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

2. 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

3. Why is there a risk of stroke with atrial fibrillation?

4. 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

5. What is a Stroke?

6. 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

7. Symptoms of Stroke

8. 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
High blood pressure
A2 – Age 75 and older
Diabetes (type 2)
Stroke or mini-stroke
Vascular disease (prior heart attack, peripheral artery disease) 1
Age – 65 to 74 years of age
Sc – female sex
Total score: 0 = low risk; 1 = low-moderate; 2+ = high

9. 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

10. 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

11. 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

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

13. 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
Liver or kidney disease or 2
Prior stroke
Advanced age
Unstable or high INR (measures blood level)
Heavy drug or alcohol use or 2
Talk with your doctor about your risk of stroke and bleeding

14. 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

15. 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

16. 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

17. 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.

18. 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

19. Q&A Session