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Heart Smart Living
Heart Smart Living

Cardiologist, author, and heart health expert Dr. Sarah Samaan offers advice on how to live a heart smart life.

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Atrial Fibrillation and What You Should Know About Blood Thinners

Atrial fibrillation is a heart rhythm disturbance that affects upwards of 2.6 million Americans. Although it’s more common after the age of 70, it can happen at any age. In atrial fibrillation the upper chambers of the heart, or atria, quiver erratically. This causes the ventricles, or lower pumping chambers of the heart, to contract irregularly and, in most cases, far more rapidly than normal. (For a detailed explanation of atrial fibrillation, check out the Heart Rhythm Society.)

While atrial fibrillation may cause fatigue and sometimes even congestive heart failure, the main risk the condition poses is stroke. That’s because the atria are not contracting normally, allowing blood to pool and form clots over time. The blood clots can then exit the heart and travel to the brain, cutting off vital blood supply. Overall, people with atrial fibrillation are two to seven times more likely to suffer from strokes. Many will suffer permanent disability or even death.

Not everyone with atrial fibrillation carries the same risk for blood clots and strokes. People at highest risk include those with congestive heart failure, hypertension, diabetes, cardiovascular disease, or a prior history of stroke. Women are more vulnerable than men, as are those over the age of 65. Your doctor should use a simple calculation (known as the CHADS2VASc score) to help determine your risk. This score is then used to decide who would benefit the most from blood thinning medication. Prescription blood thinners currently available include Coumadin (warfarin), Pradaxa, and Xarelto. If your score is very low, then aspirin may be the best choice.

This sounds quite simple, but the Alliance for Aging Research recently reported that only about half of physicians are familiar with the guidelines that address blood thinners and atrial fibrillation. As a result, only about half of all people with atrial fibrillation who should be on blood thinners are actually prescribed the drugs. This has prompted the Alliance to put together a consensus statement that helps physicians make well-informed decisions for treating their patients with atrial fibrillation.

Of course, while our aim is to prevent strokes, it’s also important to address the possibility that blood thinners may increase the risk of serious bleeding. Bleeding into the brain is the most potentially devastating complication. That’s why it’s critical that physicians and their patients go through the decision-making process together. With atrial fibrillation, as with so many other medical conditions, there is no one-size-fits-all approach.


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Tags: Heart Rhythm

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About the Author


Dr. Samaan is an acclaimed cardiologist, writer, and heart health educator.