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

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Roy Salmon, Patient, A-Fib Free,
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Walter Kerwin, MD, Cedars-Sinai Medical Center, Los Angeles, CA

More Bad News for Warfarin: Older A-Fib Patients Risk Severe Brain Bleeds

Researchers looked at 31,951 veterans with A-Fib. All were over age 75 and newly taking warfarin. The study found that one in 50 of these veterans developed severe bleeding inside the skull.  The rate of traumatic intracranial bleeding in this group was higher than previously reported in clinical trials, researchers noted.

Dementia in particular doubled the risk of intracranial bleeding.

Comorbidities may be a factor: These patients often had other illnesses (comorbidities) such as hypertension 82.5%, coronary artery disease 42.6%, diabetes 33.8% and chronic obstructive pulmonary disease 25.5%. Many of these patients also had dementia and depression.

Dementia, in particular, doubled the risk of intracranial bleeding (possibly because cerebral amyloid angiopathy increases bleeding risk).

Rates of Ischemic Stroke vs. Brain Bleeds

There’s one bit of good news. While the rates of ischemic stroke and intracranial bleeding in this study were similar, not all intracranial bleeds were traumatic.

But there’s no good news if you have a low CHAD2DS2-VASc score (low score = low risk of stroke). Intracranial bleeding remained relatively constant over the range of CHAD2DS2-VASc scores. (For more, see The CHADS2 & CHA2DS-VASc Stroke-Risk Grading Systems.)

What Patients Need To Know: Possible Options

War farin (brand name Coumadin) at

Warfarin (brand name Coumadin)

Older patients with A-Fib are between a rock and a hard place. On one hand, if you take warfarin, you reduce your risk of an ischemic stroke. But on the other hand, if taking warfarin, you may get brain bleeds which can kill you or cause dementia.

While we don’t have a guaranteed method of preventing A-Fib-related strokes, here are two options to avoid a lifetime of taking warfarin (or another anticoagulant).

• Close off your Left Atrial Appendage (LAA). This is the origin of 90%-95% of ischemic clots. LAA closure is a recognized alternative to having to take anticoagulants. Some say it’s an improvement rather than an alternative to anticoagulants.

• Have a catheter ablation to stop your A-Fib. If you no longer have A-Fib, you can no longer have an A-Fib-related stroke. Your stroke risk drops down to that of someone without A-Fib. (But, of course, people without A-Fib also have strokes.)

Warning: Anticoagulation is No Guarantee Against Stroke

Warning - cautionBe advised that warfarin greatly reduces but doesn’t totally eliminate stroke risk in A-Fib.

On a personal note, a close friend of ours with A-Fib was in the correct range of her INR testing (2.5) when she had a massive ischemic stroke that paralyzed her left side.

It breaks our hearts when we visit and have dinner with her to see food dripping from the left side of her mouth. But happily, her thinking and communication skills are still good.

For additional readings, see Watchman Better Than Warfarin and Anticoagulants Increase Hemorrhagic Stroke Risk.

Resource for this article
Dodson, JA et al. Incidence and Determinants of Traumatic Intracranial Bleeding Among Older Veterans Receiving Warfarin for Atrial Fibrillation. JAMA Cardiol. 2016 Apr 1; 1(1): 65-72. doi: 10.1001/jamacardio.2015.0345.

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