- Hey, I'm Dr. Morales
and in this video I'm gonna talk
about blood thinners for AFib.
I wanna talk to people who specifically say
"Do I really need to take one?"
"I don't wanna take a blood thinner
for the rest of my life."
Completely understandable.
So in this video I'm gonna talk
about why blood thinners are prescribed,
understanding risk of stroke.
I'm gonna talk about blood thinner options.
I'm gonna talk,
even talk about natural blood thinners as well.
As well as procedural options
for stroke risk reduction as well.
So let's talk about blood thinners for AFib.
Blood thinners is one of the most common questions
that I get from patients who say,
"I don't wanna take blood thinners."
And it's understandable.
You get bruises easily,
you don't wanna take 'em.
But because there's risk.
There's risks for significant bleeding.
There's risk of injury,
having a significant injury
if you hurt yourself when you're on a blood thinner.
So it's significantly definitely something very concerning.
But they do work very well to reduce risk of stroke.
So let's talk about risk of stroke first.
For anybody who has AFib,
it's very important
to know what your overall risk of stroke is.
And because that really determines
whether or not you need to take a blood thinner long term
because I'm sure everyone would agree having a stroke
is the most debilitating consequence of having an AFib.
I mean when somebody gets a stroke
their life is changed overnight forever sometimes
because sometimes the stroke sometimes are not reversible.
So having a stroke is the most disabling,
terrible consequence of having AFib.
And so stroke risk reduction is a very important strategy
of managing anybody with atrial fibrillation.
And so understanding your personal risk of stroke
is probably one of the most important features
about understanding this question
about whether you need a blood thinner
and what's the right treatment option for you.
And so the most commonly used scoring system
for understanding your individual risk of stroke,
used by myself and using by grand majority of doctors
called the CHADSVASc Risk Score,
C-H-A-D-V-A-S-C.
Each one of those initials stands for something
and helps a doctor like myself calculate your risk
of stroke from AFib.
C stands for congestive heart failure.
H stands for hypertension.
A is for age 65 to 74
D is for diabetes,
S is for past stroke
B is for vascular disease,
Another age for age greater than 75.
And SC stands for sex category,
which women get an add additional point.
So all of these different little parts here give you
either one or two points depending on the individual risk
that you have,
such as having age greater than 75
actually gives you two points.
Whereas age less 65 to 74 is only one point, for example.
But some of them are two points,
some of them is only one point.
And then I'm gonna include a link underneath this video
so you can help calculate
what your own individual CHADSVASc risk score is.
And that really helps give you an idea,
as well as your doctor how they calculate
what your individual risk of stroke from.
And so the CHADSVASc Risk Score may go all the way
from zero all the way to nine
and that helps understand what the risk of stroke is
for over a year.
So the lowest people who have the lowest risk factor
you don't have all those things that I mentioned to you,
the CHADSVASc Risk Score is zero
that risk of stroke is less than 1%.
But people who have all the risk factors
that CHADSVASc Risk Score of nine
that's a risk of stroke of approximately 12% per year.
So there's a lot of variability depending
on your age as well as risk factors
in terms of having an understanding
your overall risk for stroke.
So obviously if you understand what your risk of stroke is
then you understand why some medications are recommended.
According to the American Heart Association
and the American College of Cardiology
stronger blood thinning medications,
and I'm gonna talk about the different options,
is recommended for anybody with AFib
who is a man who has a CHADSVASc Risk Score
of two or greater
or a woman who has a CHADSVASc Risk Score three or greater.
So a little bit of difference
whether you are a man or a woman.
So two for men or three or for women.
And if your points are higher than that
blood thinners are usually recommended.
Why is that?
So it's been going back many years actually.
The studies go back into the mid 1980s I believe
where warfarin was the original stronger blood thinner.
That was the first one that had been around
for a very long time.
And back in the eighties they were studied
that warfarin would significantly reduce risk of stroke.
Back in those days,
they actually compared warfarin to aspirin
because that was what was available in that time
and it was actually studied multiple times
what's better warfarin versus aspirin
to reduce risk of stroke?
And over and over and over again,
warfarin won over aspirin
in terms of reducing that risk of stroke.
And it just became very clear
that stronger blood thinning medications are needed
to give a satisfactory stroke risk reduction.
So for many years,
warfarin was the main treatment option
for reducing risk of stroke
for people who have had AFib.
Plus, if your stroke risk was high enough
to warrant taking a blood thinner.
In general with your stroke risk is relatively low,
like if you have a zero or one on the stroke risk score
taking strong blood thinners is optional.
Fortunately nowadays
there's newer blood thinning medication options.
Very popular ones out there now,
which have been out for several years now.
Eliquis is a very common one.
So is Xarelto, Pradaxa other ones out there
another one called Savaysa.
The good thing about these they work slightly different
than than a Warfarin does.
In addition,
the levels don't fluctuate the way that Warfarin did.
Warfarin was a medication
where your levels could fluctuate so much
from day to day depending on what you eat,
depending on your other medications,
and your levels could fluctuate a lot.
And there have been studies that looked in the past
that have shown many times people who are taking warfarin
they may not be
in the therapeutic range a good amount of time
despite the fact that you're actually taking the medication.
So having these newer medications has been a great advantage
for a lot of patients with AFib.
And in general,
these newer medications are by far recommended
for somebody new who has AFib these days
because the blood level thinning is consistent.
When all these newer medications were approved,
they were all compared to Warfarin
and they showed that they were equivalent
in terms of stroke risk reduction.
So they all,
whether it's Warfarin, Eliquis, Xarelto,
all these blood thinners,
they reduce risk of stroke by about 60 to to 70%.
So studies have time and time shown again
that stronger blood thinning medications
reduce risk of stroke significantly
for most people with AFib.
What about other blood thinning options?
People frequently ask me about aspirin.
Can I just take an aspirin for AFib?
It's a very common question that I have
and it all goes to relative blood thinning effects.
Some blood thinners are just stronger than others.
You can imagine somebody who's lifting weights in the gym,
Who can lift more weight,
the person who lifts 20 pounds
or the person who lifts a hundred pounds.
So the blood thinners,
yes, there's different kinds of blood thinners,
some things will thin your blood,
it's about the relative strength
of that blood thinning effect
and definitely the blood thinning effect
of stronger blood thinners like Warfarin,
Eliquis and Xarelto time and time again
when studied in tens
of thousands of patients have shown
that it is significantly reduced the risk of stroke
by usually about anywhere from 60 to 70%.
But getting back to aspirin,
aspirin was compared in studies in the eighties.
We're talking about almost 40 years ago now
that it was not as good as Warfarin
and that's because it
is a relatively much lighter blood thinning medication.
It's not nearly as strong as Warfarin
or these other newer blood thinner medication
in terms of how it actually thins your blood
and it's relative strength.
And so that's why it doesn't work as well
for reducing risk of stroke for AFib.
Now it's commonly used for other heart conditions as well.
People who've had blockages in their heart
that you may recommended to take an aspirin.
But when it comes to stroke risk reduction,
it's just usually not as sufficient for AFib
to the point that the most recent guidelines of AFib,
which came out a couple years ago,
it's pretty much stopped recommending aspirin for AFib
because it really just showed
that it really didn't make a difference
in terms of actually reducing people's risk of stroke.
So in general these days,
if your stroke risk is high enough,
again that's a stroke risk
of two for men or three for women,
stronger blood thinners are recommended.
If you're on the lower spectrum,
nothing is really necessary at this time
going by the American Heart Association
or American College of Cardiology guidelines
on treatment people with AFib.
Now what about natural blood thinning medications?
Another common question I get,
there's a few natural blood thinners out there.
Nattokinaseis is probably the most commonly one
that people ask me about.
There's a few other options out there.
Even things like turmeric
or some of the other and natural things maybe
have some blood thinning effects to it.
They certainly can thin your blood,
but then this all goes into the relative strength.
What is a stronger blood thinner?
Now when it comes to nattokinase,
which is a very common or popular question I get
on natural blood thinners
their only studies I've actually seen
about the blood thinning effects were in a Petri dish.
I mean there's never actually been looked at
in a human being
to see how well that this actually thins your blood.
So all I've seen is in a Petri dish
or you know in a lab experiment
and it is significantly less
of a blood thinning effect than aspirin.
So I just told you that aspirin was not strong enough
to reduce risk of stroke for people who have AFib
and natural blood thinners are gonna be even weaker
than the aspirin in terms of its blood thinning effects
and its ability to reduce risk of stroke
because risk of stroke is what we're trying to reduce here.
We're not trying to just thin your blood for no reason.
We're trying to reduce risk of stroke.
And clearly time and time again
the stronger blood thinners such as Eliquis, Xarelto,
or Warfarin been around a long time have shown
that they are completely a much better option
for reducing risk of stroke.
In addition,
I also wanted to mention there has been emerging evidence
over the last several years
about the risk of dementia with having AFib.
People who have AFib appear
to have increased risk for dementia.
And some of that may be
because for the long spectrum of having AFib,
you have AFib for years or sometimes even decades,
they can be just tiny little blood clots
that go to your brain,
not enough to really give you a stroke
or like, Hey, that one day I had a stroke.
But then over the course of many years
you have many of them
and then increases the risk for dementia.
So that's certainly been emerging evidence
over the last few years.
And what decreases that risk?
Let the new medication like Eliquis or Xarelto.
So this is another added reason
that stronger blood thinners are unfortunately needed
for the grand majority of people that have AFib.
Now what about getting procedures for AFib?
Let's say you get an ablation procedure for AFib,
you haven't noticed any symptoms for AFib.
Can you just stop the blood thinner?
Unfortunately the answer these days is no
because it appears at this time procedures for AFib,
although they can be very successful,
there's never 100% cure,
meaning that you'll never have AFib again
for the rest of your life.
You never think about it
and your risk of stroke goes down to zero.
So because of that,
there's been a long time recommended
that you go off of your risk of stroke,
based on your risk of stroke from that CHADSVASc Risk Score
not whether you had an ablation procedure or not.
And so I kind of counsel that to my patients.
When they come to see me and say
"I wanna get an ablation
because I don't want take this blood thinner anymore."
Well if your risk of stroke was high
before an ablation procedure
it's still high after an ablation procedure
and so that risk of stroke is still gonna be there
and blood thinners will commonly still be needed
even after an ablation procedure.
What about people who can't take blood thinners?
Let's say you have been taking blood thinners for a while
and you've actually legitimately
had a medical problem from it.
You've either had significant nose bleeds,
bleeding in your stool,
bleeding in your urine,
you have low blood counts or anemia.
Nobody can really figure out why.
Say you are somebody who's prone the falls,
say you have balanced problems
and you're significant injury risk,
well that can be quite problematic
to take strong blood thinning medications
if you've already had some legitimate bleeding issues
or if you've actually significantly a fall risk
to injure yourself.
And so at some stage you have to have a discussion
with your doctor
about whether being on blood thinners is worth the risk.
And there's certainly plenty of patients out there
where the risk of the blood thinners
actually tend to start to outweigh the benefit,
especially if you've had some significant bleeding issues
or you have a legitimate fall risk issue.
Fortunately in these days,
there's actually excellent procedure options right now.
When people have AFib,
the main risk of stroke comes from an area
in the left upper chamber of the heart called the appendage.
It's like a little pocket
in the left upper chamber of the heart.
That's where most blood clots form.
That's where the main risk of stroke AFib comes from.
So people take blood thinners to reduce the risk
of having a blood clot in that left atrial appendage,
that little pocket in the left upper chamber of the heart.
But obviously thins are blood everywhere.
You can get anemia,
get bleeding in your stool or urine,
but it does help to reduce the risk of blood clots
in that little pocket right there.
However, getting rid of that pocket,
getting rid of that appendage can actually help you
get off of blood thinning medication.
Then there's actually been data
that shows that it is safe
and you can actually prevent the risk of stroke
from doing it.
There's few ways to do it.
These days one of the most common ways
is called a Watchman procedure.
This is a procedure that I do
and many cardiologists and electrophysiologists do this.
Basically going through your groin
take a catheter that goes up to your heart
and deploy a plug from the inside
to help seal that area off
so that it's no longer part of the circulation.
It's like sealing off a little pocket area of the heart
and it can be very useful for reducing risk of stroke.
Watchman been around a long time.
It's been approved for well over five years now.
Plenty of real world data will show
that it's safe,
it's effective,
and it can help reduce risk of stroke,
while not needing the really strong
blood thinning medication.
So it certainly can be an option for many people.
These days there's actually a few competitors as well.
There's another product called a Amulet,
which came out pretty recently.
That's something very similar to Watchman,
just a different shape made by a different company.
And it's actually very good
that there's different options out there right now.
In addition, there's also surgical options as well.
There's ways in which a heart surgeon
can actually sew down
or clip that appendage from the outside,
which also may work to help reduce risk of stroke
that where you don't need to take blood thinning medication.
But unfortunately all of these involve procedures.
I've done many Watchmans of people
and I found it to be a very good option
for people who otherwise cannot tolerate
traditional blood thinning medications.
So hopefully at this video you realize
that blood thinners are actually really important
and they can be very helpful
for reducing risk of stroke
as well as risk of dementia.
But there may not to be the right treatment for everybody.
Depending on your risk of stroke,
you may not need strong blood thinning medication.
There is also procedure options as well.
If you're worried that you may be stuck
with your blood thinners for the rest of your life,
your risk of stroke can change over time.
So your risk of stroke what it is today
may not be that way in a year or two.
Now there's some things that you cannot change.
You cannot change your age,
I wish you could get younger,
but there's no way to really get younger
and change your age.
But things such as your high blood pressure,
diabetes, they can get better.
And so your risk of stroke,
which may be a four,
might be one or two
in a few years if you lose weight,
or improve your blood pressure,
or improve your diabetes.
So that risk of stroke can get better over time
and that might reduce your risk of stroke
and maybe you end up
not needing blood thinning medication as well.
When people who have AFib,
lifestyle modifications are absolutely essential.
They can help reduce your reliance
on medications without procedures,
which is why I created
"The Take Control over AFib" program.
"The Take Control over AFib" program
is a step by step plan to reduce AFib naturally
to improve your symptoms,
reduce inflammation,
and reduce your reliance on medications.
So underneath the video
there's gonna be a link to my program
where you'll get to learn more about the program itself,
understand what's included in the program,
as well as see testimonials
from people who have actually taken the program
and see what they have to say.
So click the link underneath the video.
Check it out for yourself.
And I wish you the best for your AFib.