Blood Thinners Recommended for AFib Patients

Anticoagulants recommended to atrial fibrillation patients to prevent stroke

(RxWiki News) People with atrial fibrillation, a common heart rhythm disorder, face a high likelihood of stroke. To reduce the risk, the American Academy of Neurology recommends taking anticoagulants.

Because the heart beats abnormally in those with atrial fibrillation, blood may pool in the atria (the two upper chambers of the heart). When blood pools, the risk of clotting goes up, which in turn increases stroke risk.

Oral anticoagulants are a type of blood thinning pill that fight clotting.

In a newly updated guideline, the American Academy of Neurology (the world’s largest association of neurologists and neuroscience professionals) urged individuals with nonvalvular atrial fibrillation (AFib) to take this type of medication, especially if they’ve already had a stroke.

"If you have AFib, discuss stroke prevention with your doctor."

Antonio Culebras, MD, of SUNY Upstate Medical University in Syracuse, NY and a Fellow of the American Academy of Neurology, served as lead author of the guideline, which was endorsed by the World Stroke Organization.

The guideline recommendations apply to patients with nonvalvular AFib, which is more common than valvular AFib. Decades ago, there were more cases of rheumatic disease, which caused a hardening and narrowing of the heart’s mitral valve (mitral stenosis). Mitral stenonsis often led to AFib.

Nonvalvular AFib is restricted to cases in which the rhythm disturbance happens in the absence of rheumatic mitral stenosis or a prosthetic heart valve.

Since the American Academy of Neurology’s last guideline on this topic was published in 1998, several new anticoagulant pills have been introduced. These new anticoagulant pills — such as dabigatran (brand name Pradaxa), rivaroxaban (brand name Xarelto) and apixaban (brand name Eliquis) — have performed at least as well as, if not better than, the established treatment of warfarin, according to the new guideline.

Dabigatran, rivaroxaban and apixaban are also are less likely to cause bleeding in the brain, and they do not demand frequent blood monitoring that warfarin (brand name Coumadin) requires, which is an added convenience of these therapies.

To make sure that warfarin is effectively preventing blood clots but not causing excessive bleeding, users must have their blood monitored monthly, weekly or sometimes daily, depending on the patient.

These newer anticoagulants were once thought to be unsafe to use by certain AFib patients. The updated guideline, however, says that they may be safe to use for people age 75 and older, those with dementia and individuals who have a low to moderate likelihood of falling.

"Of course, doctors will need to consider the individual patient's situation in making a decision whether or not to use anticoagulants, and which one to use, as the risks and benefits can vary for each person," said Dr. Culebras in a press release.

The guideline was published in the February 25 print issue of Neurology, the medical journal of the American Academy of Neurology.

Review Date: 
February 24, 2014