I am 62, male with AF. Are there new anticoagulants?

Hi,

Welcome to icliniq.com.

I completely understand your concern.

Atrial fibrillation is a heart rhythm problem in which the upper chambers of the heart are producing an irregular, fast heart rate that can produce a variety of symptoms, including palpitations, shortness of breath, fatigue, and anxiety.

As the upper chambers of the heart are not contracting in atrial fibrillation, there is blood stasis or pooling leading to the formation of a blood clot. This clot may dislodge and cause a stroke by obstructing a blood vessel supplying the brain. The clot can also travel to the limbs and may cause limb ischemia.

Causes of worsening heart rate control in atrial fibrillation include timely management of infections, avoiding dehydration, limiting caffeine and alcohol intake, managing stress, and ensuring proper and adequate sleep. If these are properly taken care of, then the heart rate will be in an ideal range, and there will be less variation.

Depending upon the cause, atrial fibrillation can be paroxysmal (can come and go) and may be permanent. In any case, it would need medical management, including blood thinners.

After diagnosing atrial fibrillation, the need for anticoagulation (blood thinners) is determined after assessing the risk of thromboembolic events and bleeding. A final decision is based on the risk-versus-benefit ratio. The healthcare provider will use different scores to calculate your risk.

If the CHA2DS2-VASc (Congestive heart failure, Hypertension, Age, Diabetes, Stroke, Vascular disease, Age 65-74, and Sex category female) score is more than 2, blood thinners are strongly recommended. The physician must also have calculated the bleeding risk.

One of the scores used to calculate bleeding risk is the HAS-BLED score (Hypertension, Abnormal kidney or liver function, Stroke history, Bleeding history, Labile international normalized ratio (INR), Elderly, and Drugs or Alcohol use); if this score is high, physicians typically have a detailed discussion with the patient.

If your risk of bleeding is low, anticoagulation is considered safe. In case of trauma, bleeding can be massive compared to the normal population, and in such cases, the treating physician uses measures that reverse the effect of anticoagulation.

Newer oral anticoagulants are safer in terms of bleeding profile as compared to Warfarin and do not require regular monitoring.

Please remember that atrial fibrillation often has a secondary cause, including hypertension, ischemia, structural heart diseases, thyroid disorders, and electrolyte imbalances. Therefore, it is important to identify and treat the underlying cause to prevent and manage atrial fibrillation. The main pillars of treatment include heart rate control, rhythm control, anticoagulation as needed, treating the underlying cause, and, if necessary, intervention such as ablation might be needed.

Rhythm is reverted to normal sinus rhythm with the help of anti-arrhythmic medications first, and if unsuccessful or unstable, by delivering a shock, in which the patient is given sedation and paddles are placed over the chest, and a small shock is delivered. This is a very safe procedure if proper precautions are taken previously.

Surgeons sometimes perform a maze procedure to treat atrial fibrillation, and an electrophysiologist can conduct an electrophysiology study by placing different electrodes inside the heart through a peripheral vein, locating the foci of atrial fibrillation, and ablating them. These procedures are also being used very successfully now.

I hope my answer is clear to you, and if you need any details at any time, I am here and at your service.

Thank you.