Afib and stress test

I am interested that you take an anti-coagulant with afib that is only 2-3 times/year. How long does your afib last?

Usually only about 10-12 hours, but most recent time (4/8/23) I had to go to emergency after having for 36 hours. Even with all they gave me did not clear till 66 hours.

Then the meds make sense! 🙂

It's frustrating when it does not stop...66 hours is a long time to wait. Sorry for your recent experience!

The MDs go by the patient's CHADS-VaSc score. If it is indicated by the score, the patient is advised to commence anti-coagulants, usually for the rest of his/her life. The reason is that the clot, if it happens, is likely to be catastrophic, particularly among the elderly, and clots form not only DURING atrial fibrillation, but can form some days AFTERWARDS, or be dislodged from the danger chamber, the left atrium appendage where many lethal clots form during AF.

My cardiologist pressured me to take anticoagulants over a 5 year period for afib that occurred once a year (or recently, two years). My CHADS score indicated a need and he went by the protocol. Then the 1 point score for female gender was removed and I no longer met the CHADS criteria for meds! The MD told me I was probably right, that they were overmedicating people.

A hospital doc once told me to "go home and forget this happened"!

For those of us with infrequent episodes, it is important to recognize the risks of anticoagulants and balance benefit and risk.

For most people w/afib that is more frequent, anticoagulants are needed of course. I request short term anticoagulants (one month) when I have a longer episode (7 hours is my longest) and have seen studies on this, but it is not in practice yet. They give me Lovenox and an echo to check for clots and release me the next day.

The first time, in 2015, I was told to take a full dose aspirin for a month. Now they don't recommend that so I don't take anything.

Plavix, apixaban (Eliquis), and aspirin all do different things with the platelets, and they are not the same. Most of the medical system no longer recommends that half-aspirin once a day for seniors, as an example. Apixaban is now the darling. It's not without its risks, naturally, but you aren't likely to bleed to death if you get a serious lesion, say during a car accident. Apixaban delays clotting, it doesn't entirely prevent it. And they do finally have an antidote for it, although I'm unclear as to how available it might be in an ambulance or firetruck. And when I say 'antidote', I don't mean a single pill or injection, I believe it's a protocol and maybe a cocktail of drugs. This is out of my depth, but I read not long ago that they have a way of controlling it.

We are wise, I think, to want to be informed, to give informed consent, and to not willingly take everything offered to us by 'science'. But, science has a pretty heft and robust track record when it comes to medicine. Eliquis/apixaban is being used world-wide to very good effect, at least statistically. I myself felt quite squeamish about taking it, for obvious reasons, but I have scratched and cut myself once or twenty times since first taking it in late 2017, and I'm still gardening, cycling, moving things, and appreciating all my nice perennials. 😀

@1966prostreet -- Hi... hope you're hanging in there. Wanted to suggest that you ask your cardio the exact quetsion you posed here: basically, what's the puproseof the stress test? How does he believe it will improve your care?

Good luck!

/LarryG

Windyshores - Thank you for your post!!! I so appreciate reading this experience. I know we are all different, but my situation is very similar and I don't feel so 'crazy' after reading your note.

I was diagnosed with Paroxysmal Afib about 5-6 years ago with a ChadsVasc score of 7; I am female, 83 years old, with pacemaker, hx of heart attack x2 both years ago, high BP, cholesterol and all controlled very well with meds.

My electrophysiologist of 11 years, retired at end of 2022. I don't see the new doc until Jan 2024 due to packed schedules. My Afib episodes (paroxysmal) were never recorded at more than 30seconds each per the Pacemaker interrogations which are done every three months or so and my long time arrhythmia specialist said there was not a need for anticoagulants, but take 81mg timed release aspirin and other medications. Everything was fine until 2023 when the February interrogation showed that I had a 2-hour episode of Afib and all of a sudden they were talking Eliquis (this was after my doctor was retired and 'others' were making the recommendation.

I tried Eliquis but I had a reaction with severe gas, abdominal pain, passing gas was very painful; aches in my elbows, shoulders and upper arms - very much a flu like feeling. I even did a Covid home test because I though that could be a possibility, and it wasn't.

I then found this group, read about the various weakness in legs and pretty serious side effects and I explained to my Internist that I was not going to continue the med; I'd only used 4 tablets and stopped and went back to my 1 81mg baby aspirin.

All of my Afib episodes all these years are asymptomatic - Even the 2-hour episode was without symptoms. It was about 11pm and I know I was reading in bed and I had no idea whatsoever that I had it.

I agree that with infrequent episodes one should balance the benefit and risks of meds like Eliquis/Xarelto.

What is the short term anticoagulant (one month) that you take? Can you site a study regarding the longer episode and using Lovenox w/Echo to check for clots?

I see my cardiologist next week and in the meantime I'm going to increase my 81mg aspirin to 2 a day.

If you know, when was the 1 point for 'female' removed from the Chads Vasc scoring?

I would really like to hear more of your experience. The 'hospital doc that said to go home and forget it' - was it a cardiologist? So happy to hear there really ARE those who speak the basic truth. Thank you.

For something like this, first a disclaimer. I write about my experience which is different from yours, and only a doc can advise you on what to do!

So....Yes the doc who said to go home and "forget this happened" was a local cardiologist who is somewhat revered for his caring and also for his unique personality (he is a lobsterman on his day off!). My other more conventional cardiologist, the one who kept pressuring me to go on anticoagulants, told me after 5 years that I had probably been right and that he felt that "they" were maybe overmedicating people. At that point the female factor had been removed from one of the CHADS scores- 4 or 5 years ago?

The difference between you and me is that my afib is hugely symptomatic and I end up in the ER or, that last time, ICU. Do you wear an Apple watch or have a Kardia so you can keep track?

I read a study that suggested short term anticoagulation for infrequent afib that lasted more than 5 hours. It is not in practice yet. The Lovenox was standard for every hospital patient due to lying in bed, and was not treatment for my afib. The echo was reassuring and Mt. Auburn was the only hospital to do that for me, possibly because the episode was 7 hours, the first one to last longer than 3 hours. I believe clots can still form but I had to go with that.

For my first episode I was told to take regular aspirin for a month. For all my other episodes, I was told that aspirin was no longer recommended. Noone has suggested it.

Twice, I wore a monitor for a month and it is pretty clear that I always feel my afib. I had no concerning episodes during those times. So our cases are different.

If I were you I would try to find out what length of time with afib starts to pose severe risk of stroke. I would honestly be nervous with asymptomatic afib for two hours,but it is possible that is not long enough to cause clots. I do not know.

If I need an anticoagulant I might choose Coumadin because it is adjustable. But requires testing all the time. My mother was on it for continuous afib and we kept her safe for years. She went off for 5 days for a procedure and there was a screw up and docs did not provide a "bridge" like Heparin. She had a stroke on day 5. So I know this is serious business. (Then again she had vascular dementia and I wondered how Coumadin might have contributed.)

I hope you can wear something that alerts you- sounds like you do- and keep a journal of times it happens, how long, what you feel etc. Look for patterns. Keep in touch with doc. There may be small things you can do, like not eat after 5, adjust your position, take magnesium and drink low sodium V-8 for potassium, etc. etc. Tai chi and qui gong help me stay calm.

If your new doc wants anticoagulation, you can always see a second opinion. I try to remember that docs have more liability if they don't prescribe. But at the same time if your afib is increasing, they might be right on the meds. Your old doc was going by afib for seconds. I don't have the knowledge to say one way or the other, especially since you don't feel your afib and it seems to be increasing. Keeping a journal will help establish if it is increasing or that was an aberration.

I am sure I have repeated myself here but hope it is marginally helpful. Good luck!

The problem is that taking an anticoagulant AFTER THE FACT is not going to help much as taking nitro does during an angina attack, the latter being much faster acting and providing relief. An anticoagulant does not offer relief. It offers security against the risk of stroke during episodes of arrhythmia. If one is not sensitive to arrhythmias, but has them, of what use will be an anticoagulant that won't have much serum content and effect until approximately 40 minutes have passed since ingestion...about 40 minutes too late?

Eliquis and other anticoagulants are to be preventative. They're like a resume, an insurance policy, or a fire extinguisher; their use is immediate upon demand. Only if you actually take them, and only when they are present.