The heart can be compared to a two-story villa, with two important "rooms" – the left atrium and the right atrium. Like our home, the heart has walls, doors, pipelines, and an electrical system. Today, let's explore the heart's "electrical system" and the issues related to atrial fibrillation with a doctor.

1. What Is Atrial Fibrillation? Do All Patients Need Anticoagulants?

1.1. What Is Atrial Fibrillation?

The heart has an internal electrical system known as the cardiac conduction system, which controls the heartbeat. The central control of this system is the sinoatrial (SA) node, located in the upper part of the right atrium. The SA node sends out electrical signals approximately 60-100 times per minute, ensuring the heart beats in an orderly rhythm.

When this conduction system becomes disorganized, the heart can beat irregularly. If a certain area in the heart's electrical system continuously fires signals, the heart quivers instead of contracting rhythmically, leading to atrial fibrillation (AF).

Atrial fibrillation can cause serious complications, particularly stroke, which has high treatment costs, a high disability rate, and a significant risk of death. Research has shown that anticoagulant therapy is the most effective way to prevent stroke caused by AF.

1.2. Common Anticoagulant Medications

Patients with atrial fibrillation are typically prescribed one of two main types of anticoagulants:

• Warfarin (traditional anticoagulant)
• Newer oral anticoagulants (NOACs)

It's important to note that antiplatelet drugs like Aspirin and Clopidogrel are not as effective in preventing AF-related strokes as anticoagulants. Therefore, anticoagulants are preferred over antiplatelet drugs in AF treatment.

1.3. Do All Atrial Fibrillation Patients Need Anticoagulants?

Not all AF patients require anticoagulation therapy. Only those at high risk should be on long-term anticoagulation.

It is crucial to understand that stroke risk does not depend on the severity of AF symptoms. Even patients with no noticeable symptoms can still be at high risk of stroke if left untreated.

If a patient has no contraindications to anticoagulants and is at high risk, they should take anticoagulants for life to prevent stroke and thromboembolic complications.

2. Important Considerations When Using Anticoagulants (Warfarin)

2.1. Key Points When Taking Warfarin

• Regular INR monitoring (blood clotting test) is required to adjust the dosage.
• Ideal INR range: 2.0 - 3.0
  • If INR < 2.0 → Ineffective anticoagulation, increased risk of blood clots.
  • If INR > 3.0 → High risk of bleeding.
• Diet can affect Warfarin’s effectiveness:
  • Vitamin K-rich foods (leafy greens, broccoli, spinach) can reduce its effect.
  • Certain foods may increase the risk of bleeding—consult your doctor.
• If you experience any issues while taking Warfarin, consult your doctor immediately.

2.2. Potential Complications of Warfarin

• Warfarin can cause osteoporosis, increasing the risk of fractures, especially in older adults.
• Long-term use may weaken bone quality, requiring calcium and vitamin D supplementation if necessary.

2.3. Advantages of New Generation Anticoagulants

New oral anticoagulants (NOACs) such as Dabigatran, Rivaroxaban, and Apixaban have several advantages:

✔️ High effectiveness with fewer side effects
✔️ No need for regular INR monitoring
✔️ Fewer food and drug interactions
✔️ Lower risk of intracranial bleeding

However, liver and kidney function should be monitored periodically, especially in elderly patients and those with underlying conditions.

2.4. Side Effects of Anticoagulants

• Serious bleeding: Brain hemorrhage (requires immediate medical attention).
• Mild bleeding: Gum bleeding, bruising—usually not a major concern.
• Warning signs of dangerous bleeding:
  • Blood in urine or stool
  • Severe headaches
  • Nausea and dizziness
  • If these occur, seek medical attention immediately.

2.5. What to Do If You Miss a Dose of Anticoagulants?

• If you miss a Warfarin dose within 4 hours → Take it immediately.
• If more than 4 hours have passed → Skip the missed dose and continue the next day.
• Never double the dose the next day to compensate.

2.6. What to Do If You Overdose on Anticoagulants?

Overdosing on anticoagulants can cause severe bleeding, such as:

• Blood in urine, stomach bleeding, or brain hemorrhage.
• If an overdose is suspected, seek immediate medical help for evaluation and dose adjustment.

2.7. How Long Should Anticoagulants Be Used?

• Anticoagulation therapy is usually long-term.
• Stopping anticoagulants without a doctor's approval significantly increases stroke risk.
• With newer anticoagulants, INR monitoring is not needed, making long-term treatment more convenient.

Conclusion

• Atrial fibrillation can lead to stroke, but anticoagulant therapy can prevent it.
• Not all patients need anticoagulants, but high-risk patients must adhere to long-term treatment.
• Warfarin requires INR monitoring, while newer anticoagulants offer more convenience.
• Never stop taking anticoagulants on your own, and consult a doctor if you experience unusual symptoms.
• A balanced diet and regular health check-ups are key to managing the condition effectively.

By following proper treatment, we can prevent strokes and protect heart health! 🚀💙