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Reducing stroke risk in patients with atrial fibrillation

Dr. Antonio Culebras during a television interview. Photo by Kathleen Paice Froio.

Dr. Antonio Culebras during a television interview. Photo by Kathleen Paice Froio.

If you have been diagnosed with atrial fibrillation, new guidelines to reduce your risk of stroke include talking to your healthcare provider about taking an oral anticoagulant.

Upstate neurologist Antonio Culebras, MD, is the lead author of the new guideline from the American Academy of Neurology. “These guidelines are not commandments. They are recommendations,” he says, acknowledging that some people may be at greater risk of bleeding than of stroke.

Culebras says in patients who suffer a stroke for which doctors can find no cause, “we strongly suspect atrial fibrillation is the culprit.” The guidelines also suggest that these people be evaluated for atrial fibrillation, which may require wearing a heart monitor for several days. Atrial fibrillation is an irregular heartbeat which can be fast or slow and cause symptoms including fatigue, dizziness or lightheadedness. It can be constant, or it can come and go. “Because the heart does not beat regularly, there is a change in the circulation of the blood,” Culebras explains. Blood may sit in the corner of the heart, facilitating the formation of a clot that later migrates to the brain, causing a stroke.

The risk is even greater in people with atrial fibrillation who have had a stroke or TIA, transient ischemic attack, which has symptoms that mimic those of stroke but are temporary.

Anticoagulants are designed to prevent clots by thinning the blood, but they can put some patients at risk for bleeding complications.

A new series of anticoagulants — including dabigatran, rivaroxaban and apixaban — are safer and perhaps more effective than warfarin, Culebras says.

The World Health Organization calls atrial fibrillation a “growing and serious global health problem” and projects one in 20 people around the world have this condition, which tends to develop as people age.

Other factors that put a person at risk for developing atrial fibrillation include underlying heart disease, high blood pressure, binge drinking and sleep apnea, along with thyroid problems, diabetes, asthma and other chronic medical conditions, according to the American Heart Association.

Listen to a radio interview with Dr. Culebras on this subject