July 2, 2019

From anticoagulants to surgical options, here’s what you need to know to prevent and reduce AFib stroke risks.


A diagnosis of atrial fibrillation (AFib) can sound scary, especially when learning about the associated risks. One of those risks: stroke.

Before we go over treatment options, let’s delve into the reasons why having AFib increases your chances of having a stroke. Sharon Shen, M.D., a cardiologist at Vanderbilt Heart, said there are two schools of thought. First, AFib-causing erratic and ineffective contraction of the top chambers of the heart can lead to the formation of blood clots. These can then travel to the brain and block blood flow. Second, AFib is an inflammatory state that makes the body more prone to creating blood clots, she adds.

Your doctor will find the right management solutions to keep AFib symptoms under control and help lower your risk of clotting. Here are a few strategies you’ll likely discuss to reduce any AFib stroke risks.


Lifestyle changes

If you’ve been diagnosed with AFib, it’s important to take good care of your body. Getting adequate sleep, staying hydrated and reducing stress help decrease chances of AFib stroke risks. “Maintaining a healthy weight, getting physically active, avoiding tobacco and controlling one’s blood pressure and blood sugar are key to avoiding stroke,” Shen said. “In addition to preventing stroke, losing weight has been shown to decrease AFib episodes and, for some, prevent AFib entirely.”


Blood-thinning medications

Your physician may prescribe anticoagulants, also called blood-thinners. Blood-thinners work to inhibit clots from forming, thereby helping to prevent AFib stroke risks.

There are several anticoagulants available. The American Heart Association now recommends that blood-thinning medications called non-vitamin-K oral anticoagulants (NOACs) be prescribed for stroke prevention rather than warfarin. Formerly, warfarin was the most prescribed blood-thinner for people with AFib. NOACs should be used unless the person has moderate to severe mitral stenosis or a mechanical heart valve. In those cases, warfarin is still the recommended prescription. Patients who have a bioprosthetic (tissue) valve can take NOACs, however.

“Both types of blood thinners are very effective at preventing stroke in atrial fibrillation,” Shen said, “but the challenge with warfarin is that the strength of the medication is easily affected by what one eats, how much one eats, other medications and one’s health that day.” Required regular blood tests for warfarin-users ensure that the level of medication in their system is not too high or too low.

“NOACs are different in that their blood-thinning effect is very stable and predictable once the correct dose is chosen, based on certain clinical factors such as age, weight and renal function,” Shen said. NOACs don’t require regular blood tests, are not affected by diet and have fewer drug interactions than warfarin. That’s why patients often find that taking an NOAC is more convenient than taking warfarin.

Your physician will help determine which blood-thinner is right for you. “Periodically checking with your doctor that you’re on the best blood thinner for your condition and current circumstances is a smart thing to do,” said Shen, “and it should be a part of your regular doctor’s visits.”


Additional options

Your doctor might also prescribe you other medications to control AFib symptoms or may discuss surgical options called catheter ablation. Catheter ablation works by scarring or destroying specific heart tissue to interrupt the signals that cause the irregular heart rhythm. If someone has heart failure, AFib medications aren’t working or any side-effects affect quality of life, surgery becomes a primary consideration. Keep track of your symptoms and side effects, and let your doctor know how you feel. Your physician will work with you to find the best treatment plan for your condition and lifestyle.

heart attack in women

The Vanderbilt Heart and Vascular Institute’s team treats all types of cardiovascular diseases and conditions, from the common to the complex. Our team is consistently recognized by U.S. News & World Report among the best heart hospitals in the nation and the best in Tennessee. Our wide range of services are offered in convenient locations throughout the region.

Learn more