Not enough people with a heart condition called atrial fibrillation (AF) are getting the medications that might help save their lives, the National Stroke Association (NSA) says.
Three out of four strokes could be prevented if patients with AF were put on anticoagulants, or blood thinners, NSA says. Yet only 55 percent of nearly 40,000 AF patients released from the hospital were prescribed anticoagulants, according to data compiled for The Stroke Report, a research initiative sponsored by NSA.
AF causes an irregular pumping action of the heart, and the erratic blood flow causes blood to pool in the heart, increasing the risk of a blood clot. About 2 million Americans are affected each year, according to the American Heart Association. AF contributes to 90,000 strokes a year in the United States, and having AF greatly increases the risk of death or severe brain damage from a stroke.
About 750,000 people suffer a new or recurrent stroke each year, and of these 160,000 people die, making stroke the third leading cause of death in the United States, following heart disease and cancer.
“There is a dogma that patients over a certain age shouldn’t be put on anticoagulants because it is too risky,” says Arthur Pancioli, M.D., assistant professor and vice chairman of the department of emergency medicine at the University of Cincinnati Medical Center in Cincinnati and a spokesman for the American Stroke Association.
Pancioli points out that physicians worry about causing excessive bleeding, which may happen when anticoagulant dosages are not individually monitored and adjusted. Yet, when used at proper doses, these blood-thinning drugs help prevent excess clotting that could lead to strokes.
He says some patients may not comply with the strict monitoring of the medication. Patients may see the regular checks, which can be as often as every week, as inconvenient or uncomfortable.
Drug therapy is difficult to sustain, Pancioli says. “We are human beings. We find it hard to accept our own mortality.” He notes some of the noncompliance could be due to a lack of public education about the importance of stroke prevention.
Excessive bleeding can lead to serious complications with organs such as the liver, deprive the brain of oxygen or even cause dangerously low blood pressure. This is particularly problematic among people older than 80 whose bodies aren’t as resilient as younger people’s are.
A study in Stroke: The Journal of the American Stroke Association found that elderly people taking warfarin, a common blood thinner, had a 24 percent relative risk reduction of death or hospitalization for stroke or mini-strokes compared to a 5 percent relative risk reduction in those who received aspirin.
Research also showed that only half of the people judged to be good candidates for the treatment actually got the medications. People with high blood pressure usually aren’t put on blood thinners.