Understanding the Role of Blood Thinners In Atrial Fibrillation

Dr. Jason Andrade, MD, FRCPC, Cardiologist, discusses the role of blood thinners (anticoagulants), in atrial fibrillation in order to prevent stroke.

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Dr. Jason Andrade, MD, FRCPC, Cardiologist, discusses the role of blood thinners (anticoagulants), in atrial fibrillation in order to prevent stroke.
Video transcript

Featuring Dr. Jason Andrade, MD, FRCPC, Cardiologist

Duration: 3 minutes, 57 seconds

Atrial fibrillation results in abnormal contractions in the top chamber of the heart. So the main issue has to do with the loss of the pumping function in the atria, in the top chambers, which causes the blood flow to slow down and allows clots to develop. These clots can break free, and if they go to the brain that’s how they cause a stroke.

Atrial fibrillation is the most common arrhythmia we see in practice. About one to two of the population have it. The biggest problem with atrial fibrillation is once it develops, it increases the risk of stroke about five times. We know that about 20 percent of all strokes are caused by atrial fibrillation.

The risk of stroke is different for every patient with atrial fibrillation, so although atrial fibrillation will increase the risk of stroke, it’s relative to other factors that are present. In Canada, we utilize a scoring system that predicts what the overall risk of stroke is, it’s called the CHADS score.

The components of the score are basically whether you also have heart failure, if your age is over 65, if you have diabetes, high blood pressure, or you’ve had a previous blood clot or stroke. Each of those adds to the risk, and can take the risk from about two percent per year to over 18 percent per year.

Everyone experiences their atrial fibrillation differently. Some people have very few symptoms related to the arrhythmia, other people have lots of symptoms and can be profoundly affected. When we think about stroke, that risk doesn’t matter, depending on the presence or absence of symptoms.

Everyone is at a higher risk, even if they don’t feel their atrial fibrillation. For patients with atrial fibrillation who are at a higher risk of stroke, typically they’re treated with anticoagulation or blood thinners. These are medications that prevent blood clots from forming.

Historically, Warfarin has been the anticoagulant of choice, because it substantially decreases the risk of having a stroke. The biggest issues with Warfarin have to do with the fact that it interacts with other medications and with things you eat, so your diet.

It also has needs in the terms of having to monitor it and the fact that the dose is variable. In response, in recent years, there’s been some new medications developed. These medications offer benefits beyond what’s observed with Warfarin.

Typically, these medications are as good or better than Warfarin at decreasing the risk of stroke, with a safety profile that tends to be as good or better in terms of the risks of bleeding. Each of these medications has a lower risk of bleeding in the brain. Each of these medications has a lower risk of fatal bleeding, and it doesn’t require the monitoring the is required for Warfarin.

We know that anticoagulants are blood thinners, and substantially decrease the risk of having a stroke related to the atrial fibrillation. But in order to get the benefit from the medications, you have to take them. The risk is, if you’re missing doses, or in the case of Warfarin, if your INR is not in the target range, then you’re at risk of having a stroke.

The key thing, is we have to take these medications as prescribed. One of the benefits of the newer agents is their simpler dosing schedules may improve the adherence or the ability to take these medications as directed.

Beyond the drug therapy associated with atrial fibrillation, there are some key lifestyle points that are important at managing your symptoms and managing your overall cardiovascular risk. We recommend that you exercise regularly, a minimum of 30 minutes a day or more if possible, we recommend maintaining a normal body weight, or keeping your BMI under 27.

We recommend eating a healthy, balanced diet. We recommend avoiding alcohol consumption, and tobacco consumption. We recommend living healthy. This will improve your symptoms related to atrial fibrillation, it’ll improve the amount of atrial fibrillation that you’re having, and it’ll help you just remain healthy overall.

If you have any more questions about your atrial fibrillation, please speak with your primary care physician or your cardiovascular specialist.

Presenter: Dr. Jason Andrade, Cardiologist, Vancouver, BC

Local Practitioners: Cardiologist

This content is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition.