Anticoagulant Medication for Afib/Arrhythmias
Anticoagulant medication, or blood thinners, as they are colloquially known, reduce the ability of platelets in the blood to stick together and form clots. To best understand how anticoagulants work, think about a time you cut yourself and started to bleed. The wound will quickly scab over if it is a relatively minor cut. This clotting action is vital to prevent excessive blood loss. Anticoagulants reduce blood clotting ability, so that same cut may lose far more blood if you are on one of these medications. It may seem like your blood is thinner, but this is not the case – the term “blood thinner” is a misnomer.
How Does Anticoagulant Medication Help Someone With an Arrhythmia or Afib?
The short answer is that certain cardiac arrhythmias, especially Afib, increase the risk of stroke due to the increased risk of blood clotting in the heart. Each of us has a small outpouching from the left atrium, known as the left atrial appendage. The best way to describe it is in the context of the appendix in the colon. It sticks out from the structure and doesn’t serve an immediately essential purpose. However, it can be problematic for the 5+ million Americans suffering from Afib.
When the heart does not beat in a rhythmic and coordinated way, blood may pool in the left atrial appendage. Pooling blood increases the risk of that blood sticking and clotting. If one of these clots breaks away and enters the bloodstream, it can travel to the brain and cause a blockage known as an ischemic stroke. A significant number of ischemic strokes are related to Afib – some estimate 15% while other studies show upwards of 30%. As such, we urge the public to visit their electrophysiologist at the first signs of an irregular heartbeat to minimize this risk.
The Risk of Stroke
Of course, not all patients with atrial fibrillation are at very high risk of stroke. We have a risk stratification system known as the CHA2DS2-VASc score that gives us a quick measure of the risk of stroke in Afib patients based on several criteria, including age and lifestyle factors. The scale ranges from 0-10, but a score of two and above is high risk. Patients with progressively higher scores will require anticoagulants more urgently as their risk increases.
Are Anticoagulants The Best Option?
The short answer is that anticoagulant therapy, if well tolerated, is the ideal method for reducing the risk of stroke in Afib patients. Medical therapy is predictable and effective and other procedural therapies require implanted devices that come with risks of implantation not to mention the small risk of device failure. That said, a significant number of patients will not tolerate anticoagulants or will have bleeding/clotting concerns that may make anticoagulants a risky option. Those prone to falling may also benefit from a procedure known as Left Atrial Appendage LAA Closure, using the Watchman device or The Amulet (a procedure on which Dr. Tordini is currently training).
Of course, there is no 100% effective way to eliminate the risk of stroke in Afib patients. As such anyone experiencing a cardiac arrhythmia should visit their electrophysiologist for evaluation and treatment. Patients should also reevaluate their lifestyle choices including improving their diet and exercise regimens to further reduce their risk.