Stay Away From Stroke, Patients With Atrial Fibrillation Don't Forget The Good Friend ‘anticoagulant’!

"My heart is pounding", it may not be meeting your sweetheart, it may be atrial fibrillation.

Atrial fibrillation (abbreviated as atrial fibrillation) is a common arrhythmia. The electrocardiogram shows that the P wave disappears and is replaced by an irregular f wave. The most common symptom is palpitations, a small number of patients will have chest tightness, dizziness, and dark spots, and some patients have no obvious symptoms.

As mentioned above, atrial fibrillation does not appear to be fatal. But there is another set of data: Compared with people without atrial fibrillation, the risk of stroke in patients with atrial fibrillation increases by 4 to 5 times, the risk of heart failure increases by 2 to 3 times, and the risk of death increases by 2 times, at least 1/3~ One in four patients with atrial fibrillation suffers from ischemic stroke.

Atrial fibrillation is obviously a heart problem, so why is it related to stroke?
Deadly blood clot 'breeded' in left atrial appendage

The heart also has an "ear"-like structure. The left atrial appendage mentioned here refers to a blind-end-like structure under the anterior and lateral walls of the left atrium. It is responsible for regulating left ventricular filling pressure, stabilizing blood flow, and secreting atrial natriuretic peptide.

The left atrial appendage is filled with blood, and it fulfills its mission conscientiously. However, when atrial fibrillation occurs, the rhythm of the left atrium, which should be beating regularly, is irregular, and the left atrial appendage connected to it is a little confused: it is enough to follow the rhythm of the left atrium, but now it is disordered, what should I do? Is it contraction or relaxation? Does it pump blood out or stay in the left atrial appendage?

As a result of the hesitation, the blood in the left atrial appendage stagnates and eddies, and the blood flow slows down. If the atrial wall is damaged again, the blood is in a hypercoagulable state, and thrombus will be born.

The thrombus "raised" in the left atrial appendage is very unstable. It falls off and travels around with the blood flow. If it stays in the brain, it can cause a stroke.

Anticoagulant drugs to prevent stroke is the focus of atrial fibrillation treatment

The use of anticoagulant drugs is an essential means to prevent thrombosis in patients with atrial fibrillation. The "Guidelines for Primary Diagnosis and Treatment of Atrial Fibrillation" formulated by the Chinese Medical Association states that "high attention must be paid to the risk of thromboembolism in patients, and anticoagulant therapy should be carried out according to stroke risk assessment." The American College of Chest Physicians' "Atrial Fibrillation Antithrombotic Treatment Guidelines and Expert Group Report" also proposed that comprehensive management measures for atrial fibrillation include stroke prevention, symptom improvement, and risk factor control, among which stroke prevention is the central link.

Doctors will conduct a score assessment called "CHA2DS2-VASc" for patients with atrial fibrillation, including age, gender, whether they have high blood pressure, diabetes, history of stroke, heart failure, vascular disease, etc. Patients with atrial fibrillation with points ≥ 1 for males and ≥ 2 for females need to start or consider starting anticoagulant drugs for anticoagulant therapy.

The use of anticoagulants varies from person to person

At present, anticoagulant drugs used in patients with atrial fibrillation are divided into two categories: one is the vitamin K antagonist warfarin; the other is non-vitamin K antagonists, including the direct thrombin inhibitor dabigatran etexilate and direct Xa Factor inhibitors rivaroxaban, apixaban, etc.

Warfarin is a traditional anticoagulant drug, and it is also a very "exquisite" drug: if the dose is small, the anticoagulant effect will not be achieved; if the dose is large, the risk of bleeding will increase. Different patients have large individual differences in their dosage requirements, and are also easily affected by food and drugs. Therefore, the dosage of warfarin is "adjusted". After 2 to 4 weeks, the International Normalized Ratio (INR) is measured many times, and the dosage is adjusted at the same time. The INR value is "adjusted" to 2.0~3.0. Reduce stroke risk and bleeding risk.

Compared with warfarin, the new anticoagulant drugs dabigatran etexilate, rivaroxaban and other non-vitamin K antagonists may have better "user experience" because they do not need routine testing of coagulation function, but they are combined with severe liver and kidney insufficiency patients should not use.

No matter which type of anticoagulant you choose, please remember that anticoagulant is the "good friend" of patients with atrial fibrillation. Unless there are contraindications or serious adverse reactions, don't give up easily.