Managing AF

Treatment options to reduce the risk of stroke for people with atrial fibrillation (AF)

Managing AF

Treatment options to reduce the risk of stroke for people with atrial fibrillation (AF)

If you are diagnosed with atrial fibrillation (AF), you should be aware that it is a condition that will not just disappear over time. If you are experiencing few to no symptoms, it is still recommended that you speak with your doctor on a regular basis. Individuals with AF have a significantly higher risk of stroke compared to those without AF. Your doctor will decide which treatment option is most appropriate for your individual circumstances.

Ken describes how he has been managing his atrial fibrillation (AF) since being diagnosed.

Medications

Medications specifically used to prevent clot formation and reduce stroke risk

The most common cause of stroke is a blood clot—which if you have AF, can form inside your heart and be pumped through your body. If this clot reaches your brain it has the ability to cause a stroke.

There are medications called anticoagulants available today that have been proven to help reduce the risk of stroke by preventing blood clots from forming.

These anticoagulants prevent blood from ‘coagulating’ or clotting by blocking the activity of clotting factors in the blood. They are usually an important part of the long-term medical treatment for people who have AF in whom anticoagulation medications are appropriate.

Patients unable to take oral anticoagulants may instead be prescribed an antiplatelet. Antiplatelets help prevent blood platelets from clumping together to form a clot thereby reducing the risk of stroke. Also, some patients may be given an antiplatelet that does not require a prescription, such as aspirin.

Below is an overview of oral anticoagulants and antiplatelets approved for use in Canada to help reduce the risk of stroke for patients living with AF. In consultation with you, your doctor will determine which medication will suit your individual requirements.

Oral Anticoagulants

PRADAXA™ (dabigatran etexilate capsules)

What it does

PRADAXA™ helps prevent clot formation by blocking the activity of a protein called thrombin.

When it should not be used
  • If you have body lesions at risk of bleeding, including bleeding in the brain (stroke) within the last 6 months
  • If you have bleeding such as recent bleeding of a stomach ulcer
  • If you have severely reduced kidney function or your kidneys do not function
  • During and shortly after use of epidural or spinal catheters
  • During pregnancy or breast feeding
  • If you use oral ketoconazole
  • If you are allergic to any ingredient in PRADAXA
  • If you are under 18 years old
  • If you have liver disease
  • If you have an artificial heart valve
  • If you are already taking medicines to prevent blood clots, e.g. warfarin (COUMADIN®), heparin, apixaban (Eliquis™), rivaroxaban (Xarelto®), unless your physician has decided to switch you to PRADAXA
Precautions

You should tell your doctor if you:

  • know you are at a higher risk of bleeding
  • have moderately reduced kidney function
  • are pregnant, plan to become pregnant or breast-feeding
  • have reduced liver function or liver disease
  • are going to have surgery of any type or any other invasive procedure
Use with other medications

To avoid potential drug interactions, always check with your doctor or pharmacist before you start taking any new medication. Be sure to tell your doctor or pharmacist about all medicines you are taking, or have recently taken, including any vitamins, herbal supplements or non-prescription drugs.

Your doctor will decide, if you should be treated with PRADAXA and how closely you should be monitored.

Common side effects

All prescription medicines carry some risk. As PRADAXA acts on the blood clotting system, most side effects are related to signs of bruising and bleeding.

Although rare, major or severe bleeding may occur and regardless of its location, may become disabling, life-threatening or even lead to death.

Patients treated with PRADAXA may experience the following: diarrhea, nausea, bruising, rash, itching, reflux of gastric juice, vomiting, difficulty swallowing, hives, upset stomach.

Regular blood testing to monitor the level of PRADAXA is not required. However, blood may be periodically monitored for other tests such as kidney and liver function, and anemia (number of red blood cells), for example. Testing may also be done if a patient is bleeding while taking PRADAXA.

This is not a complete list of side effects. Talk to your doctor or pharmacist for more information about this medication.

XARELTO® (rivaroxaban tablets)

What it does

XARELTO® helps to prevent blood clots from forming by blocking one of the molecules that causes blood clotting (known as Factor-Xa).

When it should not be used
  • If you have severe liver disease which leads to a increased risk of bleeding
  • If you have active bleeding, especially if bleeding excessively
  • If you are aware of body wounds or injuries at risk of bleeding, including bleeding in the brain in the last 6 months or bleeding in the stomach or gut
  • If you are taking certain oral medications to treat fungal infections or HIV/AIDS such as ketoconazole or ritonavir
  • During pregnancy or breast feeding
  • If you are allergic to any ingredient in XARELTO or have one of the following rare hereditary diseases: galactose intolerance, Lapp lactase deficiency, glucose-galactose malabsorption
  • If you have severe kidney disease
  • If you have an artificial heart valve
  • If you are under 18 years old
  • If you are already taking medicines to prevent blood clots, e.g. warfarin (COUMADIN®), heparin, apixaban (Eliquis™), dabigatran (PRADAXA™), unless your physician has decided to switch you to XARELTO
Precautions

You should tell your doctor if you:

  • know you have an increased risk of bleeding
  • are going to have surgery of any type
  • are pregnant or plan to become pregnant
Use with other medications

To avoid potential drug interactions, always check with your doctor or pharmacist before you start taking any new medication. Be sure to tell your doctor or pharmacist about all medicines you are taking, or have recently taken, including any vitamins, herbal supplements or non-prescription drugs. 

Your doctor will decide, if you should be treated with XARELTO and how closely you should be monitored.

Common side effects

Like all medicines, XARELTO can cause side effects. As XARELTO acts on the blood clotting system, most side effects are related to signs of bruising and bleeding. In some cases bleeding may not be obvious, such as unexplained swelling.

Major or severe bleeding may occur and, regardless of location, may lead to disabling, life-threatening or even fatal outcomes.

Patients treated with XARELTO may also experience the following side effects: nausea, vomiting, stomach ache, constipation, diarrhea, indigestion, and decreased general strength and energy.

This is not a complete list of side effects. Talk to your doctor or pharmacist for more information about this medication.

ELIQUIS™ (apixaban tablets)

What it does

ELIQUIS™ helps to prevent blood clots from forming by blocking one of the molecules that causes blood clotting (known as Factor-Xa).

When it should not be used
  • If you are aware of body lesions at risk of bleeding, including bleeding in the brain (stroke) within the last 6 months
  • If you have certain types of abnormal bleeding such as recent bleeding of a stomach ulcer
  • If you have active bleeding, especially if you are bleeding excessively
  • If you have a severe liver disease which leads to increased risk of bleeding (hepatic coagulopathy)
  • If you are already taking medicines to prevent blood clots, e.g. warfarin (COUMADIN®), heparin, rivaroxaban (XARELTO®), dabigatran (PRADAXA™), unless your physician has decided to switch you to ELIQUIS
  • If you are also taking prasugrel (EFFIENT®) or ticagrelor (BRILINTA®)
  • ELIQUIS should not be used during pregnancy, since its effects on pregnancy and the unborn child are not known
  • If you use oral ketoconazole
  • During and shortly after use of epidural or spinal catheters
  • If you have an artificial heart valve
  • If you are younger than 18 years old and taking other anticoagulants
  • If you are allergic to any ingredients in ELIQUIS
Precautions

You should tell your doctor if you have:

  • an increased risk of bleeding
  • a severe kidney disease
  • a mild or moderate liver disease
  • a tube (catheter) inserted in your back
  • had an injection into your spinal column within the previous 5 hours, such as an epidural, for anaesthesia or pain relief
  • are pregnant, or plan to become pregnant or breast-feeding
  • had an operation for a hip fracture because this medicine has not been studied for this condition
Use with other medications

To avoid potential drug interactions, always check with your doctor or pharmacist before you start taking any new medication. Be sure to tell your doctor or pharmacist about all medicines you are taking, or have recently taken, including any vitamins, herbal supplements or non-prescription drugs.

Your doctor will decide, if you should be treated with ELIQUIS and how closely you should be monitored.

Common side effects

Like all medicines, ELIQUIS can cause side effects, although not everybody gets them.

Major or severe bleeding may occur and, regardless of location, may lead to disabling, life-threatening or even fatal outcomes.

Tell your doctor or pharmacist if you experience any of the following symptoms after taking this medicine: Like other similar medicines (anticoagulants), ELIQUIS may cause bleedings, which could possibly lead to anemia, (a low blood cell count which may cause tiredness or paleness). In some cases this bleeding may not be obvious. Nausea (feeling sick) is also a common side effect.

Patients treated with ELIQUIS may also experience allergic reactions such as rash, hives, swelling or difficulty swallowing or breathing.

This is not a complete list of side effects. Talk to your doctor or pharmacist for more information about this medication.

COUMADIN® (warfarin sodium)

What it does

COUMADIN® helps reduce clots from forming in the blood by partially blocking the re-use of vitamin K in your liver. Vitamin K is needed to make clotting factors that help the blood to clot and prevent bleeding.

When it should not be used
  • Do not take COUMADIN during pregnancy. Use effective measures to avoid pregnancy while taking COUMADIN
  • Do not start, stop, or change any medicine except on advice of your health care provider. COUMADIN interacts with many different drugs, including aspirin and aspirin-containing ointments and skin creams as well as natural medicines (e.g., bromelains, coenzyme Q10, danshen (Colocasia antiquorum), dong quai (Angelica sinensia), garlic, ginkgo biloba, ginseng and St. John’s wort)
  • Do not take any other medicines that contain warfarin. Warfarin is the active ingredient in COUMADIN
  • Do not make drastic changes in your diet, such as eating large amounts of green, leafy vegetables. The amount of vitamin K in your daily diet may affect therapy with COUMADIN
  • Avoid intake of cranberry juice or any other cranberry products. Notify your healthcare provider if any of these products are part of your normal diet
  • Do not attempt to change your weight by dieting, without first checking with your health care provider
  • Avoid alcohol consumption
  • Do not participate in any activity or sport that may result in serious injury
  • Avoid cutting yourself
Precautions

You should tell your doctor if you:

  • have bleeding problems
  • fall often
  • have liver or kidney problems
  • have high blood pressure
  • have a heart problem called congestive heart failure
  • have diabetes
  • drink alcohol or have problems with alcohol abuse. Alcohol can affect your COUMADIN dose and should be avoided
  • are pregnant or planning to become pregnant
  • are breastfeeding. COUMADIN may increase bleeding in your baby. Talk to your doctor about the best way to feed your baby. If you choose to breastfeed while taking COUMADIN, both you and your baby should be carefully monitored for bleeding problems
Use with other medications

To avoid potential drug interactions, always check with your doctor or pharmacist before you start taking any new medication. Be sure to tell your doctor or pharmacist about all medicines you are taking, or have recently taken, including any vitamins, herbal supplements or non-prescription drugs.

Common side effects

Like all medicines, COUMADIN can cause side effects. Your health care provider can tell you about possible side effects of COUMADIN, which include bleeding and allergic reactions. The most common side effect of COUMADIN is bleeding, which may be serious and life-threatening. However, the risk of serious bleeding is low when the effect of COUMADIN is within a range that is right for your specific medical condition. To lower the risk of bleeding, your PT/INR should be kept within a range that is right for you, as determined by your healthcare provider. Your prothrombin time (PT) are often recorded as an INR (International Normalized Ratio), a standard way of reporting prothrombin time. These tests help your health care provider to see how fast your blood is clotting and whether your dosage of COUMADIN should change. PT/INR tests will be needed at periodic intervals (such as one time per month) throughout your course of therapy to keep your PT/INR in the best range for your medical condition.

Please contact your health care provider right away if you experience any of the following signs or symptoms of bleeding problems:

  • headache, dizziness, or weakness
  • bleeding from shaving or other cuts that does not stop
  • nosebleeds
  • bleeding of gums when brushing your teeth
  • coughing up blood
  • vomiting blood or material that looks like coffee grounds
  • unusual bruising (black-and-blue marks on your skin) for unknown reasons
  • pink or dark brown urine
  • red or black color in your stool
  • more bleeding than usual when you get your menstrual period or unexpected bleeding from the vagina
  • unusual pain or swelling

This is not a complete list of side effects. Talk to your doctor or pharmacist for more information about this medication.

Antiplatelets

PLAVIX® (clopidogrel tablets)

Note: in patients with atrial fibrillation, PLAVIX is prescribed in combination with ASA

What it does

PLAVIX® helps reduce the chance of blood clot formation by preventing blood platelets from clumping together.

When it should not be used
  • If you are allergic to any of the substances contained in the tablets
  • If you have a medical condition that may cause bleeding, such as a stomach ulcer
  • If you have liver disease or damage
  • If you are under 18 years old
Precautions

You should tell your doctor if you:

  • are taking any other medications (such as ASA), drugs to reduce blood clotting (such as warfarin or heparin) or NSAIDS (used for pain and/or inflammation of muscles or joints), including those you buy without a prescription
  • are taking drugs to treat stomach ulcers or acidity (e.g. omeprazole)
  • have had an allergic reaction to any of the substances contained in the tablets
  • are pregnant or breast-feeding
  • have liver disease or damage
  • have a recent serious injury
  • have recently undergone surgery (including dental surgery)
  • will be having surgery
  • have a blood disorder that makes you prone to internal bleeding or tend to bleed longer than 10 minutes without taking any drugs
  • have a medical condition that is causing bleeding, such as a stomach ulcer
Use with other medications

To avoid potential drug interactions, always check with your doctor or pharmacist before you start taking any new medication. While you are on PLAVIX, it is important that you do not take any medicine other than that prescribed by your doctor. If you should see another doctor or dentist while you are using PLAVIX, you should inform them that you are using PLAVIX.

Common side effects

Occasional side effects reported with PLAVIX are: rashes and/or itching, diarrhea, abdominal pain, indigestion or heartburn, constipation, bleeding in the stomach, bowels or into the eye, liver and bile disorders, blood in the urine, generalized allergic reactions such as swelling of the face, lips and/or tongue, shortness of breath, bleeding from blood vessels inside the head has been reported in a very small number of cases.

This is not a complete list of side effects. Talk to your doctor or pharmacist for more information about this medication.

If you have been diagnosed with AF, don’t wait. Talk to your doctor about how to help reduce your stroke risk today. Only you and your doctor can determine the treatment plan that is right for you.

Pradaxa™ is a trademark used under license by Boehringer Ingelheim (Canada) Ltd. Xarelto® is a trademark of Bayer AG, used under license by Bayer Inc.

Eliquis™ is a trademark of Bristol-Myers Squibb Company used under license by Bristol-Myers Squibb Canada.

Coumadin® is a registered trademark of Bristol-Myers Squibb Company used under license by Bristol-Myers Squibb Canada.

Plavix® is a registered trademark of sanofi-aventis S.A., France; used under license.

Lifestyle/Reduce Risk

Can I do more to reduce my risk of stroke?

As part of your treatment plan, your doctor may also address other stroke risk factors you can control such as high blood pressure, high cholesterol, or diabetes. These, combined with understanding any history of previous strokes or transient ischemic attacks (TIA—an important predictor of stroke) will allow your doctor to treat these conditions appropriately, and bring them under control.

There may be additional stroke triggers such as being overweight, physical inactivity or smoking that your doctor may be able to assist you with.

Being diagnosed with AF can lead to a number of changes in your lifestyle. Find out more about how these changes will affect you here.

If you have been diagnosed with AF, it’s important to speak with your doctor frequently and follow his advice about how to help reduce your stroke risk. Only you and your doctor can determine the treatment plan that is right for you.

Continue reading about Talking to Your Family »