AFib Patients Need Vigilant Blood Thinner Monitoring

Early Bleeding Risk Highlighted in New Study

Primary care physicians are on the front lines of identifying heart conditions like atrial fibrillation (AF). Managing AF often involves prescribing blood thinners to mitigate a significantly increased stroke risk.

Understanding Anticoagulant Therapy

Individuals diagnosed with AF face a fivefold higher likelihood of experiencing a stroke. To combat this, blood-thinning medications, or anticoagulants, are frequently prescribed to reduce blood clot formation, as noted by the American Society of Hematology.

Up to six million Americans contend with AF, a condition whose prevalence escalates with age. The ASH reports that AF leads to an estimated 450,000 hospitalizations annually.

Crucial Early Monitoring for Safety

Close observation of how patients respond to blood thinners during the initial months of treatment is paramount. A recent study published in *Blood Advances* revealed that AF patients administered lower doses of oral anticoagulants encountered a greater frequency of bleeding events within the first three months of therapy.

When Should Doctors Prescribe Blood Thinners?

Primary care physicians (PCPs) should consider prescribing oral anticoagulants when they manage patients with atrial fibrillation, acute deep venous thrombosis, or acute pulmonary embolism. This recommendation comes from Dr. **R. Michael Benitez**, a cardiologist and professor at the University of Maryland Medical Center.

The decision hinges on a careful balance, weighing the patient’s stroke risk without medication against their potential for significant bleeding complications.

Clear Communication is Key

Physicians can demystify AF for patients by explaining that the heart’s upper chambers are not contracting effectively, leading to stagnant blood and clot formation. Dr. **Benitez** suggests explaining that even a small clot, about 2 mm, can cause a major stroke if it travels to the brain.

“The oral anticoagulant greatly reduces the risk of the formation of these blood clots and subsequent stroke. Stroke is a terrible event that, if survived, often changes a patient’s life permanently and significantly. In the setting of atrial fibrillation, anticoagulation greatly reduces the patient’s risk of stroke.”

—R. Michael Benitez, MD, Cardiologist

For deep vein thrombosis, doctors can illustrate how a leg clot might dislodge, travel to the lungs via the heart, and cause serious or fatal pulmonary embolism. Oral anticoagulants significantly lower this danger.

Strict Adherence to Medication Regimen

Daily adherence is critical for the effectiveness of these medications in preventing strokes. Newer direct oral anticoagulants, such as apixaban and rivaroxaban, act rapidly but also dissipate quickly. Missing even two or three doses can allow blood to clot normally again, underscoring the necessity of daily intake.

While warfarin’s effects are more prolonged, missing a dose can still impact anticoagulation levels. Patients should be reminded to take it daily as prescribed.

Discussing Potential Side Effects

It is vital to screen for drug interactions, especially when introducing new medications like antibiotics, as they can affect anticoagulation levels, particularly with warfarin. This vigilance is also important, though to a lesser degree, with direct oral anticoagulants.

Patients should be informed about minor bleeding like gum or nosebleeds that typically stop easily. However, they must monitor bleeding episodes and know how to respond if injured.

“If bleeding will not readily stop then medical attention is needed, and patients who incur major injury or trauma are likely to be taken to an emergency facility where it is important for the staff caring for them to know what anticoagulant they are taking, the dose, and when they last took it. Reversal agents are now available to normalize blood clotting.”

—R. Michael Benitez, MD, Cardiologist

Regarding diet, Dr. **Benitez** notes that most foods do not significantly interact with these medications. However, patients on warfarin require specific dietary guidance.

Warfarin, a vitamin K antagonist, necessitates limiting vitamin K-rich foods, as vitamin K acts as an antidote. Common sources include leafy greens like spinach and kale, but less obvious sources like cauliflower and soy products also contain vitamin K.

“It is important for the patient to familiarize themselves with vitamin K-containing foods and to keep the intake of them low and steady from day to day if they are taking warfarin,” stated Dr. **Benitez**.