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Treating atrial fibrillation and preventing strokes and pulmonary embolism

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man measuring his blood pressureBlood thinning medications are often prescribed to prevent strokes and pulmonary embolism (PE) in people with atrial fibrillation (AFib) and deep vein thrombosis (DVT). These conditions increase the risk of developing blood clots, which can travel to the brain or the lungs and cause a potentially life-threatening condition. Learn more about the conditions here.

These medications work by inhibiting the formation of blood clots, preventing existing clots from growing, and reducing the risk of stroke and other complications associated with AFib and DVT.

There are several different types of anticoagulant medications available. The choice of medication will depend on specific factors, including the patient’s medical history, any risk factors, and potential interactions with other medications.

There are usually recommendations for lifestyle modifications. Regular exercise, a healthy diet, and avoiding smoking can also reduce the risk of developing blood clots. People with AFib and DVT need to work with their healthcare providers to manage their condition effectively and prevent complications.

About Atrial Fibrillation

Atrial fibrillation (AFib) can be a serious medical condition leading to severe complications such as a pulmonary embolism (PE) or a stroke if left untreated. AFib presents with a rapid and irregular heart rate heart, palpitations, shortness of breath and general weakness. During atrial fibrillation, the two upper chambers in the heart (the atria) beat out of sync with the two lower chambers (the ventricles.) This may cause blood to pool in the atria and form clots that may break off and travel from the heart to the brain, blocking blood flow and causing a stroke. Alternately it may pass through the pulmonary arteries to the lungs, possibly depriving them of oxygen. Blood clots from atrial fibrillation may also cut off blood flow to other body parts.

In people with atrial fibrillation, anticoagulant medications, also called blood thinners, can significantly reduce the risk of damage due to blood clots. By slowing down the rate of clotting, blood thinners make it hard for clots to form and prevent existing clots from growing.

About Deep Vein Thrombosis

Deep vein thrombosis (DVT) and pulmonary embolism are generally regarded as different clinical manifestations of the same disease. Blood clots typically originate in deep veins, most often in the legs, and from there can embolize to the pulmonary arteries, passing through the right chambers of the heart. However, about 50% of patients with PE have no diagnostic evidence of DVT, which suggests that some PE events may arise from sites other than the deep veins of the legs. 

Treating Atrial Fibrillation

For many years, the standard anticoagulant used to prevent strokes and pulmonary embolism was warfarin, also marketed as Coumadin. Although warfarin is highly effective in preventing blood clots, it can have serious side effects, including the possibility of bleeding inside the brain. People taking warfarin require frequent blood tests to monitor the dose. The dosage has to be very accurate and controlled since if the level of warfarin is too high, there is a greater chance of internal bleeding. On the other hand, if the level is too low, coagulation is more likely. There are also many interactions between warfarin and other common medications, which can affect how the blood responds. 

More recently, drugs known as direct-acting oral anticoagulants (DOACs) are available and would be prescribed in place of warfarin where necessary. Examples are Eliquis (apixaban) and Xarelto (rivaroxaban). They are shorter-acting than warfarin, which means they do not require monitoring for the risk of bleeding or clotting. They typically have fewer drug and food interactions than warfarin. Other options are beta-blockers, such as Zebeta or Tenormin, or calcium channel blockers, such as Isoptin or Cardizem.

DOACs are not usually recommended for people with severe liver disease. Warning signs of complications while taking any blood thinners are changes in the color of the urine or stools (red or dark brown), bleeding gums and easy bruising or blood blisters.

FAQ

Can blood thinners cause internal bleeding?

One of the potential side effects of all coagulants is to cause unexpected bleeding with or without a physical cause. Depending on the severity and location, hemorrhage can result in low blood pressure, organ failure, and even death. Studies have found that Eliquis is less frequently associated with gastrointestinal bleeding.

What are treatments for atrial fibrillation, and is this serious?

People diagnosed with atrial fibrillation are usually prescribed blood thinning medications to prevent strokes and pulmonary embolisms. These conditions carry the risk of blood clots, which can potentially be life-threatening. Changes to diet, lifestyle and cessation of smoking are also frequently recommended.

What is the drug of choice for atrial fibrillation?

Depending on the specific symptoms and general health, doctors can choose between a wide range of treatments. In the past, the first choice was warfarin, but its need for constant monitoring of blood levels and more common side effects has now given preference to DOACs, beta-blockers or calcium channel blockers. In every instance, the prescribed medication will be chosen to match the specifics of the patient.

Can Eliquis cause weight gain?

There is no indication that either Eliquis or other DOACs, such as Xarelto, can have any effect on weight, causing neither gain nor loss. Usually, people prescribed medication for atrial fibrillation or DVT to prevent strokes and pulmonary embolism will also be advised to adopt a suitable diet and healthy lifestyle.

Can taking warfarin cause heart palpitations?

There is no reporting of a causal relationship between warfarin and heart palpitations. In most cases where palpitations have been reported, this was a preexisting symptom of atrial fibrillation, which is what warfarin was prescribed to correct.

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