Atrial fibrillation (AF), stroke risk and anti coagulation therapy - why doctors hesitate to treat, and what you need to weigh up.
NOTE: I am not medically qualified, this is a layperson's comment. If your doctor disagrees with what I am about to say, there will be good medical reasons for it in your individual case - so go with your doctor.
In my new post-caregiving life I volunteer for my local NHS trust, as part of which I have just sat through a seminar on cardiovascular disease for GPs, specialist nurses and allied professionals.
This included a half hour presentation on anticoagulation therapy in atrial fibrillation. The speaker was the lead specialist in his region: an excellent presenter, who unwittingly laid out for me clearly, with diagrams and videos, exactly what had first disabled then killed my mother, and why her doctors' decision not to treat her with anticoagulants was wrong.
I do not blame those doctors. They considered my mother's case carefully and came to their best clinical decision at the time. The risks they had to weigh were:
1. If they gave aggressive anticoagulant therapy (often called 'clot-busters') the patient could have suffered a bleed in the brain. This is a known risk.
2. If they withheld it, the patient could have been harbouring a large blood clot in her left atrium which would detach, head straight up the carotid artery and lodge in the main central artery in her brain causing a catastrophic stroke. This is what actually happened.
And this is what Dr H told his audience today: "we've all seen cerebral bleeds, they lodge in our memories and they wreck our perspective on risk. I've seen lots of patients on stroke wards with no quality of life and no prospect of recovery because doctors were afraid to treat, but I've never had a patient thank me for preventing the stroke they didn't know about because it didn't happen because I gave NOACs."
So if you find yourself in the ER watching your loved one's doctor wrestle with this decision, don't be afraid to ask. Ask what risks he or she is weighing up, what the likelihood is of those things happening, and what the probable outcomes are.
It could be that your loved one is among the minority of patients for whom anticoagulation is certainly too dangerous to attempt; but it could be that your doctor is among many whose fear of one risk prevents them from treating a worse risk effectively. Your doctor is the best judge in each individual patient's case, but what you can do to help is ask to be talked through the decision-making process.