← Return to Atrial Fibrillation and long-term management with medication

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@realitytest

Now I'm even more confused about scoring systems.

I have two thoughts, though.

1) I've read material whereby patients over 75 have their anticoagulants stopped because of their supposedly significantly elevated fall risk (which would lead to cerebral bleeding). (Some interventional EPs will OK a watchman on account of age alone.)

2) I am mystified about why no scoring system seems to
incorporate the risk of hemorrhagic stroke (one EP surgeon told me about 15% strokes are hemorrhagic. )

That being so, I'd think the guidelines for blood thinners would be more multifactorial and complex. Also that patient recommendations would be more individualized.

Apparently (read on cardiology website) AI is increased used to make diagnoses and predictions - for instance re severity of an aortic valve leakage. I can easily imagine AI doing a better job than mere humans providing recommendations about whether or not to take blood thinners .

Calling this discussion to the attention of @larrryg333 whose experience-based decision about taking anticoagulants was very interesting to me,

One thing is clear - as things stand, no model or clinician can completely eliminate stroke risk (especially since the two kinds of stroke carry opposite recommendations re prophylaxis and treatment.)

Larry is absolutely right about one aspect to recovery from either type stroke - how intense and immediate rehab is makes an enormous difference in how well and indeed if, a patient overcomes deficits. We have so little control of that, though. Care of the aged is already so terribly sub-par!

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Replies to "Now I'm even more confused about scoring systems. I have two thoughts, though. 1) I've read..."

My mother is on Coumadin and I see the side effects. She has vascular dementia which I imagine may be worsened by high INR's. She has nosebleeds, large bruises, hematoma, and, most seriously, a gastric bleed that has resulted in severe anemia.

A doc took her off for 5 days without bridging her, for an endoscopy, and she had a stroke on day 5- in 2012. Her afib is continuous and she has a valve issue.

If my afib becomes more frequent and the episodes longer, I will definitely consider anti-coagulation. When I turned 65 I asked the doc if I could be scored 1.1 instead of going all the way to 2 on one day, my birthday.

Knock on wood I have just gone a year without afib. I don't eat after 5 which helps.

I was very interested in the idea of a Watchman at 75 due to increased risk of falls. One doc tried to talk me into a Watchman with one episode/year!

Good luck and thanks for the info. I agree with everything you wrote and you helped me think about this.