Monday, July 01, 2013

How To Treat Atrial Fibrillation Induced Stroke?

Being an irregular heartbeat, atrial fibrillation (AF) is the commonest heart rhythm problems in cardiological clinical practice. People with AF will have abnormal beat of the upper chambers of the heart, causing stagnation of blood in the left upper chamber. Clots can then be formed and be carried in the bloodstream to the brain. The consequence is a large area of brain is damaged and permanent disability and even dead could be resulted. More importantly, an AF-induced stroke can be recurrent.

About 1 percent of the population has AF, which is the cause for 1 in 5 stroke cases. The chance for octogenarians to get an AF is 15 percent. Congestive heart failure, diabetes, high blood pressure, valve disease, coronary artery disease are some other conditions associated with AF.

While some people with AF can have symptoms such as heart palpitations, shortness of breath and tiredness, some might not feel anything at all. Taking appropriate anticoagulation drugs to prevent blood clots can actually reduce AF-induced stroke by 60 percent.

It is not recommended to prescribe anticoagulation drugs like Warfarin to patients who are not aware that they have AF, and do not have at least one of the risk factors like advanced age, hypertension, diabetes, prior history of stroke, and presence of heart failure. This is to avoid possible bleeding risk and side effects.

Fortunately, new drugs like Rivaroxaban (brand name Xarelto) have been proven to be easier to use and more effective than Warfarin. In fact, Rivaroxaban is a single fixed dosage that does not require monitoring.

In Germany, about 45 percent of the elderly with AF are not prescribed with blood thinners in fear of bleeding risk. But with Rivaroxaban, the risk of fatal bleeding is cut by 50 percent and the risk of intracranial bleeding is reduced by 35 percent. It is also 20 percent better than Warfarin in lowering stroke and systemic embolism.

But in reality, the biggest problem in preventing AF-related stroke is detecting AF itself. Many patients have no syndromes hence they do not even get diagnosed by ECG (electrocardiogram) that can detect AF for people having AF symptoms.

Meanwhile, there is a so-called temporary and transient AF, which can come and go, yet carry the same stroke risk. Unfortunately, doctors would only prescribe a blood thinner to patients who are confirmed by an ECG that they have an irregular heartbeat, and it is not a usual practice for patients to take ECGs on a regular basis just to detect AF.

AF is a tricky disease that carries a high stroke risk. But it is now possible, with the help of new drugs like Rivaroxaban that is effective and safe to take, to substantially reduce the stroke risks linked to AF.

1 comment:

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