and there is no validation of the Bernoulli model which he uses.

Carey said the following:
There are studies showing that stroke risk increases after just minutes of afib. As for fixing the contributing factors, the reason why people with afib are more likely to experience strokes despite not being actively in afib isn't fully understood.

Carey has said that you can stroke after just a few min. of AF or even if you have a couple of AFs a year or even not having AF for years. Yet safib you are saying that Carey is correct that the "long the risk is really unknown" so why does he say that you can stroke just after a few min. of AF. This double talk is driving me nuts.

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safib
Carey is correct in his statement (note he said minutes not one minute). The ASSERT trial showed even 6 minutes of AF resulted in 2.5 times increased stroke risk. Other studies have disputed this, and the trend seems to be moving away from short duration risk. In fact, there is evidence that neither the timing nor patterning nor perception of AF is predictive of stroke risk. Consequently risk assessment and anticoagulant therapy continues to be based on other risk factors using for example CHA2DS2-VASc, without stratification within the AF group. Unfortunately, many of the opinions expressed by MDs and echoed here are not current with the literature. My own EP indicated to me that his criteria for anticoagulation assuming it was not indicated by CHA2DS2-VASc was whether one fell asleep with AF and it was still present on waking. He actually said that this was based on his own experience, even though he was aware it was not aligned with current recommendations.

I have read before about the 6 mins, but the ASSERT trial showed no real risk of stroke under 24 hours. I don't really understand if subclinical results i.e., the ASSERT trial, would be different from symptomatic.

"The risk of ischemic stroke or systemic embolism in patients with SCAF between 6 min and 24 h was not significantly different from patients without SCAF."

[www.ncbi.nlm.nih.gov]

Safib;


An overview of several medical applications of the Bernoulli Equation, including a description of the Venturi mask, and how echocardiography is used to estimate pulmonary artery pressure.

In what way can one use the Bernoulli equation in AF/stroke?

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Elizabeth
Carey said:

That is flatly false and you're not doing anyone any favors scaremongering.

How is Colindo scaremongering? Isn't this a board that is open to discussion about AF, Carey anything you don't like you call it criticizing doctors, scaremongering and false. People get strokes even while they are on bloodthinners, Shannon has written about his after he had his watchman implanted, there have been a couple of people on this board that have written about their strokes while being on a blood thinner. It is a big problem and a worrisome one, I can't take blood thinners and it does worry me, I can't even take some of these natural blood thinners because they seem to give me aura migraines. I believe as we get older we cannot take a lot of these meds or even some supplements. I would like to see more open discussion about what do people do, does everybody take blood thinners or perhaps they take some natural means, I know that Dean eats Natto and it works for him.

By the way Carey, tell me when I get an episode of AF, why does it stop and I go into NSR, which I have been doing for almost 20 years, I am extremely thankful that I do, but what changes?

Colindo is scaremongering by saying that anticoagulants are going to kill you one way or another anyway. You might be an unlucky one to get a brain bleed but you'd be unlucky! Also I don't know who Dean is but how does anyone know that Natto *works* for anyone? Because they haven't had a stroke? Nothing against Natto. It's well thought of although not as a substitute. But even if they never got a stroke you don't know if it was the Natto or just good luck.



Edited 1 time(s). Last edit at 12/17/2018 05:00PM by Brian_og.

In existing studies patients with implants are followed for a few years and the estimate of the risk is annualized to a year. The caveat I referred to is that the short term risk does not necessarily compound in the way that Carey has suggested (in other posts) to yield estimates of long term risk over say a decade.

This is a different issue than whether the duration and/or frequency of AF within a year is predictive of the annualized risk based on studies spanning a few years, which is what Carey was addressing here.

The lack of clarity in both of these issues has resulted in the current recommendation that other risk factors be used for decisions about blood thinners for patients with AF, and not the temporal character of the AF.

I don't think it is double talk, but rather limitations of the inferences that can be drawn based on the existing data within a sound statistical framework. Of course, you can abandon the framework and use your intuition and biases (or cite others that take such an approach), but you should at least understand that is what you are doing. So that's my view of the situation.

Dean posts on here once in a while he has posted about his success with eating Natto. Good grief, you think that Carey isn't scaremongering always telling everyone they should be on blood thinners or they will stroke, even if you only have a few min. of AF once in a great while. I never heard this over and over until Carey, there are some of us that cannot take these blood thinners. Colindo Is saying there should be more research in finding a cure for AF instead of just drugs/bloodthinners which have caused many problems.

Liz

Safib

Thank you for the clarification, I appreciate it.

Liz