Can my wife still get a stroke with AF on blood thinners?

Hello,

Welcome to icliniq.com.

I understand your concern.

Atrial fibrillation is a rhythm disorder in which the heart's upper chambers produce an irregular, fast heart rate. This can cause various symptoms, including:

• Palpitations.

• Shortness of breath.

• Fatigue.

• Anxiety.

Because the upper chambers of the heart are not contracting properly, blood can pool, leading to the formation of blood clots. A clot may dislodge and travel to the brain, causing a stroke, or to the limbs, causing limb ischemia.

The need for anticoagulation (blood thinners) is determined by assessing your risk of both thromboembolic events (clots) and bleeding. Your healthcare provider will use different scoring systems to calculate your risk-versus-benefit ratio before making a final decision. If your CHA2DS2-VASc score is 3, your risk of developing blood clots and having a stroke is considered very high, according to the latest international guidelines.

Your physician will also calculate your bleeding risk, often using a HAS-BLED score. If this score is high, a detailed discussion with the patient is typically held. If your bleeding risk is low, anticoagulation is considered safe. Being on an anticoagulant significantly lowers the risk of stroke compared to not taking one.

Regarding irregular INR (international normalized ratio) values and heavy menstrual bleeding, I suggest you speak with your physician in person. However, if the atrial fibrillation is non-valvular, a class of drugs called DOACs (direct oral anticoagulants) can be prescribed. These are safer in terms of bleeding risk and do not require INR monitoring.

For valvular atrial fibrillation, such as with rheumatic moderate to severe mitral stenosis, anticoagulation with Warfarin is recommended regardless of the CHA2DS2-VASc score. Remember that atrial fibrillation often has an underlying cause, including:

• Hypertension.

• Ischemia.

• Structural heart diseases.

• Electrolyte imbalances.

It is crucial to identify and treat the underlying cause to prevent and manage the condition. Thyroid medications may trigger atrial fibrillation if the dosage is too high, which would be indicated by a very low thyroid-stimulating hormone (TSH) level. I advise talking to an endocrinologist about adjusting your dosage based on your TSH levels.

The primary pillars of treatment include:

• Heart rate control.

• Rhythm control.

• Anticoagulation.

• Treating the underlying cause.

• Intervention, such as ablation, if necessary.

Rhythm is first reverted to a normal sinus rhythm with anti-arrhythmic medications. If this is unsuccessful or the patient is unstable, an electrical shock may be delivered after sedation. This is a very safe procedure when proper precautions are taken. Surgeons can also perform a maze procedure, and an electrophysiologist can conduct an electrophysiology study to locate and ablate the source of the atrial fibrillation. These procedures are now being used with great success.

Depending on the cause, ablation may be effective in certain cases, while in others, the condition may recur from a different source. Even if the ablation is successful, you will likely still need beta-blockers and blood thinners.

Once your heart rate and rhythm are under control, it is safe to exercise. However, you should avoid intense activities that could lead to severe trauma. Dietary changes are not a primary treatment for atrial fibrillation; a general heart-healthy diet is advised.

I hope you are satisfied with my answer. For further queries, you can consult me at iCliniq.

Thank you.