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Why Are ~40% Of Afib Patients Who Are At Risk For A Stroke Still Just Getting Aspirin?

The results of this study (http://www.medpagetoday.com/cardiology/arrhythmias/58683), from the American College of Cardiology's PINNACLE Registry, are very concerning. Why would approximately 40% of afib patients who are at risk for a stroke (CHADS2 or CHA2DS2-VASc score greater than or equal to 2) still be getting just aspirin when we know that it does not work for preventing afib-related strokes, and in fact, causes bleeding?

In this registry, blood thinners (oral anticoagulants) were more common for those who were male (even though women have a higher stroke risk), had higher body mass, had a prior stroke (or TIA) or embolism, or had congestive heart failure. Aspirin was more common for those with high blood pressure, high cholesterol, coronary artery disease, prior heart attack, angina, recent bypass, or peripheral artery disease.

Apparently, the problems seem most likely to arise in those with other heart issues, but the guidelines make it clear that in some of those cases, such as stents, for those with a CHA2DS2-VASc score of 2 or greater, it is reasonable to use anticoagulants combined with clopidogrel, but without aspirin (Table 6, page e15 of the 2014 AHA/ACC/HRS Afib Guidelines). Thus, it is clear that doctors may need to become more aware of what to do in these special circumstances where the patient also has afib. 

We in the afib patient community have to be super-educated to make sure we are having conversations with our doctors that ensure we are getting the right treatment to protect ourselves from strokes. That is why what I'm working on today is so critically important. I shouldn't be talking about it yet (I wasn't planning to say anything until I have all the details worked out), but I'm working with Dr. Elaine Hylek (one of the top experts in afib stroke prevention) to do a webinar in a few weeks about what afib patients need to know about blood thinners. We can educate ourselves and protect ourselves. I am fully committed to this - are you?

Mellanie


**This blog post reflects the opinion of the author and does not necessarily reflect the opinions of the AHA**
Posted by Mellanie at StopAfib.org on Jun 26, 2016 12:04 PM CDT

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The recommended blood thinners suggested for A-Fib are very expensive. Eliquis, Pradaxa cost a small fortune so I take aspirin.
  • Posted Mon 27 Jun 2016 06:40 AM CDT
"We in the afib patient community have to be super-educated to make sure we are having conversations with our doctors that ensure we are getting the right treatment to protect ourselves from strokes."

The educational benefit that we get from learning what we can about Afib is something that we individually benefit from which allows us to better gauge what a doctor recommends, but as to our ability to then "educate" our doctors of what we've learned .... good luck to that. After all, our relationship is one of Doctor-Patient. They may listen to what we say but not to be "educated" by us; perhaps informed of something they may not be aware of (but never admitting it). After the 14 years or so of training they have to get to become cardiologists they aren't exactly amenable to be further "educated" by their patients in the half-hour sessions we have with them.

As for the need for anti-coagulants for those with Afib, that issue is not clear for a number of reasons. First off, the CHADS score makes no distinction between the range and types of Afibs suffered. The once per year event is treated equivalently with those in continuous Afib. Is anybody really confident that the bleeding risks of anti-coagulants are necessary in both instances or only for those in continuous Afib. And how about the ranges between those extremes? That's where the judgment of the cardiologist comes in which we depend on, at least, I do.
  • Posted Mon 27 Jun 2016 07:25 AM CDT
Three months ago I had two confirmed AFIB episodes. Had all the required tests and after seeing the 'plumber' heart doctor was put on Flecainide, Eliquis, and a baby aspirin . When I saw the 'electrician' heart doctor a few weeks later, he about came unglued that I was taking both Eliquis and aspirin. He told me to immediately stop taking the aspirin. He even said - Do you want to die by bleeding to death? (Like I took them on my own?) I was only doing what I was told to do and have the papers to prove it. Anyway, I have now completed a month of heart monitoring and went back to the 'electrician' doctor (this is how they refer to themselves) Good news - the main outcome is the Flecainide is doing it's job and keeping me from going into AFIB. At 56 years old, I have great arteries and do not need to take the Eliquis any longer. (YAH!) But if I wanted to, and it is still on the recommendations to do so, I could start taking one baby aspirin again. This is what the doctor told me - Studies have show that with patients like me, taking an aspirin has no effect on what happens with my AFIB.
For my heart issues, other than an enlarged left atrium, skipped beats, and now the controlled AFIB, I don't qualify for even 1 point on their risk grading system, and there is no known medical reason for this to have happened to me. I'm not an illegal drug user, smoker, drinker (used to holiday drink like four times a year), nor am I overweight, have diabetes, high blood pressure, clogged arteries, or old enough. Which I am EXTEMELY grateful for not having any of those problems, but I do have others not concerning the heart. The only thing on their list that qualifies me, for maybe half a point, is that I'm female. I say half because I'm not over 65. I have read where a few have asked is this forum always a downer, "where's the success stories"? We just had one with the lady who had an ablation, and I'm adding mine. Only two documented AFIB episodes and it's controlled and I don't have to take the expensive Eliquis anymore. Which leads me back to the aspirin? What about my doctor saying the studies show it doesn't help nor hinder. He told me, it's up to me to decide, (I am taking the aspirin.)
  • Posted Mon 27 Jun 2016 08:04 AM CDT
I'm IN~!

Please let me know when your webinar is happening, because that is exactly what I need to know - which anticoagulant is best for me~!

Thanks for all the great info.
Zippy
  • Posted Mon 27 Jun 2016 09:09 AM CDT
I would like to know my AFIB group at Mayo Jax Fl told me I'm Chad score One(female) n 3 years AFIB free
My AFIB Dr at Piedmont Heart in Georgia confirm the same
On 81 mg n 509 magnesium
  • Posted Mon 27 Jun 2016 10:27 AM CDT
Count me in!
  • Posted Mon 27 Jun 2016 11:52 AM CDT
I'm very interested in the webinar with Dr. Hylek.
  • Posted Mon 27 Jun 2016 10:22 PM CDT
Hi Mellanie. Just a quick question. How does anti coagulation therapy apply to someones like myself that has had a Hybrid Maze procedure, Atrial Ablation, and has had the Atrial Appendage removed? My Hybrid Maze surgeon feels that I can stop anti coagulants all together, but my Cardiologist who did the Ablation wants me to stay on my Warfarin. I understand that you have had a Hybrid Maze procedure with the removal of the Appendage as well? If so, what are you doing about anti coagulants?
  • Posted Thu 30 Jun 2016 10:39 AM CDT
First, Melanie thank you for all you do. I think many of us would feel more confident about taking a blood thinner if we knew what the long term effects are. Some say it stiffens the arteries.I have been scared into taking a blood thinner even though I feel my my afib is mild. But the fact that I am female and over 65 dictates taking the blood thinner. I don't feel good taking it and would rather go back to taking an aspirin and other supplements that thin the blood naturally. What do you all think?
  • Posted Fri 01 Jul 2016 08:53 AM CDT
I have had Afib for 2 yrs and i was put on Xarelto and i have had no side effects from it. I have episodes every now and then and it lasts from 20 min to 12 hours. It comes and goes mostly when i am resting after having been kind of active.

I am 63, retired, of course this came on me after i retired. I was on the Affordable Health Care, but this year its gotten where i can not afford to have insurance or afford Xarelto any more. I am going back to my doctor this week to see what he recommends or do for me. I am the longest living male in my family all have passed do to heart issues. All have passed before they were 60. Xarelto is over $380 for 30 day supply with the RX discounts. I am looking at just going to Aspirins. I am asking from everyone's experience's if you know of a bigger discount for the blood thinners. Only one i have found affordable with the RX discounts is Warfarin. I am going to ask my Doctor about it , this week. Is Warfarin really as troublesome as i have heard?

I would like to stay on Xarelto, i have no issues. Any Comments would be greatly appreciated.
  • Posted Mon 16 Jan 2017 07:18 AM CST