Living with Atrial Fibrillation: Preventing Stroke

Atrial fibrillation (AFib) is the most common abnormal heart rhythm in the world. The heart has 2 upper chambers called atria and 2 lower chambers called ventricles. AFib causes the atria to quiver (fibrillate) instead of pumping normally. Blood can then pool in the heart instead of moving in and out as usual. This can cause blood clots to form inside the heart. A clot can break free, travel to the brain and cause a stroke. A stroke can cause brain damage very quickly.

Taking medicine to prevent stroke

Your healthcare provider may prescribe a medicine to help prevent blood clots. This type of medicine is called a blood thinner. Blood thinners include:

• Antiplatelet medicines, such as aspirin or clopidrogrel

• Anticoagulation medicines, such as warfarin, dabigatran, rivaroxaban, apixaban, or edoxaban

Risks of blood thinner medicine

Blood thinners increase your risk of bleeding. If you take certain blood thinners, you may need to take extra steps to stay healthy. You may need regular blood tests to check the levels of medicine in your blood. You’ll need to be careful not to injure yourself. And you may need to watch your diet for foods that affect blood clotting.

If your blood is too thin, you may have symptoms of excess bleeding, such as:

• Unusual bruising

• Bleeding from the gums

• Blood in the urine or stool

• Black stools

• Vomiting blood

• Nosebleeds

• An unusual or severe headache

Taking the right dose

You’ll need to make sure to take the medicine exactly as directed by your healthcare provider. Take it at the same time each day. If you miss a dose, call your provider right away to find out how much to take. Never take a double dose. If you take too much, it can cause too much bleeding. It can cause bleeding you can see, on the outside of your body. And it can cause bleeding on the inside of your body that you may not be aware of.

Getting your blood tested

Depending on which blood thinner you take, you may need to have your blood tested on a regular schedule. This is to make sure you don’t have too much or too little of the medicine in your blood. Too much can cause excess bleeding. Too little may not prevent blood clots from harming you.

You may need to visit a hospital or clinic every week to have your blood tested. Or a nurse may come to your home and test your blood. In some cases, you may be able to test your blood at home with a small machine. Talk with your healthcare provider to find out what’s best for you. After the blood test, your healthcare provider may tell you to change your dose of medicine.

Watching your diet

Some foods can affect how certain blood thinners work. In particular, warfarin levels are sensitive to your diet. For example, many foods contain vitamin K. Vitamin K is a substance that helps your blood clot. You don’t need to avoid foods that have vitamin K. But you do need to keep the amount of them you eat steady as possible from day to day. Examples of foods high in vitamin K are asparagus, avocado, broccoli, cabbage, kale, spinach, and some other leafy green vegetables. Oils, such as soybean, canola, and olive, are also high in vitamin K.

Other foods and drinks can affect the way blood thinners work in your body. These include:

• Grapefruit and grapefruit juice

• Cranberries and cranberry juice

• Fish oil supplements

• Garlic, ginger, licorice, and turmeric

• Herbs used in herbal teas or supplements

• Alcohol

If any of these items are part of your regular diet, continue using them as you normally would. Don’t make any major changes in your diet without first talking with your healthcare provider.

You may also need to limit fats in your diet to 2 to 4 tablespoons a day.

Preventing injury

Because blood thinners make you bleed more, you’ll need to protect yourself from breaks in the skin. Follow these guidelines:

• Don't go barefoot – always wear shoes.

• Don't trim corns or calluses yourself.

• Consider using an electric razor instead of a manual one.

• Use a soft-bristled toothbrush and waxed dental floss.

You’ll also need to avoid any activities that may cause injury. If you fall or are injured, you could be bleeding inside your body and not know it. Make sure to get medical attention right away if you fall, hit your head, or have any other kind of injury.

Other safety tips

While on your medicine, be sure to:

• Tell all of your healthcare providers that you take a blood thinner for AFib. This includes all of your doctors, dental care providers, and your pharmacist.

• Ask your doctor before taking any new medicines, vitamins, or other supplements. Any of these can cause problems when you take a blood thinner.

• Wear a medical alert bracelet or carry an ID card in your wallet if you will be taking blood thinners for months or longer.

• Keep all appointments for your blood tests.

Procedures to prevent stroke

Most blood clots that form in the heart occur in a pouch of the left atrium called the appendage. This pouch can often be large and have multiple lobes which can permit blood pooling and clot formation. Left atrial appendage closure is a nonsurgical procedure in which a self-expanding plug is placed at the opening of the left atrial appendage to close off the appendage from the rest of the heart. Once the plug has fully sealed, no blood can enter or leave the appendage. This reduces blood clot formation and stroke risk. Ask your doctor if you qualify for this type of procedure.

Other ways to help prevent stroke

Your healthcare provider might give you other advice about how to lower your risk for stroke, such as:

• Lowering your cholesterol with lifestyle changes or medicine

• Not smoking

• Getting physical activity

• Losing weight if needed

• Eating a heart-healthy diet

• Not drinking too much alcohol