Dr. J.B. Ketner of Seward Memorial Healthcare Systems discussed atrial fibrillation and the use of blood thinners during the hospital’s Fridays for You on Sept. 2. He said patients with a-fib need to weigh the risks of the condition with the bleeding risks of taking blood thinners.
Dr. J.B. Ketner of Seward Memorial Healthcare Systems discussed atrial fibrillation and the use of blood thinners during the hospital’s latest Fridays for You.
On Sept. 2, Ketner said during his time as a doctor, atrial fibrillation has been a common condition in his patients.
According to Ketner, around five million Americans have a-fib and around nine percent of those older than 70 have the condition.
“This is not a rare disorder,” Ketner said.
Atrial fibrillation occurs when the atria, the upper chambers of the heart, don’t contract normally, Ketner said. Instead, they wiggle.
He said without these heart chambers contracting properly, how blood moves through the heart is affected, which can increase a person’s chance of a stroke.
Ketner said some people know exactly when their heart goes into a-fib, but others do not. He said the symptoms are mostly non-specific.
However, one symptom can be a sign of a-fib—a rapid heart rate, according to Ketner.
He said a regular heart beats around 60-80 times per minute. With a-fib, the heart might beat nearly 300 times per minute.
“Your heart can’t beat that fast,” Ketner said, adding that this causes people to feel a shortness of breath. “You feel generally bad.”
The heart not beating properly, Ketner said, can increase someone’s chances of a stroke by two to five percent each year. This means that the risk is multiplied by the years a person has left in their life.
Ketner also said a-fib is the most common preventable risk factor for a stroke.
Atrial fibrillation can cause a stroke because when blood is not moving, it tends to clot, Ketner said.
Clots are usually formed in the left atrial appendage, which Ketner described as finger-like appendages that hang off the left atria.
When the blood is not flowing properly through the heart, clots form in this appendage. These clots can dislodge and the first two exits from the heart go directly to the brain, Ketner said.
He added that once these clots are in the brain, they can cause a stroke.
Ketner said a-fib can be treated with blood thinners. But doctors and their patients must consider the balance between the risk of a stroke and the bleeding risk that comes along with taking blood thinners.
To do this, Ketner said doctors use two scoring systems to determine a person’s likelihood for a stroke. The higher the score, the more likely that person will benefit from blood thinners.
Ketner said he uses a scoring system called CHADS2, which stands for:
• Congestive heart failure.
• Hypertension.
• Age.
• Diabetes.
• Previous strokes.
There is a two after the patient’s stroke history because that criterion is weighed twice as much.
Someone who scores low on this system may not benefit from blood thinners because the bleeding risk may be too high, Ketner said, because blood thinners can prevent important blood clots from forming.
“Clots aren’t all bad,” Ketner said. “We couldn’t survive without them.”
Ketner said if a patient would benefit from blood thinners, there are a few options.
Coumadin is the most common blood thinner, Ketner said, because it was the only one used for a-fib for a long time. Now, there are also Factor Xa inhibitors that are also available.
Ketner said Coumadin works as a vitamin K inhibitor. Vitamin K is necessary in forming blood clots.
He added that there are some negatives that go along with taking Coumadin. For instance, it interacts with many other medications and it requires close monitoring by a health care provider because some people handle Coumadin well while others do not.
“There are just a lot of things that affect it,” Ketner said.
While Coumadin takes five to seven days to work, it does have a positive in being easily reversible, Ketner said. This is important if a patient taking blood thinners is ever in an accident or needs surgery. The blood-thinning effects can be reversed to make an operation or treatment safer.
Ketner said another plus for Coumadin is that it is an inexpensive generic drug.
“It’s dirt cheap,” Ketner said.
Factor Xa drugs inhibit other clotting factors in the body and they work much more quickly, Ketner said.
However, they are expensive and not as easily reversed.
One Factor Xa drug, Pradaxa, does have a reversing agent. However, Ketner said it’s roughly $5,000 a dose and is only used in emergencies.
He added that it is possible an IV infusion could reverse the blood thinning effects of these drugs, but it is still being studied.
If a person is on blood thinners, Ketner said patients should remember their bleeding risks. Two risks he mentioned were falls and head trauma and ulcers.
“Even minor head trauma when you’re on [blood thinners] can cause bleeding around the brain,” Ketner said.
Ulcers and other gastrointestinal bleeding typically don’t last very long, but this is not true for those taking blood thinners.
He compared it to cutting while shaving. He said usually the bleeding stops quickly with minor cuts, but blood thinners can cause that bleeding to last longer.
“It’s not a little, minor thing,” Ketner said.
