Latest Findings in Atrial Fibrillation (AF)

Gloaming, this was excellent information, thanks for posting the video. I think what I appreciated most was the idea that life style measures ( including weight control, exercise) could be used to possibly prevent, or at least mitigate the effects and frequency/duration of A-fib. I don't know that it surprised me to learn that the current thinking is for those people in whom A-fib is first detected during illnesses, during or after surgery to be considered as "forever" A-fibbers, seems to me that's been the thinking all along as quite often at these times it's when issues/comorbidities ( whatever you want to call them) first rear their ugly heads but they aren't a one and done type deal.
It looks as though they are continuing with the same thinking about anticoagulant therapy being a "forever" thing even when the patient has a low A-fib burden, if that patient's other risk factors ( CHA2DS2 scores) put them at a higher stroke risk- and especially if they're older patients. I see that as functions of not knowing when those A-fib episodes will occur, not knowing the time relative to the A-fib episode ( before, during, after, two weeks after.., ) at which the patient would be at the highest risk of stroke, and I've read ideas that state that the A-fib may not be the direct cause of stroke, but an indicator that other conditions are present that can lead to stroke. And I imagine that there's also an element of CYA in those recommendations as well. If these ideas have any credence ( and I think they do) that would make any idea of a PIP blood thinner hard to establish- just exactly when would one take a PIP Eliquis/Xarelto for optimum effect? I know there are studies in progress to establish the feasibility of a PIP anticoagulant, maybe in time they will figure it out.

I know my cardiologist's line of thinking has been along this "conservative" line regarding anticoagulant use when he answers my question in the affirmative about whether or not he sees me as a "lifer" on Eliquis, even with a low burden of A-fib and their knowing, thanks to my quarterly pacemaker monitor reports, exactly when and how long my A-fib episodes occur. He's always followed that with pointing out that I have other risk factors for stroke, and I know he isn't wrong. Fortunately I've had no adverse reactions at all to the Eliquis, and it's not even all that expensive for me as I'm able to use a manufacturer's coupon to get the drug for $30 for a 90day supply.

But I'd certainly have questions about having to continue the use of anticoagulant after a single A-fib episode if I were younger, had a low risk of A-fib or other related stroke, and I'd take it up with the prescribing physician. Those recommendations on the video are guidelines, they are certainly not one-size fits all mandates, and the guidelines include "informed" decision making, ie, ensuring that patients understand their choices, the pros and cons of each choice and arriving at a consensus for each patient. Which means, in the vernacular, that each patient needs to be included in any decision regarding the use of an anticoagulant.

@chanemann1 I’ve asked that question and was told the only danger is an increased bleeding risk. Any medication they prescribed for me my first question is does this hurt any other organs in my body

@chanemann1 What would life be like after a stroke..............................................one wonders. Would it be a life worth living? We all endure some inconvenient risk and discomfort, and as we age we incur more of it. The DOACs, while they may be intolerable, in which case you simply don't take them (Aspirin or Warfarin are all that I know that would be left for them), only have a risk of serious bleeds, but as I replied to someone earlier, maybe not in this thread, a serious bleed is likely to be that serious with or without a DOAC working in the system. A deep enough cut, torn limb, aortal rupture, etc, is likely to be only slightly more lethal with a DOAC. The treatment would be the same in either case: stanch the bleed, bind the limb with cords or a belt/tourniquet, and get to a hospital ASAP.

A DOAC does not prevent clotting. It retards the process of clotting. Anyone on Eliquis or Xarlelto who has gouged their skin or cut their finger slicing onions soon learns that the pain is far worse than the ensuing bleed...which will stop.

@gloaming I honestly only worry about a brain bleed. GI bleeds can get ugly, but I’m more worried about a brain clot than a GI bleed. Those interesting studies showing improved outcomes after dropping DOACs post ablation should differentiate those with atrial myopathy from those with normal atrial size and function post ablation. Atrial strain numbers aren’t part of the stroke risk scales but I’m wondering if they should be. Maybe just differentiating those with p waves longer than 120 ms from those with shorter p waves since a good echo costs more. DOACs certainly are wonder drugs. That was a well done lecture, thanks for posting it.