Understanding Atrial Fibrillation and Stroke Risk A Program for Patients & Caregivers Prepared by Prashanth Katrapati, MD, FACC Last reviewed: September 2017

Today’s Program Stroke and Atrial Fibrillation How do I know if I am at risk? Blood thinners: What are my options? Are there side effects? How much will this cost me? What to expect over time

Why is there a risk of stroke with atrial fibrillation?

Stroke and AFib Atrial fibrillation (AFib) is an irregular heartbeat in the 2 top chambers of the heart This irregular beat leads to a sluggish flow of blood through the heart, specifically the atria (top chambers) Slow flow of blood can lead to clots, which can travel to other organs When clot travels to brain, it can cause a stroke About 15%-20% of strokes may be due to AFib

What is a Stroke?

Stroke: A Big Deal AFib raises your risk of stroke nearly 5x Many of these strokes can be severe causing significant disability, including difficulty with speech, movement and may even lead to death Many of these strokes can be prevented with early detection and treatment with blood thinners

Symptoms of Stroke

How Do I Know if I Am at Risk? CHA2DS2-VASc is a formula to calculate your risk of stroke. Each risk factor is assigned 1 or 2 points: POINTS Congestive heart failure 1 High blood pressure 1 A2 – Age 75 and older 2 Diabetes (type 2) 1 Stroke or mini-stroke 2 Vascular disease (prior heart attack, peripheral artery disease) 1 Age – 65 to 74 years of age 1 Sc – female sex 1 Total score: 0 = low risk; 1 = low-moderate; 2+ = high

Blood Thinners Warfarin is the most common blood thinner This medication is in the form of a pill It works by blocking your body’s ability to create some (not all) essential clotting factors This medicine is sometimes referred to as “rat poison,” but the current pill form is not at all associated with any poisonous substances It requires frequent blood tests to help monitor its levels and ensure that it is working well The cost is usually low, but there are some dietary restrictions

Blood Thinners Newer blood thinners include: Eliquis (Generic name: Apixiban) Pradaxa (Generic name: Dabigatran) Savaysa (Generic name: Edoxaban) Xarelto (Generic name: Rivaroxaban) These newer agents also block some essential clotting factors, but do so in a more specific manner

Blood Thinners Advantages of newer blood thinners: Less risk of bleeding in the brain with similar or better prevention of stroke No need for routine monitoring with frequent blood tests Disadvantages Increased cost compared to warfarin Not approved for use in patients who have an artificial (metal) heart valve More difficult to stop/reverse the effect of the drug during life-threatening bleeding

Blood Thinners: Double-Edged Sword Although blood thinners help prevent stroke, they also increase an individual’s risk of bleeding 

Blood Thinners: Double-Edged Sword HAS-BLED is a formula to assess your risk of bleeding. Each risk factor is assigned 1 or 2 points: POINTS High blood pressure 1 Liver or kidney disease 1 or 2 Prior stroke 1 Advanced age 1 Unstable or high INR (measures blood level) 1 Heavy drug or alcohol use 1 or 2 Talk with your doctor about your risk of stroke and bleeding

Blood Thinners: Side Effects Some patients may experience minor side effects such as: Bruising Increased nose bleeds Increased bleeding while shaving Major side effects include Significant bleeding from the colon or esophagus Bleeding into the brain

How Much Will This Cost? For most patients with commercial insurance, blood thinners may be free or up to about $100 per month (depending on your plan) For patients on federal insurance such as Medicare, the cost is about $50 per month but can vary depending on your Part D plan

What to Expect Long-Term It is important to know that although blood thinners decrease your risk of stroke, they do not eliminate it completely If you are not on blood thinners, your risk of stroke increases the longer you have AF Therefore, it is important to keep your follow-up health visits for routine monitoring of labs, heart function and medication side effects

How to Make a Decision Your health care professional will work with you to decide whether you should be on a blood thinner and choose one that’s right for you. What works for some people may not for others. Many factors can influence the choice of blood thinner.

Need Help Making Your Decision? CardioSmart has a decision aid that you can use together with your health care professional to determine your treatment options for living with Atrial Fibrillation. CardioSmart.org/Decisions

Q&A Session