Living well with AFib starts with self-advocacy

JANET

Age 72

Diagnosed with AFib in 2014

This year's our 50th wedding anniversary. We're getting the whole family and grandkids and everything together," says Janet S., age 72. Janet is celebrating this milestone on a family trip where the whole clan plans to listen to live music and go to amusement parks.

In 2014, while getting bloodwork done for an unrelated procedure, Janet was diagnosed with AFib. Luckily, her procedure went well, but her AFib remained since it is a separate condition. At that point, Janet worked with her doctor to understand her diagnosis while also doing her own research.

lineWhat is AFib?

AFib is an irregular heartbeat that keeps the upper and lower chambers of the heart from working together. This can cause blood to pool in the heart, which can lead to complications like blood clots.

Up to 6.1 MILLION Americans are estimated to have atrial fibrillation (AFib), a condition that causes:

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IRREGULAR HEARTBEAT

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HEART PALPITATIONS

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Which lead to:
BLOOD POOLING IN THE HEART

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Causing:
A BLOOD CLOT TO FORM

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"The causes of AFib are varied," explains Dr. Sanjum Sethi, a cardiologist at Columbia University Medical Center. Other causes include high blood pressure, sleep apnea, excessive consumption of alcohol, being overweight, smoking, diabetes, a family history of AFib, and other heart conditions.

If you have a heart valve problem or prior cardiac surgery, those could predispose you to AFib, but most commonly, it's a disease of aging…as we age, the incidence [of AFib] increases quite dramatically."

Dr. Sanjum Sethi

lineJanet's Stroke Risk

Janet's doctor explained the CHA2DS2-VASc score to her, which is based on certain conditions that determine risk for stroke. “The scoring system helps us determine what the actual risk is for developing stroke if you have AFib. Not every patient who has AFib is at equal risk for stroke. The CHA2DS2-VASc score allows us to determine which patients will benefit the most from receiving anticoagulation," explains Dr. Sethi. Janet has a score of 3 out of 9, with her age, gender, and type II diabetes as the three factors.

You can find out your score by using this calculator.

CHA2DS2-VASc: KNOW YOUR RISK

Add points below for each condition you have

Points
Condition
Points
Condition
1

CONGESTIVE HEART FAILURE

Signs/symptoms of heart failure confirmed with test of heart failure

1

HIGH BLOOD PRESSURE

Resting blood pressure >140/90 on at least 2 occasions or on blood pressure meds

1

AGE 65 TO 74 YEARS

1

DIABETES MELLITUS

Fasting blood sugar >125 mg/dL or on medications or insulin

2

STROKE

Includes any history of stroke

1

VASCULAR DISEASE

Prior heart attack, peripheral artery disease, or aortic plaque

2

AGE 75 YEARS OR OLDER

1

SEX CATEGORY (FEMALE)

Female gender means a higher risk

The American Heart Association recommends anticoagulation with a blood thinner for a score of 2 OR HIGHER.

REMINDER: Even if you are taking medicine to treat your AFib and not experiencing symptoms, YOUR STROKE RISK WILL CONTINUE TO INCREASE OVER TIME.

YOUR DOCTOR IS ALWAYS YOUR BEST RESOURCE. He or she knows your situation best and can help you determine a treatment plan.

lineSymptoms

Common symptoms of AFib are a rapid and irregular heartbeat, heart palpitations, chest pain or pressure, dizziness, fainting, shortness of breath, or fatigue—but some people experience no symptoms at all. When Janet was first diagnosed, she would experience short periods of heart racing but was lucky that her symptoms never reached extreme levels.

AFib is tricky in the sense that some people are very symptomatic, and some people have no symptoms at all. AFib is an electrical problem of the heart where the top chamber is beating a lot faster than the bottom chamber. The body is often able to compensate for the electrical problem, so you may experience no symptoms at all."

Dr. Sanjum Sethi

Because of all her research, Janet was aware that AFib can cause blood clots, which can lead to stroke, so she made the decision with her doctor to start an aspirin regimen to lower her risks.

People with AFib are5 TIMES MORE LIKELY to have a stroke

Stroke is a serious consequence of AFib. Complications from AFib, such as heart palpitations and irregular heartbeats, can cause blood to pool in the heart, where a clot can develop.

Why blood clots matter:

CLOTS CAN TRAVEL FROM
THE HEART TO THE BRAIN

CREATING BLOCKAGES

WHICH CAN CAUSE A STROKE

Even if you are treating your AFib and feeling fine, your stroke risk continues to increase over time. That's why it's important to periodically review your CHA2DS2-VASc score with your doctor.

Janet's
Turning Point

After initially treating AFib with aspirin, Janet saw a doctor who recommended a blood thinner called XARELTO. While aspirin was once considered a treatment for those at low risk for stroke, the AHA no longer recommends aspirin for the treatment of AFib, regardless of risk level. As her own best advocate, Janet stays up-to-date on the benefits and risks of taking XARELTO. Her husband also plays a large role in her health.

He really wants me to take XARELTO because he doesn't want me to have a stroke either. We support each other. He'll remind me to take my meds after dinner."

Janet

With 6 children and 15 grandchildren, there's no shortage of people who are counting on Janet to stay healthy. "I know how devastating [strokes] can be and I did think about my children and grandchildren and my husband…I thought if I could avoid having one, that would be good—live a longer life without impairment, that would be great. I know some people that've had strokes, and it's really tough," says Janet. Along with taking XARELTO, Janet now exercises more. She belongs to a local gym and goes on a vigorous walk once a week. This has also allowed her to take advantage of her city's metro park system.

Janet is proof that working with your doctor is integral to managing AFib-related stroke and blood clots. A combination of her own research and conversations with various doctors has led her to a plan that includes once-daily XARELTO to lower her risk for stroke. Because XARELTO is a blood thinner, it helps prevent or reduce blood clotting, which significantly reduces the risk of stroke in people with AFib not caused by a heart valve problem.

How did I get AFib?

There are different risk factors of AFib. Your doctor can help identify which ones apply to you.

It's also important to note that sometimes your doctor may not know why you developed AFib.

How is AFib related to stroke?

AFib can cause blood clots, which can lead to stroke. An irregular heartbeat can cause blood to pool in the heart, where a blood clot can develop. If a clot forms, it can travel from the heart to the brain and lead to a stroke.

How high is the chance for stroke?

People with AFib are five times more likely to have a stroke, and an AFib-related stroke is typically more severe than other types of strokes.

How do I determine my risk?

You can assess your risk with the CHA2DS2-VASc calculator. Your CHA2DS2-VASc score is based on certain factors that can determine your risk for stroke* and whether you need to take an anticoagulant blood thinner.

Add points for each condition you have.

*Stroke risk increases over time with age and other medical conditions.

What are my treatment options?

Medical treatment options for AFib range from medications, to procedures, to surgery, with the goal of getting your heart back into rhythm. There are a range of medications that can treat AFib, and you may already be taking one.

Some medications control your heart rate (like beta blockers), others control your heart rhythm (like sodium or potassium channel blockers), and blood thinners are prescribed to prevent blood from clotting. Your doctor will consider the severity of your AFib and risk of stroke in prescribing the best treatment for you.

How can I protect myself from increased stroke risk?

If your CHA2DS2-VASc score is 2 or higher, the American Heart Association recommends anticoagulation with a blood thinner. While there are a number of different types of anticoagulants available to help treat AFib, direct oral anticoagulants (DOAC) are one of the newest classes that have some notable advantages when compared to others, including no known dietary restrictions and no routine blood monitoring.

The AHA no longer recommends aspirin for AFib-related stroke risk protection, regardless of your risk level.

How can I manage my stroke risk with a DOAC?

XARELTO is a direct-acting oral anticoagulant blood thinner approved by the FDA that significantly reduces the risk of stroke in people with AFib not caused by a heart valve problem.

In fact, in a clinical study, more than 96% of people taking XARELTO remained stroke-free.

Work with your doctor to determine what's best for you. Consider the severity of your condition and your treatment goals.

What else can I do to support my health?

Heart-healthy activities will not only benefit your AFib condition but also help your overall health. This includes staying active, eating healthy foods low in fat and salt, controlling cholesterol, and maintaining an appropriate weight.

XARELTO offers 24-hour stroke-risk reduction in a once-daily pill.*

*Taken with the evening meal

In fact, in a clinical study, more than 96% of people taking XARELTO remained STROKE-FREE.

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If you have AFib, talk to your doctor about all your options.

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You'll also want to calculate your CHA2DS2-VASc score so you know what your risk for stroke is, or if it has increased.

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If you'd like to stay updated on XARELTO news, register here. And remember, you are not alone.

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There is a community of people with AFib just like you, and you can educate yourself and others by staying informed and spreading the word.

Help Reduce Your Risk of AFib-Related Stroke

Learn More
WHAT IS XARELTO (rivaroxaban)?

XARELTO is a prescription medicine used to:

  • reduce the risk of stroke and blood clots in adults who have a medical condition called atrial fibrillation that is not caused by a heart valve problem. With atrial fibrillation, part of the heart does not beat the way it should. This can lead to the formation of blood clots, which can travel to the brain, causing a stroke, or to other parts of the body
IMPORTANT SAFETY INFORMATION

WHAT IS THE MOST IMPORTANT INFORMATION I SHOULD KNOW ABOUT XARELTO?

XARELTO may cause serious side effects, including:

  • Increased risk of blood clots if you stop taking XARELTO. People with atrial fibrillation (an irregular heart beat) that is not caused by a heart valve problem (nonvalvular) are at an increased risk of forming a blood clot in the heart, which can travel to the brain, causing a stroke, or to other parts of the body. XARELTO lowers your chance of having a stroke by helping to prevent clots from forming. If you stop taking XARELTO, you may have increased risk of forming a clot in your blood.
  • Do not stop taking XARELTO without talking to the doctor who prescribes it for you. Stopping XARELTO increases your risk of having a stroke. If you have to stop taking XARELTO, your doctor may prescribe another blood thinner medicine to prevent a blood clot from forming.

  • Increased risk of bleeding. XARELTO can cause bleeding which can be serious and may lead to death. This is because XARELTO is a blood thinner medicine (anticoagulant) that lowers blood clotting. During treatment with XARELTO you are likely to bruise more easily, and it may take longer for bleeding to stop. You may be at higher risk of bleeding if you take XARELTO and have certain other medical problems.

You may have a higher risk of bleeding if you take XARELTO and take other medicines that increase your risk of bleeding, including:

  • Aspirin or aspirin-containing products
  • Long-term (chronic) use of non-steroidal anti-inflammatory drugs (NSAIDs)
  • Warfarin sodium (Coumadin, Jantoven)
  • Any medicine that contains heparin
  • Clopidogrel (Plavix)
  • Selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs)
  • Other medicines to prevent or treat blood clots

Tell your doctor if you take any of these medicines. Ask your doctor or pharmacist if you are not sure if your medicine is one listed above.

Call your doctor or get medical help right away if you or your child develop any of these signs or symptoms of bleeding:

  • Unexpected bleeding or bleeding that lasts a long time, such as:
  • Nosebleeds that happen often
  • Unusual bleeding from gums
  • Menstrual bleeding that is heavier than normal, or vaginal bleeding
  • Bleeding that is severe or you cannot control
  • Red, pink, or brown urine
  • Bright red or black stools (looks like tar)
  • Cough up blood or blood clots
  • Vomit blood or your vomit looks like "coffee grounds"
  • Headaches, feeling dizzy or weak
  • Pain, swelling, or new drainage at wound sites
  • Spinal or epidural blood clots (hematoma).People who take a blood thinner medicine (anticoagulant) like XARELTO, and have medicine injected into their spinal and epidural area, or have a spinal puncture, have a risk of forming a blood clot that can cause long-term or permanent loss of the ability to move (paralysis). Your risk of developing a spinal or epidural blood clot is higher if:
    • A thin tube called an epidural catheter is placed in your back to give you certain medicine
    • You take NSAIDs or a medicine to prevent blood from clotting
    • You have a history of difficult or repeated epidural or spinal punctures
    • You have a history of problems with your spine or have had surgery on your spine
  • If you take XARELTO and receive spinal anesthesia or have a spinal puncture, your doctor should watch you closely for symptoms of spinal or epidural blood clots.

    Tell your doctor right away if you have:

    • back pain
    • tingling
    • numbness
    • muscle weakness (especially in your legs and feet)
    • or loss of control of the bowels or bladder (incontinence)

    XARELTO is not for use in people with artificial heart valves.

    XARELTO is not for use in people with antiphospholipid syndrome (APS), especially with positive triple antibody testing.

    Do not take XARELTO if you or your child:

    • Currently have certain types of abnormal bleeding. Talk to your doctor before taking XARELTO if you currently have unusual bleeding.
    • Are allergic to rivaroxaban or any of the ingredients of XARELTO.

    Before taking XARELTO, tell your doctor about all your medical conditions, including if you or your child:

    • Have ever had bleeding problems
    • Have liver or kidney problems
    • Have antiphospholipid syndrome (APS)
    • Are pregnant or plan to become pregnant. It is not known if XARELTO will harm your unborn baby.
      • Tell your doctor right away if you become pregnant during treatment with XARELTO. Taking XARELTO while you are pregnant may increase the risk of bleeding in you or in your unborn baby.
      • Females who are able to become pregnant: Talk with your doctor about pregnancy planning during treatment with XARELTO. Talk with your doctor about your risk for severe uterine bleeding if you are treated with blood thinner medicines, including XARELTO.
      • If you take XARELTO during pregnancy, tell your doctor right away if you have any signs or symptoms of bleeding or blood loss.See "What is the most important information I should know about XARELTO?" for signs and symptoms of bleeding.
    • Are breastfeeding or plan to breastfeed. XARELTO may pass into your breast milk. Talk to your doctor about the best way to feed your baby during treatment with XARELTO.

    Tell all of your doctors and dentists that you or your child are taking XARELTO. They should talk to the doctor who prescribed XARELTO for you before you have any surgery, medical or dental procedure.

    Tell your doctor about all the medicines you or your child take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

    Some of your other medicines may affect the way XARELTO works, causing side effects. Certain medicines may increase your risk of bleeding. See "What is the most important information I should know about XARELTO?"

    HOW SHOULD I TAKE XARELTO?

    • Take XARELTO exactly as prescribed by your doctor.
    • Do not change your dose or stop taking XARELTO unless your doctor tells you to. Your doctor may change your dose if needed.
    • Your doctor will decide how long you should take XARELTO.
    • XARELTO may need to be stopped for one or more days before any surgery or medical or dental procedure. Your doctor will tell you when to stop taking XARELTO and when to start taking XARELTO again after your surgery or procedure.
    • If you need to stop taking XARELTO for any reason, talk to the doctor who prescribed XARELTO to you to find out when you should stop taking it. Do not stop taking XARELTO without first talking to the doctor who prescribes it to you.
    • If you have difficulty swallowing XARELTO tablets whole, talk to your doctor about other ways to take XARELTO.
    • Do not run out of XARELTO. Refill your prescription of XARELTO before you run out. When leaving the hospital following a hip or knee replacement, be sure that you will have XARELTO available to avoid missing any doses.
    • If you take too much XARELTO, go to the nearest hospital emergency room or call your doctor right away.

    If you take XARELTO for:

      • Atrial Fibrillation that is not caused by a heart valve problem:
        • Take XARELTO 1 time a day with your evening meal.
        • If you miss a dose of XARELTO, take it as soon as you remember on the same day.Take your next dose at your regularly scheduled time.
      • Blood clots in the veins of your legs or lungs:
        • Take XARELTO1 or 2 times a day as prescribed by your doctor.
        • For the 10-mg dose, XARELTO may be taken with or without food.
        • For the 15-mg and 20-mg doses, take XARELTO with food at the same time each day.
        • If you miss a dose:
          • If you take the 15-mg dose of XARELTO 2 times a day (a total of 30 mg of XARELTO in 1 day): Take XARELTO as soon as you remember on the same day. You may take 2 doses at the same time to make up for the missed dose. Take your next dose at your regularly scheduled time.
          • If you take XARELTO 1 time a day: Take XARELTO as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
      • Hip or knee replacement surgery:
        • Take XARELTO 1 time a day with or without food.
        • If you miss a dose of XARELTO, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
      • Blood clots in people hospitalized for an acute illness:
        • Take XARELTO 1 time a day, with or without food, while you are in the hospital and after you are discharged as prescribed by your doctor.
        • If you miss a dose of XARELTO, take it as soon as you remember on the same day. Take your next dose at your regularly scheduled time.
      • Reducing the risk of serious heart problems, heart attack and stroke in coronary artery disease:
        • Take XARELTO 2.5 mg 2 times a day with or without food.
        • If you miss a dose of XARELTO, take your next dose at your regularly scheduled time.
        • Take aspirin 75 to 100 mg once daily as instructed by your doctor.
      • Reducing the risk of a sudden decrease in blood flow to the legs, major amputation, serious heart problems or stroke in people with peripheral artery disease, including those who have recently had a procedure to improve blood flow to the legs:
        • Take XARELTO 2.5 mg 2 times a day with or without food.
        • If you miss a dose of XARELTO, take your next dose at your regularly scheduled time.
        • Take aspirin 75 to 100 mg once daily as instructed by your doctor.

    For children who take XARELTO:

    • The dose of XARELTO depends on your child's body weight and will be calculated by your child's doctor. Your child's doctor will tell you if XARELTO can be given to your child with or without food.
    • The adult caregiver should give the dose.
    • If your child is taking the tablet, the tablet should be taken whole and should not be split in an attempt to provide a lower dose of XARELTO.
    • If your child is taking the oral suspension, use the syringes provided in the original carton. The suspension will be prepared by the pharmacy. See the Instructions for Use included in the carton on how to properly give a dose of XARELTO oral suspension to your child.
    • Do not switch between the XARELTO oral suspension or tablet without first talking to your doctor.
    • If your child vomits or spits up:
      • right after or within 30 minutes of taking the oral suspension, give a new full dose.
      • more than 30 minutes after taking the oral suspension, do not give the dose again. Give the next dose at the regularly scheduled time.
      • if vomiting or spitting up persists, contact your child's doctor right away.
    • If your child misses a dose:
      • If your child is taking XARELTO 1 time a day, give the dose as soon as you remember on the same day. If this is not possible, skip this dose and give the next dose at the regularly scheduled time.
      • If your child is taking XARELTO 2 times a day, give the missed morning dose as soon as you remember. You may give the missed morning dose together with the evening dose. However, a missed evening dose can only be taken in the same evening.
      • If your child is taking XARELTO 3 times a day, skip the missed dose and give the next dose at the regularly scheduled time.