Starting in 2015 I have had afib with very rapid heart rate, once a year, or even had a two year interval. This past year I had one episode in late August 2023, two in early October, and I just had one two nights ago, 4/16, with heart rate peaking around 200.
I am meeting with a new cardiologist at a teaching hospital and am going to ask about the "pill in a pocket" approach meaning short term anticoagulation. Some say a month, some say less time. And there is a lot of difference of opinion on how long it takes to form a clot.
When one of my episodes lasted 7 hours (usually they are 45 minutes to 2 1/2 hours) the hospital did an echocardiogram to check for clots.
A cardiologist pressured me to take a blood thinner back in 2015 and I declined. He later told he he agreed (much later) and that they were "probably" overmedicating people. Then again, my mother had continuous afib and had a stroke when off Coumadin for 5 days.
Bottom line, if you are prepared to accept the personal risk and responsibility for the clot, and a subsequent stroke, go for it. Some EPs will agree that you can go off NOACs once your CHADs2 score drops to a mere 1 or less, especially if you have a Watchman implanted and the area is deemed to be closed to blood accumulation.
Some won't. The variance may be attributable to the numbers of subsequent strokes that the various EPs report in their 'cured' patients. In turn, that might be due to the skills, or even to the grade of difficulty of the patients' conditions, of the EP agreeing to treat a set of people.
In my time reading on various fora, the two principle fears or objections are over the cost and the risk of hemorrhage. There's little to argue about the former, but the latter is entirely moot and there is no evidence the NOACs cause bleed-out. They do retard clotting, but they don't prevent it. I have had several bloody scrapes and never had uncontrollable bleeding. If I leave it alone, next I look it has clotted.
Across people and their circumstances, your chances of a stroke, once you have a history of arrythmia and of general age-related disorders and syndromes, is at least twice what the risk would be of a serious bleed. But were you to poll those who have lived past a serious stroke, I'm pretty sure they'd encourage you to take the prescription. Those who have died....are unpollable.
@gloaming I think it depends on frequency and duration of afib episodes, and some are doing short term anticoagulation. I have gone 9 years with afib and no meds and have not had a stroke. That said, I monitor and find the best medical care possible.
The book The Afib Cure by Day and Bunch is quite helpful.
I have constant Very mild afib w normal heartrate & they put me on Eliquis bcuz of stroke risk. I chose to take it Rather than possibly Have a Stroke....its your choice. Do what feels right for you!
I have constant Very mild afib w normal heartrate & they put me on Eliquis bcuz of stroke risk. I chose to take it Rather than possibly Have a Stroke....its your choice. Do what feels right for you!
Just to clarify @kevkat73 your afib is continuous. I have two hours once a year. The original poster has paroxysmal afib, which occurs at times rather than continuously. It is not clear how often or for how long @lenmayo has afib. I just wanted to offer a different view point, which both my cardiologists have signed off on.
I don't know what you mean by "mild afib." Either it is afib or not afib and the stroke risk comes from afib.
The fact that I end up in the hospital or even the ICU is because of low blood pressure and the way treatment of afib further lowers it. But my risk isn't any greater because of the apparent seriousness of the episodes. They are very infrequent and short in duration.
I am seeking short term anticoagulation from my next appointment, and guidelines on how long an episode has to be to require anti-coagulation. There are huge discrepancies on what duration is said to be dangerous for stroke; a few minutes to 48 hours.
I think that @gloaming gave you the best advice. It is a personal decision. After my ablation in 19, my EP believed very highly in staying on Eloquis which I did. The first EP moved, the second EP looked at two different weeks when I wore the monitor with no evidence of Afib plus my telling him that at least every hour I check my HR via a Fitbit, he took me off Eloquis. And 8 months ago, I have a pacemaker implanted for Bradycardia. Too many factors for each individual risk, if there is any doubt, I would stay on the med. .
Bottom line, if you are prepared to accept the personal risk and responsibility for the clot, and a subsequent stroke, go for it. Some EPs will agree that you can go off NOACs once your CHADs2 score drops to a mere 1 or less, especially if you have a Watchman implanted and the area is deemed to be closed to blood accumulation.
Some won't. The variance may be attributable to the numbers of subsequent strokes that the various EPs report in their 'cured' patients. In turn, that might be due to the skills, or even to the grade of difficulty of the patients' conditions, of the EP agreeing to treat a set of people.
In my time reading on various fora, the two principle fears or objections are over the cost and the risk of hemorrhage. There's little to argue about the former, but the latter is entirely moot and there is no evidence the NOACs cause bleed-out. They do retard clotting, but they don't prevent it. I have had several bloody scrapes and never had uncontrollable bleeding. If I leave it alone, next I look it has clotted.
Across people and their circumstances, your chances of a stroke, once you have a history of arrythmia and of general age-related disorders and syndromes, is at least twice what the risk would be of a serious bleed. But were you to poll those who have lived past a serious stroke, I'm pretty sure they'd encourage you to take the prescription. Those who have died....are unpollable.
RE: the cost of Eliquis, I was paying $100. per month until about a year ago when a generic brand of Apixaban became available. Now it costs $30.00 per mo.
That's for 5mg.x 2 per day. I have Paroxysmal A-fib....I don't even know when or if I'm having episodes. I think mine is caused by a bicuspid aortic valve.
@gloaming I think it depends on frequency and duration of afib episodes, and some are doing short term anticoagulation. I have gone 9 years with afib and no meds and have not had a stroke. That said, I monitor and find the best medical care possible.
The book The Afib Cure by Day and Bunch is quite helpful.
Windyshores you are correct. Frequency, duration and I would add HR. When you get over a 100 BPM it becomes more dangerous. I alway carry with me Eliquis whenever I leave the house. I am one of those lucky ones that always feels when I go into Afib. The deal I have with my EP is anything shorter than 12 hours I take a 24 hour eliquis. Anything longer than that I take it for 30 days. I usually self-convert. I also have a blood clotting disorder called Factor V Leiden which increases the chance of a clot about the same amount as taking an oral contraceptive. The past 9 months have been rougher and I have had more frequent Afibs. (Ablation in 2019). They have been coming about every 3-5 weeks with duration of 1 hour to 3 days. My HR never goes above 80 BPM. I decided to take eliquis daily due to frequency of events. So far all my events have started when I was awake. But there is always the chance of of starting at night without me knowing when. My EP feels that anything longer that an hour risks the start of a clot formation. My brother ignored his butterflies for 9 days and ended up all but dead. He had multiple PEs in both lungs. The docs said it was a miracle he lived. I think majority of people are clueless about their medical care. They are not proactive about their medical care and expect the white coat to tell them what to do and they do it. That is why cardios got 100% all in on all people. Unless of course you can prove you are smarter than the average patient.
Windyshores you are correct. Frequency, duration and I would add HR. When you get over a 100 BPM it becomes more dangerous. I alway carry with me Eliquis whenever I leave the house. I am one of those lucky ones that always feels when I go into Afib. The deal I have with my EP is anything shorter than 12 hours I take a 24 hour eliquis. Anything longer than that I take it for 30 days. I usually self-convert. I also have a blood clotting disorder called Factor V Leiden which increases the chance of a clot about the same amount as taking an oral contraceptive. The past 9 months have been rougher and I have had more frequent Afibs. (Ablation in 2019). They have been coming about every 3-5 weeks with duration of 1 hour to 3 days. My HR never goes above 80 BPM. I decided to take eliquis daily due to frequency of events. So far all my events have started when I was awake. But there is always the chance of of starting at night without me knowing when. My EP feels that anything longer that an hour risks the start of a clot formation. My brother ignored his butterflies for 9 days and ended up all but dead. He had multiple PEs in both lungs. The docs said it was a miracle he lived. I think majority of people are clueless about their medical care. They are not proactive about their medical care and expect the white coat to tell them what to do and they do it. That is why cardios got 100% all in on all people. Unless of course you can prove you are smarter than the average patient.
I agree 100 percent. You have to know your body well and fight for good health. I mean educated yourself so when you go to the doctor you know what’s going on. It’s a struggle but that’s what it takes.
@harveywj I have waited a few months for the best most up-to-date cardiologist I could find, at a teaching hospital. My hope is to do exactly what you are doing. I want a protocol for stroke prevention after episodes, other then continuous long term anti-coagulation.
In 2015 one doc wanted continuous anti-coagulation and one doc said "Just go home and forget it happened." I want something in-between!
My mother had a stroke when off Coumadin for 5 days for a procedure so I am well aware of the risk. I am nervous about each episode. Ironically I was the least nervous after my longest (7 hours) episode because they did an echo. Not 100% but reassuring.
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I don't take any blood thinners at all.
Starting in 2015 I have had afib with very rapid heart rate, once a year, or even had a two year interval. This past year I had one episode in late August 2023, two in early October, and I just had one two nights ago, 4/16, with heart rate peaking around 200.
I am meeting with a new cardiologist at a teaching hospital and am going to ask about the "pill in a pocket" approach meaning short term anticoagulation. Some say a month, some say less time. And there is a lot of difference of opinion on how long it takes to form a clot.
When one of my episodes lasted 7 hours (usually they are 45 minutes to 2 1/2 hours) the hospital did an echocardiogram to check for clots.
A cardiologist pressured me to take a blood thinner back in 2015 and I declined. He later told he he agreed (much later) and that they were "probably" overmedicating people. Then again, my mother had continuous afib and had a stroke when off Coumadin for 5 days.
How often do you have afib?
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5 ReactionsBottom line, if you are prepared to accept the personal risk and responsibility for the clot, and a subsequent stroke, go for it. Some EPs will agree that you can go off NOACs once your CHADs2 score drops to a mere 1 or less, especially if you have a Watchman implanted and the area is deemed to be closed to blood accumulation.
Some won't. The variance may be attributable to the numbers of subsequent strokes that the various EPs report in their 'cured' patients. In turn, that might be due to the skills, or even to the grade of difficulty of the patients' conditions, of the EP agreeing to treat a set of people.
In my time reading on various fora, the two principle fears or objections are over the cost and the risk of hemorrhage. There's little to argue about the former, but the latter is entirely moot and there is no evidence the NOACs cause bleed-out. They do retard clotting, but they don't prevent it. I have had several bloody scrapes and never had uncontrollable bleeding. If I leave it alone, next I look it has clotted.
Across people and their circumstances, your chances of a stroke, once you have a history of arrythmia and of general age-related disorders and syndromes, is at least twice what the risk would be of a serious bleed. But were you to poll those who have lived past a serious stroke, I'm pretty sure they'd encourage you to take the prescription. Those who have died....are unpollable.
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Like -
Helpful -
Hug
7 Reactions@gloaming I think it depends on frequency and duration of afib episodes, and some are doing short term anticoagulation. I have gone 9 years with afib and no meds and have not had a stroke. That said, I monitor and find the best medical care possible.
The book The Afib Cure by Day and Bunch is quite helpful.
-
Like -
Helpful -
Hug
6 ReactionsI have constant Very mild afib w normal heartrate & they put me on Eliquis bcuz of stroke risk. I chose to take it Rather than possibly Have a Stroke....its your choice. Do what feels right for you!
-
Like -
Helpful -
Hug
3 ReactionsJust to clarify @kevkat73 your afib is continuous. I have two hours once a year. The original poster has paroxysmal afib, which occurs at times rather than continuously. It is not clear how often or for how long @lenmayo has afib. I just wanted to offer a different view point, which both my cardiologists have signed off on.
I don't know what you mean by "mild afib." Either it is afib or not afib and the stroke risk comes from afib.
The fact that I end up in the hospital or even the ICU is because of low blood pressure and the way treatment of afib further lowers it. But my risk isn't any greater because of the apparent seriousness of the episodes. They are very infrequent and short in duration.
I am seeking short term anticoagulation from my next appointment, and guidelines on how long an episode has to be to require anti-coagulation. There are huge discrepancies on what duration is said to be dangerous for stroke; a few minutes to 48 hours.
-
Like -
Helpful -
Hug
2 ReactionsI think that @gloaming gave you the best advice. It is a personal decision. After my ablation in 19, my EP believed very highly in staying on Eloquis which I did. The first EP moved, the second EP looked at two different weeks when I wore the monitor with no evidence of Afib plus my telling him that at least every hour I check my HR via a Fitbit, he took me off Eloquis. And 8 months ago, I have a pacemaker implanted for Bradycardia. Too many factors for each individual risk, if there is any doubt, I would stay on the med. .
-
Like -
Helpful -
Hug
6 ReactionsRE: the cost of Eliquis, I was paying $100. per month until about a year ago when a generic brand of Apixaban became available. Now it costs $30.00 per mo.
That's for 5mg.x 2 per day. I have Paroxysmal A-fib....I don't even know when or if I'm having episodes. I think mine is caused by a bicuspid aortic valve.
-
Like -
Helpful -
Hug
5 ReactionsWindyshores you are correct. Frequency, duration and I would add HR. When you get over a 100 BPM it becomes more dangerous. I alway carry with me Eliquis whenever I leave the house. I am one of those lucky ones that always feels when I go into Afib. The deal I have with my EP is anything shorter than 12 hours I take a 24 hour eliquis. Anything longer than that I take it for 30 days. I usually self-convert. I also have a blood clotting disorder called Factor V Leiden which increases the chance of a clot about the same amount as taking an oral contraceptive. The past 9 months have been rougher and I have had more frequent Afibs. (Ablation in 2019). They have been coming about every 3-5 weeks with duration of 1 hour to 3 days. My HR never goes above 80 BPM. I decided to take eliquis daily due to frequency of events. So far all my events have started when I was awake. But there is always the chance of of starting at night without me knowing when. My EP feels that anything longer that an hour risks the start of a clot formation. My brother ignored his butterflies for 9 days and ended up all but dead. He had multiple PEs in both lungs. The docs said it was a miracle he lived. I think majority of people are clueless about their medical care. They are not proactive about their medical care and expect the white coat to tell them what to do and they do it. That is why cardios got 100% all in on all people. Unless of course you can prove you are smarter than the average patient.
-
Like -
Helpful -
Hug
2 ReactionsI agree 100 percent. You have to know your body well and fight for good health. I mean educated yourself so when you go to the doctor you know what’s going on. It’s a struggle but that’s what it takes.
-
Like -
Helpful -
Hug
2 Reactions@harveywj I have waited a few months for the best most up-to-date cardiologist I could find, at a teaching hospital. My hope is to do exactly what you are doing. I want a protocol for stroke prevention after episodes, other then continuous long term anti-coagulation.
In 2015 one doc wanted continuous anti-coagulation and one doc said "Just go home and forget it happened." I want something in-between!
My mother had a stroke when off Coumadin for 5 days for a procedure so I am well aware of the risk. I am nervous about each episode. Ironically I was the least nervous after my longest (7 hours) episode because they did an echo. Not 100% but reassuring.
-
Like -
Helpful -
Hug
2 Reactions