Blood Thinners continued...
While Coumadin has been around longer, periodic blood tests to check on Coumadin levels may be less desirable. Pradaxa (twice a day) and Xarelto (once a day) may be more convenient, but can also be more costly. "Pradaxa also has certain bleeding risks that you don’t have with Coumadin; if you’re in a traumatic accident, the drug’s effects may be more difficult to reverse," Wylie adds.
Xarelto is approved to prevent stroke in patients with AFib not caused by a heart valve problem. It also raises the risk for bleeding. But Xarelto can also raise the risk of stroke if people stop taking it without medical supervision. That's the main warning in the "black box" on the Xarelto label. A black box warning is the FDA's strongest warning.
Xarelto had previously been approved to prevent blood clots in patients receiving hip and knee replacements.
Eliquis is approved only for use in people with AFib that is not caused by a heart valve problem. People with prosthetic heart valves should not take Eliquis. Study results showed that people who took Eliquis twice a day had 21% fewer strokes than those on the blood thinner warfarin. Monthly blood tests are not required for those taking the drug. Eliquis is now the third new blood thinner to be approved as an alternative to warfarin since 2010.
Rate Control Medications
Once your stroke risk is addressed, you may live a perfectly normal life if you don't have symptoms of atrial fibrillation, such as shortness of breath, fatigue, and dizziness. But it’s not wise to go too long with a heart that’s beating too fast.
“If your heart rhythm is off but the rate isn’t too fast, that isn’t as much of a problem,” says Whang. “But when the heart rate is over 100 beats per minute for very long, the bottom pumping chamber -- the ventricle -- can become weak.” This leads to a condition called cardiomyopathy, which puts you at greater risk for heart failure.
The medications that slow down a racing heart are known as rate control medications. There are two types that are most commonly used:
- Calcium channel blockers
These drugs have been used in millions of people for many years to treat high blood pressure and coronary artery disease. “They’re very well understood, and very well tolerated,” says Whang.
Your doctor may also prescribe medications called anti-arrhythmics to address the irregularity of atrial fibrillation. Not everyone with AFib needs them. If you aren’t bothered by symptoms from your AFib, your doctor may decide that correcting the rhythm may not be worth the side effects of the various medications that are available.