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AFIB stopped-should I still be taking Xarelto?
Heart Rhythm Conditions | Last Active: 1 day ago | Replies (16)Comment receiving replies
The calculator posted above calculated both stroke and bleeding risk. I found that helpful since for me it is a wash. If I were overweight, had high blood pressure or diabetes the calculator would be different.
It seems you might have asymtompatic afib at times. That is important too. I have monitoring to make sure I am not having hidden, subclinical afib. If that happens the whole ball game shifts!
Replies to "The calculator posted above calculated both stroke and bleeding risk. I found that helpful since for..."
I use my Apple watch for monitoring. It alerted me in both episodes. One lasted 2 months and the other 3 weeks. These are not very short periods like what you are describing. Also, if you are taking meds that make your blood pressure normal, are you scored as hypertensive in all these “models” that determine whether you should be prescribed Xarelto? I have a problem with a model that gives you -0- if you are 64 and a full 1 if you are 65.
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Excerpt: though the study does not include anything as yet this was in the intro:
Guidelines recommend using risk scores, such as the CHA2DS2-VASc, to inform anticoagulation decisions.9,10 However, these are based solely on clinical risk factors and do not include AF temporal patterns or burden.
A meta-analysis of almost 100,000 patients with AF showed that both the adjusted and unadjusted stroke and mortality risks are lower in paroxysmal AF.11 Similarly, the yearly stroke rate was below 1% in non-anticoagulated patients with AF paroxysms of < 23.5 hours’ duration and a CHA2DS2-VASc score between 1 and 2, suggesting a lower stroke risk in association with short AF episodes.12
The justification for continuous, long-term OAC in such patients appears to be weaker and, furthermore, indefinite OAC may expose patients with short or infrequent AF episodes to a high bleeding risk relative to the more limited benefit in stroke reduction.
A tailored or ‘pill-in-the-pocket’ OAC strategy is based upon the concept that the thromboembolic risk is dynamic in that it increases during and shortly after an AF episode and then decreases during periods of sinus rhythm. With the advent of direct oral anticoagulants (DOACs), appropriate anticoagulation is established in just a few hours and no monitoring or dose adjustments are required.
Limiting OAC to periods of AF in carefully selected patients with low stroke risk and infrequent episodes of AF may offer the same thromboembolic protection as continuous OAC, while reducing healthcare costs and bleeding complications, and potentially improving adherence.