Atrial Fibrillation: Anticoagulation Risks and Rewards

        Dr. Kevin Coy served as the Director of the Community Medical Practice for Jackson Memorial Hospital. Dr. Coy is currently the Director of the Cardiac Catheterization Lab at Aventura Hospital Dr. Coy has interests in a variety of areas of both non-invasive and invasive interventional cardiology and has been the co-principal investigator or principal investigator in a number of trials during the past 16 years he has spent in South Florida. Haute MD chats with Dr. Coy, Cardiology expert, about Atrial Fibrillation, and the risks associated with anticoagulants.

Atrial FibrillationPhoto Credit: Shutterstock

Atrial Fibrillation( AFib) is a common problem encountered in cardiology today. Most patients either feel poorly with shortness of breath or may have no symptoms at all and are brought to attention when an ECG is performed. The cause is multifactorial with hypertension and coronary heart disease being the most prevalent triggers. Cardiologists evaluate each patient to improve symptoms and the treatment decisions include converting the patient back to a normal rhythm or, in others with longstanding  AFib, controlling the heart rate. By far the most severe complication of AFib is stroke; an often catastrophic complication that may lead to death or major disability and represents a huge cost to the health care budget.

         With that said, the most important treatment option is to anti-coagulate the patient and minimize the risk of stroke. There are a number of pharmacologic agents that are effective in this regard.  Warfarin is the most widely recognized agent with the longest indication however, more recently, what are called “novel” anticoagulants have come on the market. These agents have proven to be as effective as warfarin with a better safety profile. The major complication of anticoagulants is bleeding some of which may be major.  Physicians use various scoring systems to determine who should be anticoagulated or not.  The first of these scoring systems was the  CHADS score which has now been modified several times but the concept is the same.  Patients with scores above a certain level are candidates for blood thinners unless they have a contraindication such as bleeding risk.

human heartPhoto Credit: Shutterstock

          Recently, technological advances have developed procedures that have been shown in studies to prevent the risk of stroke similar to anticoagulants, however, reduce the bleeding risk significantly.  One such device is the Watchman device (Boston Scientific). Our group has been performing this procedure for the past 3 years in Dade County and has one of the largest experiences and highest success rates in the country.  The device is implanted in the heart using catheter-based techniques and under sedation.  Patients are discharged from the hospital within 23 hours and resume full activity levels by the next day. After 45 days patients may successfully discontinue anticoagulant medications and be treated only with anti-platelet agents.  This represents a significant improvement in treatment options for patients with atrial fibrillation and has modified the way we practice in 2020. “The  Watchman is watching”.