HCA Midwest Health - December 20, 2018
by Dr. Dhanunjaya Lakkireddy

For atrial fibrillation (AF or Afib) patients and their loved ones, the connection between afib and stroke can be frightening. Stroke is the leading cause of adult disability and the fifth leading cause of death in the United States.

And AF can increase a person’s risk of stroke by up to five times. But the good news is, there have been some significant advancements in treatment options that can help to substantial lower that risk.

The AF and Stroke Connection

Atrial fibrillation causes poor blood flow and allows blood to pool in the upper chambers of the heart. This can allow blood clots (thrombis) to form. If a piece of the clot (embolus) breaks off, it can enter circulation and may cause a blockage in a small blood vessel. An embolus can travel to the eyes, kidneys, spine, arms, legs or other organ. The most serious complication of afib is arterial thromboembolism or the sudden blockage of blood flow to an organ by a blood clot. The most identifiable occurrence of this is ischemic stroke.

A stroke can occur when an artery in the brain (cerebral artery) is blocked. It can lead to permanent brain damage and can even be deadly. Afib related strokes are nearly twice as fatal and twice as disabling as non-atrial fibrillation related strokes. AF is also associated with longer transient ischemic attacks (TIAs). All of this may be due to larger clots.

A patient’s risk of stroke increases with age. Without medication, about 1.3 percent of people with afib each year who are between the ages of 50 and 59 have a stroke. The risk gradually increases each year with about 5 percent of afib patients 80 to 89 years old having a stroke. Other stroke risk factors include:

  • Diabetes
  • High blood pressure
  • Congestive heart failure
  • Prior stroke
  • Prior embolus

Blood Thinners for Stroke Prevention

The most common treatment used to reduce a person’s risk of developing blood clots is anticoagulants also known as blood thinners. Blood thinners have been proven to reduce the risk of blood clots in patients with all types of atrial fibrillation and at all stroke risk levels. For some, taking a blood thinner may reduce the chance of stroke by 50 - 70 percent. Examples of anticoagulants include warfarin, dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa, Lixiana).

For a few relatively low-risk people, antiplatelet drugs such as aspirin may be an option for stroke prevention instead of blood thinners. Talk to your doctor about the best medication for you. Your options will depend on your unique situation, medical history and risk factors.

Left Atrial Appendage Closure

Some afib patients are at a high-risk bleeding. These patients are not able to take blood thinners, however, there is still a pressing need to reduce their risk of stroke. For these patients, a relatively new procedure called left atrial appendage occlusion may be recommended.

The left atrial appendage (LAA) is a sac-like structure in the upper left chamber of the heart. “In afib patients, ninety plus percent of strokes seem to originate in the left atrial appendage,” says Dhanunjaya “DJ” Lakkireddy, M.D., the medical director of the Kansas City Heart Rhythm Institute (KCHRI) at the HCA Midwest Health Heart and Vascular Institute. “A simple, effective procedure called left atrial appendage occlusion, can be performed to reduce stroke risk in patients who are at high risk for bleeding and cannot take blood thinners.”

During a left atrial appendage closure procedure, the LAA is sealed so that blood clots are unable to escape and cause a stroke. “We offer several methods of closure,” states Dr. Lakkireddy. “Including some of the latest innovations that are still in clinical trials.”

  • WATCHMAN
  • AtriClip
  • LARIAT
  • Amulet

“It’s essential to reduce a patient’s risk of stroke,” says Dr. Lakkireddy. “If a patient is not on anticoagulants or has not had a closure procedure, it is only a matter of time before they have a stroke.”

The Kansas City Heart Rhythm Institute

At KCHRI, our renowned electrophysiologists are continuously working to advance the care and treatments for patients with afib. We offer leading-edge, minimally invasive treatment options which may offer a faster recovery and a significant improvement in symptoms within just a few months. Learn more about how we work tirelessly to improve the quality of life for the patients we serve.

Find an Electrophysiologist

Post approved by Dr. Dhanunjaya Lakkireddy

tags: heart care , t4b