"This book is incredibly complete and easy-to-understand for anybody. I certainly recommend it for patients who want to know more about atrial fibrillation than what they will learn from doctors...."

Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

"If you want to do some research on AF go to A-Fib.com by Steve Ryan, this site was a big help to me, and helped me be free of AF."

Roy Salmon Patient, A-Fib Free; pacemakerclub.com, Sept. 2013

How to Avoid the Bleeding Risk of Anticoagulants

Taking almost any prescription medication has trade-offs.

In the case of anticoagulants, on the one hand you get protection from having an A-Fib stroke (which often leads to death or severe disability), but on the other hand you have an increased risk of bleeding. That’s how they work. Therefore blood thinners are inherently dangerous. “Oral anticoagulants are high-risk medications” as stated by Drs. Witt and Hanseen of the University of Utah College of Pharmacy.

As an A-Fib patient, whether or not to be on anticoagulant or not, and which one, is one of the most difficult decisions you and your doctor must make.

Your Risk of Life-Long Anticoagulation Therapy

With the 2014 Guidelines for Management of Patients with Atrial Fibrillation, came significant changes to the rating scale doctors use to assess your risk of stroke. The guidelines call for many more people to be on a lifetime of anticoagulant therapy.

An anticoagulant should not be prescribed as a precaution, but only when a significant risk of stroke exists.

But taking an anticoagulant isn’t like taking a daily vitamin. An anticoagulant should not be prescribed as a precaution, but only when a significant risk of stroke exists.

Long term, we know the blood thinner warfarin (Coumadin) is associated with microbleeds, hemorrhagic stroke, and developing early dementia. What about the newer NOACs? There’s little long-term risk data, but we expect similar long-term risks.

Was 10 years of Anticoagulant Use the Cause of this Patient’s Dementia?

Dr. John Day, in an editorial in The Journal of Innovations in Cardiac Rhythm Management, described his patient, Bob, who had been on anticoagulation therapy for 10 years (even though he had had a successful catheter ablation and was A-Fib free).

“Could the drug therapy be the cause of this case of dementia? – Dr. John Day”

Bob was suffering from early dementia. A cranial MRI revealed many cerebral microbleeds (probably from taking anticoagulants for years). Both antiplatelet and anticoagulant therapy significantly increase the risk of cerebral microbleeds which are associated with dementia. These microbleeds are usually permanent and irreversible.

Dr. Day asked, “Could it be that this was an iatrogenic [caused by a doctor’s activity or therapy] case of dementia? Was his 10 years of anticoagulant use for atrial fibrillation the cause of his dementia?”

Safer, Healthier Alternatives to Anticoagulants

If you are facing a lifetime of anticoagulant therapy―you should be very concerned about the associated risks. But don’t worry. You do have alternatives.

#1 Alternative: Consider non-prescription blood thinners

Ask about your CHA2DS2-VASc score (a stroke risk assessor). If your score is a 1 or 2 (out of 10), ask if you could take a non-prescription approach.10 Red Vert - Become yoour own best patient advocate 600 x 1100 pix at 300 res

Perhaps you can benefit from an increase in natural blood thinners such as turmeric, ginger and vitamin E or especially the supplement Nattokinase.

#2 Alternative: Get rid of your A-Fib.

As EP and prolific blogger Dr. John Mandrola wrote: “…if there is no A-Fib, there is no benefit from anticoagulation.”

Action: Request a catheter ablation procedure. Today, you can have an ablation immediately (called ‘first-line therapy’). You don’t have to waste a year on failed drug therapies.

#3 Alternative: Close off your Left Atrial Appendage (LAA).

The Left Atrial Appendage is where 90%-95% of A-Fib clots originate.

Action: Request a Watchman device. The Watchman device is inserted to close off your LAA and keep clots from entering your blood stream.

What Patients on Anticoagulants Need to Know

Most EPs are well aware of the risks of life-long anticoagulation. Never-the-less, you can expect your EP to insist adamantly that you be on life-long anticoagulation.

What you can do: Start a dialog with your doctor about the associated risks of taking anticoagulants: cerebral microbleeds, the greater risk of hemorrhagic stroke, and developing early dementia.

Talk about alternatives to anticoagulants:

• Non-prescription blood thinners
• Catheter ablation
• LAA closure (Watchman device)

Remember: You must be your own best patient advocate. Don’t settle for a lifetime on anticoagulants or blood thinners.

Further reading: see my articles: Risks of Life-Long Anticoagulation., Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients, and Watchman Better Than Lifetime on Warfarin

References for this article

Witt, Daniel W. and Hansen, Alisyn L. editorial in New Oral Anticoagulants Can Require Careful Dosing Too. by Scott Baltic. Medscape/Reuters Health Information, December 29, 2016. http://www.medscape.com/viewarticle/873821?src=wnl_edit_tpal

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