: Dumn Question -warfarin or not

[Guest guest]

All,

I am strongly in favour of giving warfarin, my reasons are simply that if

in the unlikely chance of a stroke this therapy may prevent it. I remember a

Uk member that was on amiodarone and played JUDO. As you can imagine the

risk of a heavy bleed and severe bruising was significant. He refused

Wafarin and took 300mg of asperin a day. He ended up with a mild stroke and

lost the use of one of his arms and speech (he regained his speech later).

If you have a PVA and return to NSR you can stop Wafarin but you cannot

return to the past before the stroke.

My views on this.

C

Ps I was pretty lucky my INR was stable unless there was a drug change, my

father who is 81 hasa trouble with his diet and that affect his INR.

In the UK the NHS have set out guidelines. One can argue about the

quality of care provided by the NHS, and generally their treatment

of AFib is pretty abysmal, but their guidelines are a good place to

start. For anti-coagulation for all types of AFib this is as follows:

High risk:

.. Previous ischaemic stroke/TIA or thromboembolic event

.. Age ≥ 75 with hypertension, diabetes or vascular disease

.. Clinical evidence of valve disease, heart failure, or impaired

left ventricular function on echocardiography

- anti coagulate with warfarin if no contraindications

Medium risk:

.. Age ≥ 65 with no high-risk factors

.. Age < 65 with diabetes, hypertension or vascular disease

- either warfarin or aspirin could be considered. Owing to lack of

sufficient clear-cut evidence, treatment may be decided on an

individual basis, and the physician must balance the risk and

benefits of warfarin versus aspirin. As stroke risk factors are

cumulative, warfarin may, for example, be used in the presence of

two or more moderate stroke risk factors. Referral and

echocardiography may help in cases of uncertainty.

Low risk:

.. Age < 65 with no moderate or high risk factors

- aspirin 300mg p.d. if no contraindications

So from this it would seem that anyone with Afib younger than 65

with no risk factors (or even one moderate factor such as

hypertension) should not be on warfarin.

I would challenge your doctor, it may be he's got a good reason.

I play hockey and go cycling, which would be a bit of a no-no if I

was on warfarin due to the risk of uncontrolled bleeding.

Mark