If you’re one of the 2.7 million Americans who suffers from atrial fibrillation, you probably know that blood thinners are one way to treat the symptoms and limit your risk of stroke. However, not everyone can tolerate these medications.
Q. What is atrial fibrillation?
A. Normally, the electrical signal that causes a heart to beat moves through the heart in an organized fashion. When someone has atrial fibrillation, also known as Afib, the electrical signal in the top two heart chambers, called atria, is disorganized. That can lead to an irregular and often fast heart rate.
Q. What are the symptoms of Afib?
A. While some people may not have symptoms due to Afib, others may experience a number of symptoms including the following:
- Palpitations - a sense of a racing and irregular heart beat
- Chest pain
- Shortness of breath
Q. What are the risks of Afib?
A. While not often immediately life threatening, atrial fibrillation can result in a number of risks. First and foremost, have Afib puts a patient a great risk of having a stroke – five times more risk than a person without Afib. A patient with underlying cardiovascular or heart valve disease may have a difficult time tolerating being in Afib. In addition, if unrecognized or untreated, the rapid heart rate often seen with Afib may lead to a weakening of heart function (cardiomyopathy).
Q. How is Afib commonly treated?
A. A key treatment is the administration of an anticoagulant (blood-thinning) drug, if appropriate, to decrease stroke risk. Atrial fibrillation can cause the blood flow in the atria to become stagnant which can lead to the formation of clots. These clots can then potentially travel outside of the heart and to the brain causing a stroke. A blood thinner reduces the risk of stroke by preventing the formation of clots.
Q. How do blood-thinning medications work?
A. Blood thinners work by blocking certain factors or agents vital in the formation of clots. The function of several clotting factors depends on vitamin K. Coumadin® or warfarin can affect clotting by blocking the reactivation of Vitamin K. Newer agents, called direct oral anticoagulants (DOACs) inhibit other factors in the clotting process independent of Vitamin K.
Q. What are the risks of taking a blood thinner for the long term?
A. The use of an anticoagulant can increase the risk of bleeding. This can include life-threatening bleeding such as an intracranial hemorrhage —bleeding within the skull.
Q. What’s the risk of stroke in patients who take blood thinners?
A. Blood thinners can reduce it by as much as 50 to 60%.
Q. Doctors commonly use warfarin for patients with Afib. What are alternatives?
A. Based on a recent update to the guidelines on the treatment of atrial fibrillation, direct oral anticoagulants (DOACs) are recommended over warfarin unless the patient also has a prosthetic heart valve or moderate-to-severe narrowing of the mitral valve.
These drugs include rivaoxaban (Xarelto®), apixaban (Eliquis®), dabigatran (Pradaxa®), and Savaysa®.
Q. Are any other treatments available?
A. There is an alternative for patients that cannot tolerate blood thinning medications to reduce the risk of stroke. The Watchman™ device is an implant, about the size of a quarter, which closes off the left atrial appendage, or LAA, where the vast majority of clots form.
Q. What is the left atrial appendage (LAA), and what does it do?
A. The left atrial appendage is a small chamber extending from the main section of the left atrium. The function of the LAA is unclear; however, some believe that it may function as a sort of decompression chamber for the left atrium.
Q. To implant the Watchman™, what type of medical procedure is involved?
A. The cardiologist delivers the Watchman™ device to the heart using a catheter through the femoral vein in the groin.
Q. What type of anesthesia is required?
A. General anesthesia is required. This enables the interventional cardiologist to control the patient’s breathing and test the device once it’s placed in the LAA.
Q. How do you know if you qualify for the procedure?
A. You should consult with your primary care doctor or cardiologist. If you have atrial fibrillation, not due to heart valve disease, and it has been recommended that you be on a blood thinner but you have had significant bleeding on these medications then you may be a candidate for the Watchman™ device. In addition, if you have any conditions that may increase your risk of being on a blood thinner, such as balance issues resulting in frequent falls, then you may also be considered.
Q. Is the Watchman™ device FDA approved?
A. The U.S. Food and Drug Administration approved it for commercial use in 2015.
Q. What are the benefits of the Watchman™ implant?
A. Like blood-thinning medications, the Watchman™ device can effectively reduce the risk of stroke related to atrial fibrillation. Although patients need to take an anticoagulant for 45 days after the procedure, once it is confirmed that the LAA is permanently closed, they no longer need blood thinners for their atrial fibrillation.
Q. How do I know which treatment option is right for me?
A. It’s important to talk to your doctors about your treatment options for Afib.