- Clot forming and embolism in the heart: due to blood pooling primarily in left atrial appendage
- Atrial Fibrillation or A. Fib significantly increases risk of stroke. As much as 5 times compared to patients without A. Fib
- 4 times greater risk of recurrent stroke
- More severe disability
- 2 times higher risk of dying from stroke
Because of the increase risk in stroke, chronic oral anticoagulation treatment is recommended.
Oral anticoagulants have been shown to lower the risk of stroke significantly in nearly all patients with A. Fib.
Estimation of Thromboembolism
Your doctor can calculate your risk for stroke using the Chadsvasc score calculator.
- A Chadsvasc score of 0 is a very low risk and your doctor will recommend either no therapy or aspirin.
- If your Chadsvasc score is 1, a moderate to high risk. Your doctor will recommend aspirin or anticoagulation.
- If your Chadsvasc score is 3 or higher than your doctor will recommend anticoagulation.
Anticoagulation
Anticoagulation medications: These are medications that slow down how fast your blood can form a clot.
The most common and widely used anticoagulant is warfarin. There are newer anticoagulants such as Pradaxa, Eliquis, Xarelto, Savaysa, and Bevyxxa.
Major Side Effects of Anticoagulants
Anticoagulants increase the risk of bleeding, but their benefit outweighs this risk. Anticoagulants like warfarin demand careful monitoring and frequent changes in dosing. Newer anticoagulants have far less interactions and do not require regular monitoring.
Often A. Fib is Undertreated from an Anticoagulation Standpoint
•Patient intolerance or poor adherence to medication and/or monitoring
•Under recognition of A. Fib itself
•Physician treatment bias:
–Inclination to correlate burden of A. Fib with stroke risk
–Belief that aspirin is an acceptable protective alternative to oral anticoagulants
–27% of patients decline anticoagulants based on shared decision-making (i.e., fear of complications)
De Breucker S, et al. Drugs Aging. 2010;27(10):807-813. Why Is AF Undertreated from an Anticoagulation Standpoint?
Atrial Fibrillation patients with scores of 1 and higher should consider anticoagulation to prevent strokes or heart attacks. There is a higher risk with Atrial Fibrillation to have a stroke and to die from one.
