- Thank you for visiting Dr. AFib.
I'm Dr. Morales.
In today's video segment we're gonna
be talking about both coronary artery disease
as well as atrial fibrillation
and how the two conditions affect each other.
In the past I've talked about how
the risk factors for developing atrial fibrillation
are very similar to the risk factors
for developing coronary artery disease.
So if you've been diagnosed with atrial fibrillation
it's very important to be screened
for coronary artery disease because the risk factors
are very similar between the two.
Such as high blood pressure, diabetes,
obesity are all very common risk factors
and so please get yourself screened
for coronary artery disease including things
such as a stress test for example,
would be a good way to screen for coronary artery disease.
But what about the patients who
already have coronary artery disease?
You've already had bypass surgery or
have you already had stents in your heart
and then you develop atrial fibrillation afterwards.
So how does having the two conditions need
to be managed by your doctor?
First, I'll talk about controlling symptoms,
then I'll talk about the blood thinners.
So for controlling symptoms fortunately
the most common medication used for controlling
some of the symptoms for atrial fibrillation
is a medicine in the category of beta blockers.
Which probably Metoprolol is one
of the most commonly one used.
Those medications slow down your heart
and they're also a little bit
of blood pressure medication to help reduce symptoms.
And they've also been used for coronary artery disease
for a long time as well so it's good that there's
some overlap in terms of the medications
that can be used for atrial fibrillation
as well as coronary artery disease.
However there are some stronger medications
that are used for atrial fibrillation
in the category of antiarrhythmics which,
once you've had coronary artery disease,
if you've had stenting or bypass surgery,
you are at increased risk for having complications
from those type of medications.
So people who have coronary artery disease
are not candidates typically for some types
of antiarrhythmic medications.
Now let's talk about the blood thinning medication.
People who have had stents inside
of their heart are frequently taking
blood thinners such as aspirin,
or Plavix or Brilinta or Effient,
are the most commonly ones used.
And these are very good blood thinners.
They work well to keep people's stents open.
But they work on your blood by effecting
this little, tiny cells called platelets
which help clot your blood.
And that's how they keep the blood thin
because it blocks those little platelets.
However even though they work very well
for opening up your stents,
they don't work as well for reducing risk
of stroke from atrial fibrillation.
And so when,
for in order to reduce risk of stroke
from atrial fibrillation people
frequently require stronger blood thinners.
Something in the category of anticoagulation.
That's your medications like Warfarin,
Xarelto, Eliquis or Pradaxa.
And those work differently than the medications that they,
people take for stents.
The ones for atrial fibrillation actually affect
these tiny little proteins that help clot your blood,
that's why they're in a
different category called anticoagulation.
So when people are first diagnosed
with atrial fibrillation and they're
already taking medications like Plavix for example,
I'll explain to them,
know that you need to be on blood thinners
for your risk of stroke and they'll say,
well I'm already on blood thinners.
And so I have to explain to them
that medications that you take for stents
or coronary artery disease thin your blood
in a different way than medications that
thin your blood for atrial fibrillation.
And so they work differently in order to help maximize,
not only keeping your stents open
but also to help reduce your risk of stroke.
Now the tricky part can be if you're
on aspirin and Plavix for example
and then you develop atrial fibrillation,
then you need a third blood thinner,
such as Coumadin or Xarelto or Eliquis.
And being on multiple blood thinners,
up to three blood thinners makes your blood very thin
and unfortunately these people are
at higher risks for having bleeding complications
from being on multiple blood thinners.
So it can very tricky to manage people
who have both coronary artery disease
as well as atrial fibrillation when people
are required to be on multiple blood thinners.
Fortunately sometimes when people
are on medications for stenting,
depending on when your stent was put in,
we may be able to decrease some blood thinning medications,
depending on your overall circumstance.
So if you're on multiple blood thinning medications,
please discuss with your doctor
the risks and benefits of being on multiple blood thinners
in terms of your stents and atrial fibrillation
and also risk of bleeding so its very important
to be knowledgeable about the pros and cons
of taking blood thinners okay.
Thank you for visiting this video segment
of Dr. AFib, I'll see you next time.