Hi Liz,
Your assumption that (in paraphrase) "undergoing a successful LAA closure, if stroke risk scores were 2.0 or greater, would offer no benefit" is not the conclusion at all I would draw.
First of all, most experienced EPs and even Cardio's will tend to determine your stroke risks not just on the cookie cutter CHA2DS2-VASc numbers alone .. these scores form the basis for making a more nuanced decision based on also including the individual patient. After the basic scores are calculated, smart docs will then consider individual variables for each patient in determining their actual overall stroke risk assignment. As such, most smart docs will often underuse 'Female sex' as an added point, especially if there are little to no other real CVD risk factors adding to a higher stroke score..
Once over 75yrs old there will be less 'discounting' of such stroke scores, but even then, when the person is in otherwise good cardiovascular health and doesn't have type two diabetes, is not significantly overweight or obese, has no sleep apnea and no longer has any AFIB ...even though having OSA and AFIB, oddly enough, do not add official points on these admittedly imperfect stroke score metrics ... Then, also using the all-important professional judgment and assessment of each individual person's overall health and CVD signs and symptoms along with adding in the stroke risk and bleeding risk scores, makes good common sense.
Dr Natale is known to discount a women's age in some cases, especially when she has taken very good care of her own health and has limited 'real world' risk factors like Hypertension, prior Strokes, TIAs or other CVAs (often the most significant risk factors) Vascular disease, T2Diabetes, etc. assuming that revised assessment of her stroke scores and overall CVD health results in an overall stroke score under 2 ... not counting her sex.
In any event, did you appreciate the rest of what I was saying about aspirin use? There are legitimate reasons for including aspirin in one's drug protocol, as I noted in my reply to your previous post above and as we discussed on the phone a couple of weeks ago Liz. But using Aspirin in lieu of a true blood- thinner such as a NOAC or Warfarin when AFIB/LAA-based stroke risk is one's primary concern, is little more than a waste of time,.and for some people is clearly counter-productive if they are prone to more bleeding risk with a daily aspirin.
Again, the exceptions in which a smart Doc like Dr Natale might cotinue recommending at least a baby aspirin include those patients of his that may also have had a previous MI and thus the risk/reward in possibly helping to prevent a second heart attack grants a very minor edge to continuing an 81mg baby a day. By extension though, some docs also stretch that recommendation rational to those patients who have had, or still have, AFIB and who also have clear cardiovascular disease with arteriosclerosis, plaque build up etc more as a preventative measure in those for whom they make a professional assumption that the risk reward of the baby aspirin 'probably' falls narrowly on the side of continuing the baby aspirin. However, there is remaining controversy about even this class of patients taking aspirin.
This is not at all true for those patients without prior history of CVD, or prior MI, and with no stents or other metallic devices implanted in the vascular system, few of whom will typically get an aspirin at all in place of a blood thinner by knowledgeable up-to-date EPs.
And the other group of patients who will get a daily aspirin are often those who have had a prior stent or other metallic device inserted into the vascular system where said device will be in contact with systemic blood flow, at least until complete endothelial-ization encases any metal exposed to blood flow.
In a case like yours Liz, with ongoing AFIB since you are ruling out an ablation process at your more advanced age, a strong case could be made too for an even more robust stroke-risk reduction protocol that might include both a Watchman and an oral anti-coagulant (OAC). Though in a case such as yours it might be possible to rely on a half dose of Eliquis along with a Watchman device in patients with little to no CVD risk factors making up your stroke scores. But clearly that would have to be discussed with Dr Natale or whatever doctor you choose, if you were to decide to install a Watchman.
One BIG advantage of having one's LAA closed off, especially with on-going AFIB, is not solely depending on a blood thinner for protection since even the best blood thinners are NOT guaranteed stroke/TIA preventatives and they certainly are not going to eliminate bleeding risks, just the opposite!
The very real possibility of being able to reduce the NOAC dose in half for some afibbers, assuming the overall individual's scenario makes that a good bet in combination with total closure of one's LAA, makes good sense and could be the safest course of action for many folks such as yourself who are otherwise quite healthy for your age and with minimal CVD risk factors.
Consider, too, the vagaries of not uncommon advancing memory decline in which doses of NOAC are often forgotten, and/or simple drug supply interruptions too can and do occur. The possible impact of such missed doses might not have such a risky consequence with a sealed up LAA! Especially for those living alone.
In any event, its not nearly as black and white as your assumption that, " ... If my stroke score is 2.0 or greater there it no benefit at all for considering an LAA closure since I will likely require life-long Oral anti-coagulant to some degree in any event,". This decision needs to be sorted through carefully with a very well-informed EP, in your case one who can help you assess all angles of your real world scenario.
Finally, in your last paragraph in your post above, you seem to be questioning whether or not Afibbers.org still encourages people to share their experiences with AFIB, as well as various therapeutic approaches and their outcomes? I''m not sure I understand where this is coming from Liz? Nothing at all has changed in our format or the foundation of this website and forum that promotes controlling or stifling dialogue about AFIB and not sharing the full range of experiences people have had during often years of trial and adjustments in learning how best to manage or eliminate this lousy condition from their lives.
This wonderful resource has always been a gathering place for folks of all walks of life who want to better understand all the best options available to them during the ever evolving course of their live's history in dealing with the challenges that living with AFIB certainly brings.
However, with that open investigation also comes the responsibility to do our best in vetting those options presented here, such that less well thought-out and less well validated concepts are giving a hearing, but are not automatically embraced as clear recommendations for our readers.
One of the things that make our forum somewhat unique is our focus of including the very best of cardiology and electrophysiology combined with the best of integrative/functional medicine that has also been well-vetted too, often by peer-reviewed research. And that many of us have found can confer at least strong anecdotal support offering some degree of help in managing AFIB and/or reducing life-style risks that we know contribute to a worsening of arrhythmia and cardiovascular health in general.
With this truly 'holistic' approach of combining the best of both ends of medical and nutritional/life style risk-reduction research, this forum and website can hopefully continue to contribute toward educating and fostering the most informed group of afibbers we possibly can, going forward. But in order to do so, we have to base our recommendations on careful discrimination and evidence-based analysis as well, and thus lend our support only to those protocols that are seen to work reliably and repeatedly over our almost two decades now as the oldest patient education and advocacy resource on the web.
Be well,
Shannon
Edited 1 time(s). Last edit at 04/23/2018 01:57AM by Shannon.