Are only people with Atrial Fibrillation prescribed anticoagulants?

Hi, I am posting on behalf of my father. He had a TIA in 2017 and was prescribed Clopidogrel. Initially, the drug worked wonders for him: before clopidogrel, he was getting black holes in his vision and was almost constantly dizzy.

Unfortunately, from 2018 onwards he started to decline with more stroke, with a big step change in March 2022, but he was not prescribed an anticoagulant (he was not even put on aspirin). I am trying to find out if not prescribing anticoagulant is normal? When I questioned the doctors as to why he was not prescribed an anticoagulant, I did not get an answer, so any insight or experience on the matter would be much appreciated. Is it really only people with Atrial Fibrillation that get prescribed anticoagulant?

In 2018, my dad had an MRI which showed signs of further stroke - no medication change. In Jan 2022, he had another MRI which showed more signs of stroke. This combined with a step change in March 2022 led to a TIA referral being made. Unfortunately, he had a big stroke mid April that led to a hospital admission. Even after the big stroke, his medication was not changed - he was still only prescribed Clopidogrel (same dosage). He was discharged from hospital after the first week even though he declined whilst in there. Due to his decline I opted to wait for a discharge to assess bed as I thought his strokes might not be over. He was discharged to a care facility where he continued to decline - I told the staff I thought he was having mini strokes - they told the doctor who visited the facility. His medication was not changed - still only prescribed Clopidogrel - not even sent for an MRI (but that’s an aside).

Long story short he was eventually readmitted to an acute stroke ward where they gave him an MRI and said that yes, they suspected he had been having mini strokes since his original discharge from them. Unfortunately, he ended up with Basilar Artery Thrombosis and then Basilar Artery Occlusion.

My question is given my dad’s history of stroke, age (75) , diabetes, heart disease , hypertension, high cholesterol etc. was he not prescribed a medication like Apixaban, after his big stroke in April? And, when he continued to decline, why was his medication not reviewed ?

He did not have haemorrhagic stroke.

Any insight into whether the above is normal medical procedure would be much appreciated. He did not have Atrial fibrillation, but given his history and conditions I’d have thought he’d qualify for anticoagulant?

@Qwerty firstly welcome you lovely forum where we all talk by experience. But I’m so sorry your dad has gone through all of this and you and your family.

I cannot help as my stroke was cerebellum. But it doesn’t sound ok to me. Which hospital was this? How is your Dad doing now? Could you get a second opinion about his medication? I changed my stroke consultant as she was useless and misdiagnosed me. Maybe someone on our forum will be able to advice @Rups he is really clued up. I’m sorry I’m not much help but I wish your dad well and hope you get some answers.

Kind wishes loraine

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I have had a heart scan, no problems. A stroke affected the left side of my brain, associated with extreme weakness to the limbs on the right side of my body.
I am prescribed blood pressure medication, a statin and clopidogrel. The latter because my stroke was a result of blockage by blood clotting I believe.
I am not in any way conversant with medication and how it is administered but I think I am under a pretty standard regime.

I don’t know if this info is any use but I suggest a chat/discussion with the hospital doctor, your GP, a practice nurse, might be more informative.
I wouldn’t vouch for it but an online search for ‘clopidogrel stroke’ might throw up more info. You could bring the results of your search here and ask for the opinions of others here too.

I hope this is better than no reply.
and I hope you find useful info somehow, somewhere.

Bob

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Sorry to hear of all these problems. As far as I am aware, blood thinning drugs can be used for strokes (except for haemorrhagic stroke ) I am on low dose asprin, clopidogrel didn,t suit me. I would recommend in the first instance, getting in touch with the stroke association, who will be able to guide and assist you. Or as Loshy said get a second opinion, as I am sure this is not right. Please let us know how you get on.
Best wishes, Jane.

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Hi @Qwerty welcome to the forum and sorry to hear about your dad, he’s been through the mill.

I think the standard starting medication prescribed for Ischaemic stroke is usually clopidogrel and a statin. Given your father’s history I would have thought he’d have a medication review, he should definitely speak to the stroke consultant to see if there is any better medication he could take, or you could go with him to an appointment and ask these questions on his behalf.

Best wishes

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@Qwerty welcome to the forum. Sorry to hear of everything your dad & you have been through. I had an ischaemia stroke & was prescribed clopidogrel & statins which I was told I will take for life. No AF found in my case.
I echo what others have said re second opinion.
Good luck xxx

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Hi, I’m new to this. Had my stroke 15wks ago, mild thank goodness. I know how lucky I am. I was prescribed Clopidogrel, which I was told was for stroke. I then found out I had AF, and prescribed Apixaban. Was on both for about 6wks until it got confirmed that I did not need Clopidogrel, so just on Apixaban with Digoxin for lowering heart rate. Sending a hug for you and your Dad.

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Hi @SarahG it’s good to know they’ve got your medication sorted and they found the AF which is being treated.

Best wishes

Hi, thanks for your welcome and advice.

He passed away unfortunately. I wish I had got a second opinion and been more pushy on my side in making sure that my dad had got reassessed once he started to decline - I focused more on telling the care assistants & nurses about the day to day deterioration that I was seeing and assumed that the information would be acted upon. I’m not that naive anymore.

I’ve requested all of my dad’s medical records from April onward. Once they’ve arrived, I will try and get a second opinion. I think there were many flaws in his treatment/care. One being that he deteriorated so much-gradually- before any action was taken.

I kept a detailed log of events, so will be able to cross check my records against those of the hospital and care facility. I’m grateful for the care that some of the staff provided to my dad, but think that because there’s so many pressures on the health care system at the moment things just aren’t working as they should.

I’m hoping that by at least pinpointing what went wrong with my dad’s care, it might raise awareness at the hospital & facilities he was treated at. Or at the very least provide another case study of what can go wrong.

@Qwerty sorry to hear your dad passed away. A difficult time for you. I hope you manage to get some answers & that it brings you some closure. Hopefully there will be some lessons learnt & whilst it won’t help you or your dad it may help others in the future.
So sorry for your loss. xx

@Qwerty I’m so sorry to hear about your father, my condolences on your loss.

Take care

So sorry to hear that. Lets hope you get some answers. it wont help your Dad I know, but it may help you and others in the same situation.
Thinking of you.
Jane.

Hi @Qwerty - I’m sorry to hear about your father.

What you’ve said has reminded me of my own father’s death a few years ago. He had chronic kidney disease and declined to have dialysis (the right decision for him). Because of this he was on the palliative care register with his GP and yet the last two weeks of his life were horrendous as he was moved from place to place before ending up in the hospice only a few hours before he died. It turned out that the GP hadn’t informed anyone of the palliative care.

I complained to the NHS and felt like I was fobbed off so I eventually took the complaint to the Ombudsman. They upheld the complaint and the GP practice had to apologise, and more importantly, to review their systems. The Ombudsman process is lengthy and fairly gruelling but I’m glad I did it.

Wishing you all the best.

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