right. but - speaking as a guy who's spent up to 40 hours out of sinus rhythm - after EKGs, utrasounds, nuclear stress tests, etc., at the end of it all i take a baby aspirin every day. per the doctors orders. as my blood thinner.
others might have to take warfarin, but, have you researched the increased risk of stroke by this with afib? i ask because when i did it seemed to me the increase was pretty small, so much that when i see the TV ads pushing blood thinners for those with afib i really wonder if we've gotten to a kind of ridiculous stage.
so, i'm eager to be taught, but, what do you think the increased risk of stroke is, versus a similar cohort not beset with afib?
Executive summary, my cardiologist reckons stroke risk is roughly double for me, but warfarin introduces other risks that make it much closer to a wash.
When I first presented with permanent AF, I was cardioverted. Didn't last more than a month or so; cardioverted again and put on Tikosyn (dofetilide), a potassium channel blocker. Several months later I was back in AFib. At that point, my cardiologist presented these choices:
- the various types of ablation procedures
- the Maze procedure
- do nothing but take warfarin
- do nothing
His experience is that the reversion rate of the various ablation procedures is pretty high when you check a few years down the road, and he has done a lot of them. So he no longer recommends ablation. The Maze procedure is open-heart surgery, which has all the risks associated with that. And it is not guaranteed, either. My AF is quite moderate, I never realized I had developed it until an annual physical, and except at high efforts, I don't notice it at all. When doing something hard, like intervals or following some froggy SOB on the group ride, it feels like I don't have the last gear or two I used to have, but I don't notice it at all at moderate steady-state efforts. Given that, he recommended doing nothing, unless things worsened to the point where I couldn't do the activities I wanted to do. Regarding warfarin, his opinion is that a person without other risk factors has approximately a 1% risk of a stroke. Not treating my AF will double that. I have read articles online that have said the increased risk is 5x, but I think he factored into that my overall fitness and activity level. Warfarin in his opinion introduces a similar overall risk increase; stroke risk does not rise as much, but there is the bleeding thing and some other warfarin side effects. He recommended a daily aspirin, but after some months of that I started to feel really crappy, like overtrained. My GP immediately thought GI bleeding, and he was right, I am one of the 20% who will develop an ulcer from a daily aspiring regime. Discussed again with the cardiologist, and decided against warfarin for the reasons above. Knock on wood, but it's been a couple of years now with no treatment and things have not changed for better or worse.
In a way, I can't help but feel responsible, I always knew that you were insane