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Doctors & patients are saying about 'Beat Your A-Fib'...


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"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...."

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ischemic stroke

A-Fib Produces More Ischemic Strokes, Despite Improvements in Stroke Prevention

A good friend of ours with A-Fib recently had a crippling ischemic stroke, even though her INR on Coumadin was 2.5, right in the middle of the desired range. Her left side is paralyzed. It’s heartbreaking to eat dinner with her and watch food dribble from the side of her mouth.  She’s getting good care and physical therapy, but she will probably never recover fully.

A-Fib Ischemic Stroke All Too Common

A recent retrospective study of more than 930,000 stroke patients found that 20% of acute ischemic stroke patients had A-Fib in 2014, up from 16% in 2003.

CT brain with Ischemic stroke at A-Fib.com

CT brain with Ischemic stroke

And despite recent improvements in stroke treatment outcomes (and stroke prevention), the negative effect of A-Fib was pretty much the same over the 12-year period of the study. Nearly 10% of A-Fib stroke patients died (“mortality”), compared to about 6% for patients without A-Fib.

According to co-author Dr. Mohamad Alkhouli of West Virginia University in Morgantown,

…the prevalence of A-Fib among patients admitted with acute ischemic stroke is rising, especially among white and elderly patients.

A-Fib stroke patients in this study were older (82 versus 70 years), more likely to be female (59.3% versus 51.8%, and Caucasian (80.6% versus 67.3%). (Females on average live about 5 years longer than males. Increased stroke probably relates to the fact that females live longer than males rather than female gender. See Being a Woman Not a Risk Factor for Stroke)

A-Fib Ischemic Stroke Worse Than “Normal” Stroke

The authors found that A-Fib patients were more likely to receive thrombolytic therapy. But even so, they showed worse outcomes, with 9.9% dying versus 6.1% of the non-A-Fib patients. And the A-Fib group had a higher rate of acute kidney injury, bleeding, infectious complications, and severe disability. They had longer hospital stays, higher costs of care, and more non-home discharges.

Danger of Hemorrhagic Stroke

This study didn’t investigate hemorrhagic stroke which is more likely to happen with increased age. 99% of people over age 65 have microbleeds in the brain. Taking anticoagulants to decrease the risk of an ischemic stroke can turn these microbleeds into full hemorrhagic strokes. Older A-Fib patients are between a rock and a hard place. See Anticoagulants Risky over Age 65.

Don’t Just Live With Your A-Fib

Living with A-Fib, especially as you get older, is often a death sentence. Don’t settle for a life on meds. Seek your cure!

Resources for this Article
Alkhouli M, et al “Burden of atrial fibrillation associated ischemic stroke in the United States” JACC Clin Electrophys 2018; DOI: 10.1016/j.jacep.2018.02.021.

George, Judy. Afib Found in Growing Proportion of Strokes―And despite improved stroke care, worse outcomes persist in Afib. Medpage Today. May 2, 2018. https://www.medpagetoday.com/neurology/strokes/72659

VIDEO: Hearing it from Dr Brain—Protecting Yourself Against A-Fib Stroke

A light-hearted, more “entertaining” approach (perhaps for younger family members) featuring two animated characters, Dr. Brain and the Heart.

Introduction to the structure and functions of the heart; the risks and symptoms of Atrial Fibrillation; danger of clot formation and ischemic stroke; and use of anticoagulants to protect yourself against stroke. ( 4:53 min.)

Produced by Boehringer Ingelheim [manufacturer of the newer anticoagulants].

YouTube video playback controls: When watching this video, you have several playback options. The following controls are located in the lower right portion of the frame: Turn on closed captions, Settings (speed/quality), Watch on YouTube website, and Enlarge video to full frame. Click an icon to select.

If you find any errors on this page, email us. Y Last updated: Monday, January 15, 2018

Return to Instructional A-Fib Videos and Animations

More About Stroke and Dementia…Link to Artificial Sweeteners

It’s commonly assumed that both sugarsweetened and artificially-sweetened soft drinks have been linked to cardiometabolic risk factors, which increase the risk of cerebrovascular disease and dementia.

But results from the well-known Framingham Heart Study Offspring indicate otherwise.

Researchers studied 2,888 participants over 45 years old for incidents of stroke, and 1484 participants over 60 years old for incidents of dementia. Adjustments were made for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity, and smoking.

A-Fib, Stroke Risk and Dementia at A-Fib.com

A-Fib, Stroke Risk and Dementia

Risks of Ischemic Stroke, All-Cause Dementia

Researchers found that higher recent-intake and higher cumulative-intake of artificially sweetened soft drinks “were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s disease dementia.”

But results were not the same for sugar! Sugar-sweetened beverages were not associated with a higher risk of stroke and dementia.

What Patients Need To Know

The bad news: For those of us worried about an A-Fib stroke and dementia, we need to avoid artificially-sweetened beverages.

The (somewhat) good news: The same warning doesn’t seem to apply to sugar-sweetened beverages. (This doesn’t necessarily mean that sugary drinks are healthy or good for you.)

For more about Dementia: see A-Fib and Dementia: My Top 5 Articles.

Reference for this Article
Pase, MP et al. Sugar- and Artificially Sweetened Beverages and the Risks of Incident Stroke and Dementia: A Prospective Cohort Study. Stroke/American Heart Association, 2017. STROKEAHA. 116.016027, April 20, 2017. http://stroke.ahajournals.org/content/early/2017/04/20/STROKEAHA.116.016027

FAQs A-Fib Treatments: Medicines and Drug Therapies

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

Drug Therapies for Atrial Fibrillation

Atrial Fibrillation patients often search for unbiased information and guidance about medicines and drug therapy treatments. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)

1. “I have a heart condition. Which medications are best to control my Atrial Fibrillation?” What medications work best for me?“

2. HRT: “Do you have information about Hormone Replacement Therapy (HRT) and if it might help or hinder my atrial fibrillation?”

3. Rate Control Drug: “I take atenolol, a beta-blocker. Will it stop my A-Fib.”

4. Antibiotics: “Which antibiotics are less liable to cause an A-Fib attack? How is Clindamycin for dental work? In the past I reacted to Azithromycin and Advil.”

Antiarrhythmic Drugs

1. “Is the “Pill-In-The-Pocket” treatment a cure for A-Fib? When should it be used?” (“Pill-In-The-Pocket” makes use of an antiarrhythmic drug such as flecainide)

2. I’ve been on amiodarone for over a year. It works for me and keeps me out of A-Fib. But I’m worried about the toxic side effects. What should I do?”

3. “Is the antiarrhythmic drug Multaq [dronedarone] safer than taking amiodarone? How does it compare to other antiarrhythmic drugs?”

4. “My doctor told me about the Tikosyn drug option that I want to consider in getting rid of my 5-month-old persistent A-Fib. That seems like something that should be discussed on your web site.”

Blood Thinners/Anticoagulants

Note: August 2015 Update: Aspirin is no longer recommended as first-line therapy to prevent A-Fib stroke.

1. “Are anticoagulants and blood thinners the same thing? How do they thin the blood?

2. Should everyone who has A-Fib be on a blood thinner like warfarin (brand name: Coumadin)?”

3. For A-Fib patients, which is the better to prevent A-Fib-related stroke—warfarin (Coumadin), a NOAC or aspirin?”

4. “I am on Coumadin (warfarin). Do I now need to avoid foods with Vitamin K which would interfere with its blood thinning effects?”

5. Are natural blood thinners for blood clot treatment as good as prescription blood thinners like warfarin?”

6. “I’m worried about having to take the blood thinner warfarin. If I cut myself, do I risk bleeding to death?“

7. “I”ve read about a new anticoagulant, edoxaban (brand names: Lixiana, Savaysa) as an alternative to warfarin (Coumadin). For A-Fib patients, how does it compare to warfarin? Should I consider edoxaban instead of the other NOACs?”

Related question: My new cardiologist wants me to switch from Pradaxa to Eliquis. if bleeding occurs, is Eliquis safer, easier to deal with?

Related question: My heart doctor wants me to take Xarelto. I am concerned about the side effects which can involve death. What else can I do?”

Post-Procedure

1. I’ve had a successful catheter ablation and am no longer in A-Fib. But my doctor says I need to be on a blood thinner. I’ve been told that, even after a successful catheter ablation, I could still have “silent” A-Fib—A-Fib episodes that I’m not aware of. Is there anything I can do to get off of blood thinners?“

2. “I just had an Electrical Cardioversion. My doctor wants me to stay on Coumadin for at least one month. Why is that required? They mentioned something about a “stunned atrium.” What is that?“

A-Fib Stroke Risk

1. “What are my chances of getting an A-Fib stroke?

2. “The A-Fib.com web site claims that an A-Fib stroke is often worse than other causes of stroke. Why is that? If a clot causes a stroke, what difference does it make if it comes from A-Fib or other causes? Isn’t the damage the same?“

3. “How long do I have to be in A-Fib before I develop a clot and have a stroke?

4. “Is there a way to get off blood thinners all together? I hate taking Coumadin. I know I’m at risk of an A-Fib stroke.”

5. “I’ve heard of people with A-Fib on anticoagulants who still had a stroke. What can I do to make sure I never have a stroke?

If you find any errors on this page, email us. Y Last updated: Wednesday, June 20, 2018
Return to Frequently Asked Questions

Blizzard of 2016 Increases Risk of A-Fib Stroke

We’ve all heard of someone dropping dead from a heart attack while shoveling snow. But along with record snowfall and subfreezing temperatures comes a warning for those with Atrial Fibrillation. Winter increases stroke risk in people with A-Fib.

Winter and increased risk of stoke at A-Fib.com

Winter: increased stroke risk

Do You Live in a Cold Climate?

In a study from Taiwan, nearly 300,000 people with new-onset A-Fib were followed for eleven years. Almost 35,000 suffered an ischemic (A-Fib) stroke.

The risk for an ischemic stroke was nearly 20% higher in winter than in summer.

“When the average temperature was below 68⁰ F (20⁰C), the risk of ischemic stroke significantly increased compared to days with an average temperature of 86⁰F (30⁰C).”

Why More Ischemic Strokes During Winter?

Cold weather may make blood more prone to coagulate.

Cooler temperatures may produce greater plasm fibrinogen levels and factor VII clotting activity and may lead to “increased coagulability and plasma viscosity,” according to the author of this study, Dr. Tze-Fan Chao. 

Ischemic stroke was nearly 20% higher in winter than in summer.

What Patients Need To Know

The cold temperatures can put you more at risk for an A-Fib (Ischemic) stroke. So act accordingly. Bundle up during winter. Keep the thermostat set to keep you warm enough.
If you’re on a blood thinner, discuss this research with your doctor. You need to keep your anticoagulant levels up during winter.
References for this article
Chao, Tze-Fan. Cold weather linked to increased stroke risk in atrial fibrillation patients. European Society of Cardiology Congress News Release, August 26, 2015 17:21. http://www.alphagalileo.org/ViewItem.aspx?ItemId=155774&CultureCode=en

Archive: FAQs A-Fib Treatments: Medicines and Drug Therapies

FAQs A-Fib Treatments: Medicines and Drug Therapies

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

Drug Therapies for Atrial Fibrillation

Atrial Fibrillation patients often search for unbiased information and guidance about medicines and drug therapy treatments. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)

1. Which medications are best to control my Atrial Fibrillation?” “I have a heart condition. What medications work best for me?

2. “Is the “Pill-In-The-Pocket” treatment a cure for A-Fib? When should it be used?”

3. “I take atenolol, a beta-blocker. Will it stop my A-Fib.”

4. I’ve been on amiodarone for over a year. It works for me and keeps me out of A-Fib. But I’m worried about the toxic side effects. What should I do?”

5. Should everyone who has A-Fib be on a blood thinner like warfarin (Coumadin)?”

6. Which is the better anticoagulant to prevent stroke—warfarin (Coumadin) or aspirin?

7. What’s the difference between warfarin and Coumadin?

8. I’m on warfarin. Can I also take aspirin, since it works differently than warfarin? Wouldn’t that give me more protection from an A-Fib (ischemic) stroke?

9. “What are my chances of getting an A-Fib stroke?

10. “I’m worried about having to take the blood thinner warfarin (brand name Coumadin). If I cut myself, do I risk bleeding to death?

11. “I am on Coumadin (warfarin) to thin my blood and prevent A-Fib blood clots. Do I now need to avoid foods with Vitamin K which would interfere with the blood thinning effects of Coumadin?” UPDATED

12. “The A-Fib.com web site claims that an A-Fib stroke is often worse than other causes of stroke. Why is that? If a clot causes a stroke, what difference does it make if it comes from A-Fib or other causes? Isn’t the damage the same?

13. “I just had an Electrical Cardioversion. My doctor wants me to stay on Coumadin for at least one month. Why is that required? They mentioned something about a “stunned atrium.” What is that?

14. Are natural blood thinners for blood clot treatment as good as prescription blood thinners like warfarin?”

15. “How long do I have to be in A-Fib before I develop a clot and have a stroke?

16. I have to be on aspirin for stroke prevention. Which is better—the low-dose baby aspirin (81 mg) or a high dose (325 mg)? Should I take the immediate-release (uncoated) or the enteric-coated aspirin?

17. I don’t want to be on blood thinners for the rest of my life. I’ve had a successful catheter ablation and am no longer in A-Fib. But my doctor says I need to be on a blood thinner. I’ve been told that, even after a successful catheter ablation, I could still have “silent” A-Fib—A-Fib episodes that I’m not aware of.  Is there anything I can do to get off of blood thinners?

18. “My last cardiologist had me on Pradaxa. My new cardiologist wants me to switch to Eliquis. Is Eliquis easier to deal with if bleeding occurs?

19. “My doctor told me about the Tikosyn drug option that I want to consider in getting rid of my 5-month-old persistent A-Fib. That seems like something that should be discussed on your web site.

20. “I hate taking Coumadin. Is there a way to get off blood thinners all together? I know I’m at risk of an A-Fib stroke.”

21. “I”ve read about a new anticoagulant, edoxaban, as an alternative to warfarin (Coumadin) for reducing risk of stroke. For A-Fib patients, how does it compare to warfarin? Should I consider edoxaban instead of the other NOACs?

22. “Do you have information about Hormone Replacement Therapy (HRT) and if it might help or hinder my atrial fibrillation?

23. Are Anticoagulants and blood thinners the same thing? How do they thin the blood?

24. I have A-Fib, and my heart doctor wants me to take Xarelto 15 mg. I am concerned about the side effects which can involve death. What else can I do?

25. “Is the antiarrhythmic drug Multaq [dronedarone] safer than taking amiodarone? How does it compare to other antiarrhythmic drugs?”

Last updated: Saturday, February 11, 2017

Back to FAQs by Patients with Atrial Fibrillation

ATRIA Research Findings: Anticoagulants for Stroke Prevention in A-Fib Patients

A-Fib & Risk of Stroke

A-Fib & Risk of Stroke

ATRIA Findings: Anticoagulants for Stroke Prevention Versus Risk of Intracranial Hemorrhage

By Steve S. Ryan, PhD

Anticoagulants are prescribed for Atrial Fibrillation patients to reduce the risk of clots and stroke. But anticoagulants can also increase the risk of intracranial hemorrhage. So, who benefits and who may be harmed?

The “AnTicoagulation and Risk Factors in Atrial Fibrillation” Study (ATRIA) has contributed significantly to better understanding which A-Fib patients will benefit most from anticoagulant therapy.

A-Fib and Stroke Risk

As a consequence of atrial fibrillation, the pooling of blood in the atrial chambers of the heart significantly increases the risk of formation of blood clots. If a piece of a blood clot breaks off and travels to the brain it can occlude (block) a blood vessel and prevent blood from reaching the affected area of the brain. This condition is known as an ischemic stroke and can cause severe disability including the inability to walk or talk.

Ischemic Stroke Versus Intracranial Hemorrhage

In order to reduce the risk of ischemic stroke in people with atrial fibrillation, anticoagulant (blood thinner) medications are often prescribed. The most commonly used blood thinner is warfarin (Coumadin) although aspirin may also sometimes be used. While blood thinners can prevent ischemic stroke in people with atrial fibrillation, paradoxically, they can also cause bleeding into the brain, a condition known as intracranial hemorrhage.

Unfortunately, doctors don’t have a fool-proof method of determining which patients with atrial fibrillation will benefit from blood thinners (prevention of ischemic stroke) and which patients may be harmed by blood thinners (cause an intracranial hemorrhage).

Clearly, more research is necessary to more accurately identify those patients who would benefit the most from taking blood thinners as opposed to those who are more likely to be harmed by taking blood thinners.

The “AnTicoagulation and Risk Factors in Atrial Fibrillation” Study (ATRIA)

The “AnTicoagulation and Risk Factors in Atrial Fibrillation” Study (ATRIA) published in 2009, by a collaborative group of researchers from the Massachusetts General Hospital, the University of California at San Francisco, and Kaiser Permanente of Northern California, has contributed significantly to better understanding which patients with atrial fibrillation would benefit most from receiving anticoagulants for stroke prevention.

The study population consisted of 13,559 people with atrial fibrillation with a median age of 73 years. Twenty (20) percent of the subjects had no major risk factors for ischemic stroke. The major risk factors for ischemic stroke include older age (75 years or older), previous history of stroke, diabetes, hypertension, and congestive heart failure. This stroke-risk classification system is known as the CHADS2 grading system and is used by doctors as a basis for classifying patients with atrial fibrillation into stroke risk categories (low, intermediate, or high).

The researchers followed the clinical course of these 13,559 patients for a median of 6 years. At the time of enrollment into the study, 53% of the subjects were receiving warfarin (Coumadin) as prophylaxis for stroke prevention. During the follow-up period, the researchers identified a total of 1,092 thromboembolic events (occlusion of a blood vessel by a blood clot) among the study subjects, the overwhelming majority of which (1,017 cases or 93%) were ischemic strokes. Of the patients who experienced a thromboembolic event, 37% were receiving warfarin and 63% were not receiving warfarin.

The researchers also identified 299 patients among the study cohort who experienced an intracranial hemorrhage, of which 193 patients (65%) were receiving warfarin.

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ATRIA Study Key Findings

The major findings of the study can be summarized as follows:

• The greatest benefit of anticoagulation therapy for the prevention of ischemic stroke was observed among patients with a history of ischemic stroke and those in the highest stroke risk category as determined by the CHADS2 stroke-risk grading system.

• In general, the net benefit of receiving warfarin anticoagulation therapy increased with advancing age. Patients with atrial fibrillation in the oldest age group (85 years of age or older) derived more benefit from warfarin prophylaxis than patients in the 75 to 84 year age group, although the benefits of warfarin prophylaxis was apparent in this age group as well.

• This finding strongly suggests that elderly people with atrial fibrillation who are not taking warfarin are at increased risk for ischemic stroke, however, adding warfarin for prevention of ischemic stroke in elderly people does not significantly increase the risk of intracranial hemorrhage.

• Younger people with atrial fibrillation (64 years or younger) who are considered at low risk for developing an ischemic stoke as measured by the CHADS2 stroke-risk grading system, appear to derive little benefit from warfarin prophylaxis and, indeed, adding warfarin may do more harm (intracranial hemorrhage) than good (prevention of ischemic stroke).

Who Will Benefit, Who May Be Harmed

In summary, this study has contributed significantly to more clearly identifying which patients with atrial fibrillation will derive the most benefit from warfarin anticoagulation therapy and which patients may be harmed by this treatment.

If you have atrial fibrillation, talk to your doctor about the risks and benefits of taking blood thinner medications. In general, older people and those at highest risk for ischemic stroke as determined by the CHADS2 stroke-risk grading system will gain the most from anticoagulation therapy.

Blood thinners, however, may not be advantageous and may cause more harm than good in younger patients with atrial fibrillation who are considered to be at low risk for developing an ischemic stroke.

Reference for this Article
Singer, DE, et al. The Net Clinical Benefit of Warfarin Anticoagulation in Atrial Fibrillation, Annals of Internal Medicine, 2009 Vol 151, 5 pp297-305. Last accessed Jan 10, 2013 URL: http://www.ncbi.nlm.nih.gov/pmc/articles/pmc2777526/

Posted January 2013

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Return to Index of Articles: Drug Therapies (Medicines)

Last updated: Sunday, February 15, 2015

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