Atrial Fibrillation: Alternative treatment to prevent blood clots and stroke risk
Can This Common Blood Thinner Prevent Stroke?
The greatest danger from atrial fibrillation is stroke, and prevention starts with taking an anticoagulant.
By Barbara Sadick
Medically Reviewed by Pat F. Bass III, MD, MPH
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One of the most frightening aspects of atrial fibrillation — the most common kind of arrhythmia, or irregular heartbeat — is the risk of a life-threatening stroke.
During atrial fibrillation, the heart’s two small upper chambers — or atria — beat chaotically, increasing the risk of blood clots. If a clot breaks free and travels to the brain, you can suffer a stroke, which can be fatal.
People with atrial fibrillation are five times more likely to have a stroke than those who don’t have the condition. In fact, one in four strokes in people over age 80 is a direct result of atrial fibrillation. That makes stroke prevention a key part of atrial fibrillation treatment.
Stephen Kopecky, MD, professor of medicine at the Mayo Clinic, says that when working with patients who have atrial fibrillation, the biggest hurdle is deciding whether to prescribe an anticoagulant — a medication to prevent blood clots from forming. Because the average age of an atrial fibrillation patient is 76, the risk of stroke has to be weighed against the risk of bleeding. After that, he says, the decisions get easier.
Preventive Treatment: Anticoagulant Pros and Cons
Anticoagulants, commonly called blood thinners, are drugs that slow the clotting of blood, so they help prevent blood clots from forming and traveling to the brain, to reduce stroke risk.
If your doctor is concerned about your stroke risk, the first line of preventive treatment is medication. Since the 1950s, warfarin (Coumadin, Jantoven) has been the most widely used anti-coagulant. Newer anti-coagulants include Eliquis (apixaban), Pradaxa (dabigatran), and Xarelto (rivaroxaban).
Because most people with atrial fibrillation are older, various factors need to be considered. Dr. Kopecky says the risks for stroke are higher in those who have diabetes, high blood pressure, or have experienced heart failure, making an anticoagulant an important part of overall treatment in these cases.
Kopecky says fragile patients who fall and are at increased risk of problems from internal and external bleeding, or those who can’t remember to take medication as prescribed, probably shouldn’t be taking an anticoagulant. For them, he says, it’s probably wise to simply recommend an aspirin every day. Aspirin reduces the risk of stroke by 20 percent; anticoagulants reduce that risk by 80 percent.
For atrial fibrillation patients who have equal risks of bleeding and stroke, doctor and patient should make an informed decision together based on factors such as lifestyle, diet, physical activity, access to clinics and doctors, work, and travel.
“Every patient is an individual,” says , a cardiologist at Montefiore Medical Center and associate professor of clinical medicine at Albert Einstein College of Medicine in New York City. “The decision about what medication to take should not be dictated by what you read in the media or what you hear from pharmaceutical companies, but by a long conversation between patient and doctor,” he says.
Atrial Fibrillation Anticoagulants: Warfarin
Warfarin is a powerful drug that reduces the chemical reaction of vitamin K in the liver that causes — and lengthens the time it takes for — blood to clot. Its effectiveness depends on the amount of vitamin K in the body.
Vitamin K is found in many leafy green vegetables, such as spinach, Brussels sprouts, and kale. Warfarin interacts with those vegetables and with various medications, supplements, and over-the-counter drugs, making it vital that people on it be monitored at least once a month. Too much warfarin increases the risk of bleeding, and too little increases the risk of stroke. No new foods or medicines should be added to or eliminated from your diet without consulting a doctor, and you'll want to seriously limit the amount of alcohol you drink.
Patrick J. Tchou, MD, associate section head of electrophysiology and cardiac pacing in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine, and codirector of the Ventricular Arrhythmia Center at the Cleveland Clinic, says he still considers warfarin to be the gold standard for comparison with other anticoagulants. But the drawbacks of warfarin, he notes, are that doses have to be individually adjusted, and a patient has to carefully watch levels of vitamin K. If you're able and willing to regularly go for blood level measurement checks and keep in touch with your doctor about any diet or lifestyle changes, warfarin may be a good choice.
Warfarin is inexpensive when covered by insurance. Unlike some of the newer anticoagulants, warfarin has an antidote for emergency situations, such as during surgery when the drug must be immediately counteracted.
In addition to the risks of internal bleeding, warfarin side effects can include headaches, confusion, weakness, fever, numbness, nausea, and diarrhea. If you experience any of these, contact your doctor immediately because you may need a dose change.
RELATED: I Have Atrial Fibrillation Which New Blood Thinner Should I Take?
Atrial Fibrillation Anticoagulants: New Options
Newer anticoagulants have now been proven to be as effective as warfarin, says Kopecky. According to reports in the September 2011 issue of theNew England Journal of Medicine, several important studies showed they're equal or superior at preventing blood clots, as compared with warfarin.
The drugs Pradaxa (dabigatran) and Eliquis (apixaban) are taken in fixed doses twice a day, get into the blood in a matter of hours, and don’t require close monitoring or dietary considerations. Xarelto (rivaroxaban) is taken in a fixed dose once a day for prevention of stroke in atrial fibrillation. But these aren't advised for anyone with heart valve disease or serious kidney or liver problems. And unlike warfarin, they're expensive, and can cost about ,000 a year. Side effects are similar to those of warfarin.
“As we get to know these drugs better,” says Kopecky, “we’re migrating toward them more.” He said he likes to recommend them for patients younger than 65, who are active and have no other health issues.
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