Source www.telegraph.co.uk
Did you know that there is a type of heart condition that puts people at risk for a stroke? Patients with Atrial Fibrillation suffer from a condition that results in their heartbeat being fast and abnormal. (more on AF here: https://www.mmgazette.com/is-your-heart-skipping-a-few-beats-dr-nur-hidayati/)
Almost all strokes in AF are caused by blood clots that form in the left side of the heart due to the abnormal blood flow. These clots can dislodge and travel through the blood vessels and reach the blood vessels in the brain. Once the clot is lodged in the brain’s blood vessel, it will prevent oxygen reaching that particular area of the brain, resulting in a stroke.
It is a scary fact that many patients with AF might not be diagnosed until they have a stroke because they may not show any other symptoms except for an irregular heart beat, which patients may not notice or bring to the attention of their doctor. That is why doctors are taught since medical school that even the simplest act of taking a patient’s pulse is important, as you can easily diagnose an irregular heart beat by doing so.
In order to prevent the formation of blood clots and protect the patient from getting a stroke, they are given an anticoagulant called warfarin (commonly known as a blood thinner or “ubat cair darah”). Since the biggest complication of warfarin is bleeding, the most severe of which are intracranial bleeds or bleeding in the brain/head, warfarin is given with very close monitoring. How well warfarin works to prevent blood clots and its safety of use is highly dependant on maintaining a specific range of international normalized ratios (INR ). Patients will have to regularly go to the hospital or KK to check their INR via a blood test. This may sometimes feel like a burden to the patients or their relatives, but it is essential that patients do not miss their regular INR checks to ensure that their warfarin dose is enough to prevent blood clots but not too much that it can cause bleeding.
Newer oral anticoagulants are now available, which may prove to have less bleeding complications but a lot more still needs to be learned regarding their safety and efficacy. As with most things in life, the balance between stroke prevention and bleeding in patients with AF treated with warfarin is an important one to achieve.
Dr. Hidayah is a medical lecturer in a local university with a Masters in Pharmacology. She is also the Chief Editor of The Malaysian Medical Gazette.
References:
- Managing atrial fibrillation to prevent stroke, Seah YM, Medical Tribune, (1-15 March)
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]