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Anticoagulation in Atrial Fibrillation

Discuss the use of blood thinners to prevent clot formation in atrial fibrillation, comparing Warfarin and Dabigatran medication options, including benefits, risks, and monitoring requirements.

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Anticoagulation in Atrial Fibrillation

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  1. Anticoagulation in Atrial Fibrillation Warfarin or Dabigatran

  2. Discussing Anticoagulation in AF with Patients • What is atrial fibrillation? • The back chamber has a pocket in which blood can stagnate and clot. • If a piece of this clot breaks and travels with the blood to the brain then can have minor or major stroke. • The risk of clot forming is higher is some persons that other persons. • Good news is that we can markedly reduce the risk of clot forming by taking a blood thinner called Warfarin.

  3. Discussing Anticoagulation in AF with Patients • Warfarin is also used as a rat poison! • Warfarin is poisonous if the blood becomes too thin and this can then cause serious bleeding. Serious bleeding can occur into the brain or elsewhere. • To use Warfarin as a medicine rather than a poison we need to have regular blood tests to make sure the blood is thin enough to prevent clot but not too thin that will have bleeding.

  4. Discussing Anticoagulation in AF with Patients • Some people need more Warfarin than others to get the right result and so unlike a lot of other medication one has to have regular blood tests. • The Warfarin level in the blood may be just right but can suddenly change because many medications including antibiotics that can interfere with Warfarin and also food risk in Vitamin K like broccoli and spinach can reduce the level of Warfarin. This could cause the blood to become too thin and cause bleeding or make the blood not thin enough and increase risk of stroke.

  5. Discussing Anticoagulation in AF with Patients • Despite these difficulties there are many patients that take Warfarin successfully. • We now have a new medication that does not have many of the disadvantages of Warfarin called Dabigatran- it is too expensive to use as a rat poison. • Dabigatran • Has to be taken twice a day and does not need blood testing. • You can go on a long holiday and not have to worry about getting blood tests. • Unlike Warfarin only a small number of medications interfere with Dabigatran.

  6. Discussing Anticoagulation in AF with Patients • One drawback is that there is no antidote. We have an antidote for Warfarin. • Is you are in car accident, or fall down the stairs and get bleeding into the brain, or have some other serious bleeding problems then when you get to hospital we cannot give you and antidote. • We need to stop the medication and wait 2-3 days for its effect to wear off. • Some persons may end up needing more blood transfusions and suffer complications because of this lack of an antidote. • One other drawback is that there might be a slight increased risk of having a heart attack with Dabigatran than with Warfarin.

  7. Discussing Anticoagulation in AF with Patients • Despite the lack of an antidote, in a huge clinical trial, Dabigatran was better than Warfarin in preventing stroke. • Despite the lack of antidote to Dabigatran , there are fewer strokes caused by bleeding into the brain with Dabigatran than with Warfarin. • Despite the lack of an antidote, there is no more serious fatal bleeding with Dabigatran than Warfarin. • Despite the lack of an antidote, it seems there is a reduced risk of dying on Dabigatran compared with Warfarin.

  8. Anticoagulation in AFDabigatran or Warfarin • What is atrial fibrillation? • The back chamber has a pocket in which blood can stagnate and clot.

  9. Anticoagulation in AFDabigatran or Warfarin • The back chamber has a pocket in which blood can stagnate and clot.

  10. Anticoagulation in AFDabigatran or Warfarin • The back chamber has a pocket in which blood can stagnate and clot.

  11. Anticoagulation in AFDabigatran or Warfarin

  12. Anticoagulation in AFDabigatran or Warfarin HASBLED score greater than 3 indicates high risk for bleeding

  13. Anticoagulation in AFDabigatran or Warfarin

  14. Anticoagulation in AFDabigatran or Warfarin

  15. Anticoagulation in AFDabigatran or Warfarin

  16. Dabigatran Dosing • Dabigatran 150mg bd • Dabigatran 110mg bd if • Have moderate renal impairment • Aged over 75 years • Contraindicated in those with severe renal impairment • NOTE: is USA FDA only approved the 150mg bd dosing, but also approved 75mg bd for those with severe renal impairement

  17. RELY- INR levels

  18. RELY- INR levels

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