Science moves fast. The American Academy of Neurology on Monday issued new guidelines on the use of blood thinners for people with an irregular heartbeat, after last considering the issue in 1998. Since then, several new anticoagulants have proven at least as effective as the traditional warfarin treatment for nonvalvular atrial fibrillation, and is safe for those who’ve survived stroke or its precursor, a transient ischemic attack.
Dr. Antonio Culebras, an Academy fellow at SUNY Upstate Medical University, says blood thinners are especially important for people at risk of stroke. "The World Health Organization has determined that atrial fibrillation is nearing epidemic proportions, affecting 0.5 percent of the population worldwide,” he said in a statement.
Although presenting no immediate danger, an irregular heart rhythm allows blood to collect in the heart’s upper chambers, where it may clot. Eventually, blood clots forming in the heart may flow to the brain, obstructing vessels and arteries. Approximately one in 20 Americans with an untreated irregular heartbeat will suffer stroke this year, the Academy says. To date, doctors have exercised caution in prescribing blood thinners, wary of the risk of bleeding. However, new drugs on the market carry a reduced risk of bleeding in the brain, with much greater convenience. Patients on warfarin today require frequent blood testing to monitor risk for bleeding.
But wait, there’s more. A greater safety profile for blood thinners extends the range of patients who might benefit. Such drugs may now help more elderly patients, including those with dementia and those at moderate risk of falls — factors considered too dangerous for the old-line of anticoagulants.
"Of course, doctors will need to consider the individual patient's situation in making a decision whether or not to use anticoagulants, and which one to use, as the risks and benefits can vary for each person," Culebras said.
As a point of clarification, Culebras emphasized that the Academy’s guidelines differ for developing countries where newer blood thinners may be either unavailable or unaffordable. Where available, however, doctors should be prescribing more of these life-saving drugs, experts say.