Anti coagulation shows no benefit in Preventing a second stroke

Interesting article. It does also discuss AFIB "grey zone". Article does not discuss first stoke prevention.



[www.medscape.com]

A shame the study didn't match for CHADS-Vasc scores. I think that would likely be a big part of the explanation. People on anticoagulants very likely also had higher scores and that would tilt the results toward no benefit for the ACs.

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Carey
A shame the study didn't match for CHADS-Vasc scores. I think that would likely be a big part of the explanation. People on anticoagulants very likely also had higher scores and that would tilt the results toward no benefit for the ACs.

And what Chad’s score do you consider high? I am a 3 now and I am on the low-dose Eliquis as extra protection. As a reminder though, I will say that the last thing that moved me from a 2 to 3 was starting Farxiga for very borderline, minor pulmonary hypertension. But because I have some left sided heart disease with HFpEF, I guess that means I am under the category of congestive heart failure even though it seems minor to me, especially at my age. Don’t know how long it takes for something as minor as what I have now progress to something serious.

I would consider 3 or above to be high, but I don't think HFpEF would be considered congestive heart failure. Ask your doc how they would score it.

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Carey
I would consider 3 or above to be high, but I don't think HFpEF would be considered congestive heart failure. Ask your doc how they would score it.

Hi Carey, This is why I asked as I don't think in black & white like my cardiologist who goes by the numbers. I feel more like a 2 is what I would have. He gave me the 3 just bec he put me on Farxiga for the left heart diastolic dysfunction giving me PH, I presume, presume meaning the CV score of 3 bec of Farxiga, not bec of my type of PH.

I am doing great & have only mild PH, group 2 with no changes since my R. ht cath in 9/2023 & numbers at that time were only borderline. I just had a TTE (transthoracic echocardiogram) & it was relatively the same with regard to PH. The only change was that my EF had fluctuated from 60-65 down to 50-55, but other parameters of TR (tricuspid valve regurg) was mild to moderate & estimated RVSP was the same at ~48 (i assume the same means since my right heart cath Sept 2023).

When I ordered a booklet from the Pulmonary Hypertension Association, it explained a lot to me in simpler terms. I had no idea there were many types of PH. Mine is group 2 & there are 5 types. I don't think every kind of PH means you already have CHF, hopefully.

No, PH does not mean you have CHF. CHF is its own diagnosis with its own symptoms, causes, and diagnostic criteria.

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Carey
No, PH does not mean you have CHF. CHF is its own diagnosis with its own symptoms, causes, and diagnostic criteria.

Well, then it does not seem to me I warrant being a three with the Chads Vasc score just because he put me on Farxiga to help left heart disease to prevent the heart wall from thickening and stiffening more. Other than my mild pulmonary hypertension, I warrant a point for high blood pressure being on meds for that & for my age, and that’s it.

Yeah, you're probably right, but it's one of those fuzzy things in medicine (everything in medicine is fuzzy). You're probably a CHADS 2 but some might argue you're a 3, so call it 2.5.

This is very interesting. Excuse me if I am being naive. If the risk of hemorrhagic stroke a greater while on an anticoagulant and the anticoagulant doesn’t prevent a recurring stroke what is the benefit?

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Dini
This is very interesting. Excuse me if I am being naive. If the risk of hemorrhagic stroke a greater while on an anticoagulant and the anticoagulant doesn’t prevent a recurring stroke what is the benefit?

The statement that the anticoagulant doesn't prevent a recurring stroke is probably wrong. See my first comment in this thread.