Stroke Prevention in Atrial Fibrillation
Table of Contents
Introduction
Atrial fibrillation (AF) is a type of heart disease which is characterized by too slow, too fast, or irregular heartbeat rate and may further lead to stroke occurrence. The rate of mortality among the individuals with AF after suffering stroke is approximately twice higher than among those who do not have this condition. However, there are several ways of stroke prevention treatments, the most effective of which is anticoagulant therapy. Therefore, the following paper describes atrial fibrillation disease as well as some alternative ways of its treatment. What is more, the paper examines anticoagulant therapy by providing its general overview, evaluation of advantages and disadvantages, and the ways of controlling its possible negative effects.
Atrial Fibrillation
Atrial fibrillation (AF) is the problem that concerns the rhythm or the rate of heartbeat making it too slow, two fast, or irregular (NIH, 2014). In order to gain more understanding of this kind of arrhythmia, it is useful to comprehend the meaning of the words ‘fibrillate’ and ‘atria’. The first one means irregular and fast contraction, while the second is the name of the two upper chambers of the heart. Following these definitions, atrial fibrillation can be defined as fast and irregular contracts of the heart’s upper chambers, caused by the disorganized electrical signals. It appears in the condition when atria (upper chambers) and ventricles (lower chambers) do not function together in a proper way, and thus, blood is not pumped into the heart completely.
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However, people that have atrial fibrillation may not even feel any symptoms. In such situation, the condition of a patient may be discovered only by means of physical examination. Unfortunately, even if the symptoms of AF are not observed, the risk of stroke does not decrease. The signs of atrial fibrillation are as follows: rapid and irregular heartbeat, dizziness, general fatigue, weakness, anxiety and shortness of breath, sweating, confusion or faintness, fluttering in the chest, and chest pressure or pain (American Heart Association, 2016). The last symptom signifies an emergency and requires immediate medical intrusion. It should be mentioned that AF may appear from time to time, or may become continuous or even constant condition.
The main complication of AF is an increased risk of stroke due to its ability to affect the blood flow in the heart chambers. Such interference into the blood flow may sometimes cause the formation of small blood clots. They are able to reach different parts of the body, for instance brain, by moving through blood vessels. If vessels are small, clots may get stuck in such a way depriving the brain of the blood supply and further leading to stroke. What is more complicated, patients with atrial fibrillation may experience strokes with much higher severity; AF is also the reason for half of all the embolic strokes; in worst case, it may result in mortality (AFA, n.d.).
Stroke Prevention
Anticoagulant Therapy
The major goal of medical treatment of the patients with atrial fibrillation is to reduce the risk of clots’ formation, and as a result, decrease the possibility of stroke occurrence. In this regards, there are several options of the necessary treatment, but taking anticoagulants is the most effective one among them. The main benefit of these medicines is their ability to prolong the time needed for clots to be formed in the blood. There is an opinion, that anticoagulants make the blood “thinner,” yet there is no definite answer to this question so far. Nevertheless, the majority of he studies demonstrate that taking anticoagulants may reduce the risk of stroke occurrence approximately by two third. In other words, if patients with AF apply this medication timely and properly, almost 6 strokes from 10 may be prevented due to this treatment.
Apart from its benefits, taking the anticoagulant medicines has potential side effects as well. The most serious one is an increased bleeding risk. For instance, taking the Coumadin, also known as warfarin considerably increases the possibility of having a serious bleeding. Therefore, its dose has to be checked regularly, and there is a need to do the blood tests while taking Warfarin to control the blood condition. Besides, newer and more advanced medicines, such as apixaban, rivaroxaban, or dabigatran, may considerably increase the risk of bleeding too. However, these medicines do not remain in human’s body as long as warfarin does, so even in the case of severe bleeding, it would disappear quite quickly. Usually, it takes approximately 12-24 hours for these medicines to go out of the body.
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However, warfarin, or Coumadin still remains the best choice for reducing stroke occurrence in the patients experiencing atrial fibrillation. There are several reasons for it, including the price of the medicine and the period of its usage. It is evident that the medicine, which has been applied a lot, and did not show any considerable negative effects, and the benefits and possible risks of which are well-known, will have an advantage when choosing the medication to avoid or decrease the risks of strokes during atrial fibrillation.
Alternative Treatments
As for the alternative treatments, they are mostly aimed at slowing down the heartbeat rate, in such a way increasing the ability of the heart to pump blood effectively as well as return to and maintain its normal rhythm. These options include taking the channel blockers medicines and cardioversion.
Calcium channel blockers and ß-blockers are the medicines that can decrease the heartbeat rhythm. They are quite useful for the patients with too fast heart rate, since it can be a reason for the heart failure. Moreover, the patients with the high heartbeat rhythm are usually short on breath and may feel very tired.
Another option that is very effective in dealing with the discussed condition is a cardioversion. It is a medical procedure that helps to stabilize the abnormally fast heart rate called arrhythmia or tachycardia via drugs or electricity. Therefore, the cardioversion is divided into pharmacologic cardioversion and electrical cardioversion respectively (chemical cardioversion). During electrical cardioversion, electric charge is given through the patients’ chest to the heart. Besides, it may be performed with the help of the surgery, which is called a Maze procedure and consists in making several incisions on the right and left atriums of the heart. These incisions do not conduct electricity and ruin the path of the abnormal electrical impulses (USC, n.d.). The other way that involves surgery for performing the cardioversion is the usage of the catheter, and it is called a catheter ablation. During this particular procedure, the catheters – small wires – are inserted into the blood vessels in arm or neck. Through the vessels, these wires are lead into the heart. After it, the special machine sends electric charges to destroy the areas of the heart tissues where the abnormal heartbeat may occur or arrhythmia is likely to develop (NIH, 2012). The above-described procedures are often used to help the patients with severe symptoms.
As for the pharmacological cardioversion, it is an important and a cost-effective alternative to the electrical cardioversion and the surgery, when the treatment of the patients with atrial fibrillation is concerned. Specifically, chemical cardioversion is useful for the individuals with fibrillation of recent onset (NCBI, 2012). Since there are different classes of agents that are effective for the pharmacological cardioversion, this procedure may be applied in various situations. For instance, it is quite useful for maintaining normal heartbeat rhythm after the electrical cardioversion, or it can be utilized before electrical cardioversion to decrease the heart rate. However, it should be mentioned that pharmacological cardioversion is less effective when compared to the electrical one, includes side-effects of taking drugs, and is useless for the chronic atrial fibrillation. At the same time, it is convenient and simple, and has a success rate for the patients with the fibrillation of recent onset.
Overall, taking different medicines, drugs, and undergoing various therapies are not the only ways of stroke prevention. The easiest technique is a healthy life-style of an individual. Furthermore, the steps that may lower the risk of heart disease considerably and prevent people from stroke occurrence include maintaining healthy weight, not smoking, being physically active, limiting alcohol consumption, as well as addressing the cases of high cholesterol and blood pressure timely.
INR Self-Testing
As mentioned above, taking anticoagulants is the most effective way to reduce the possibility of stroke occurrence. Yet, it has the possibility of side-effects appearance, the most dangerous of which is bleeding. In this regard, the only way to avoid such complication is to control the dosing and take blood tests. The test is called INR and is crucial for the patients taking anticoagulants, for instance warfarin, because its low rate put individual at risk of clotting and its high rate may lead to bleeding.
There are several ways of performing this test. According to Clot Connect (2011), these ways are the following:
- Testing in an anticoagulant clinic or physician’s office.
- Undergoing the test in a physician’s office using point-of-care (POC) device.
- Testing at home or elsewhere by individuals themselves using POC device.
- Self-management, enabling the patients to not only do the testing using POC devices, but also learn to adjust their own dosing.
The Reasons for Doing INR Self-Testing
Some patients are willing to visit anticoagulant clinic or physician office to perform INR test, while others prefer to do it at home by themselves, and the nature of the procedure makes it possible for both of the options to be realized. What is more, individuals who are doing INR self-testing appear to have less clotting and bleeding complications, and their anticoagulant therapy is better controlled on the whole. INR self-testing may also provide the patients with a sense of security, since they are able to perform the testing whenever and wherever they want. In addition, some individuals have to do this test more frequently than others, so self-testing is rather convenient option for them. The procedure gives more freedom to the patients using it, so they do not have to visit physician office every time they need the testing to be done thus saving their time. Besides, INR self-testing empowers patients to be more active in their medical care (Clot Connect, 2011). Importantly, while using the INR self-testing device, individuals may easily travel without the need to track down the service providers of INR testing during their journeys. Lastly, the procedure helps to deal with language barriers and bureaucracy that the patients may face in other state or country.
Conclusions
To conclude, it is evident that atrial fibrillation is rather dangerous condition, since it may result in further complications. They include the increased risk of the heart stroke and thus the higher rate of mortality of the individuals. One of the effective ways to deal with the above difficulties is to opt for the anticoagulant therapy, which has several advantages and disadvantages, with the latter being observed in the form of possible bleeding. The complications can be prevented by the regular INR testing which is performed in the number of ways. The most convenient and easy one is INR self-testing that can be done at home by the patients themselves using POC devices.
