Atrial fibrillation can produce palpitations, shortness of breath, lightheadedness, weakness, and chest pain, or may occur without symptoms. The main concern, however, is that atrial fibrillation can lead to the formation of blood clots in the heart, which can travel to the brain and cause a stroke.
Anticoagulants have been known for many years to produce a striking (more than 50%) decrease in the rate of stroke, but they also prevent clotting in locations and situations where clotting is desirable. In other words, they can cause bleeding
warfarin had been the only drug approved for the prevention of stroke in patients with atrial fibrillation. In the last few years new oral anticoagulants have been approved by the FDA.
dabigatran, rivaroxaban, and apixaban. Like warfarin, all three are ‘blood thinners’ that reduce the overall risk of stroke related to atrial fibrillation but they also cause bleeding.
dabigatran, rivaroxaban, and apixaban have some advantages, including fewer interactions with food and other drugs, rapid onset, and freedom from the need to have periodic blood test monitoring. And whereas the effects of these drugs wane within a short time frame after they are stopped, a day or so, the effects of warfarin persist for many days after it is discontinued.
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