Stroke is the first cause of disability worldwide and the third cause of disability in Turkey. Stroke, which is the second cause of death after heart diseases, becomes more common with age, especially after the age of 60-65. One of the reasons that increases the risk of stroke is "atrial fibrillation", which is among the most common rhythm disorders in the heart.
Stroke due to arrhythmia can be more dangerous
Atrial fibrillation (AF), that is, abnormal heart rhythm or arrhythmia, even if there is no underlying heart disease such as heart valve diseases. It increases the risk of stroke by 4-5 times. Approximately one-third of all strokes appear to develop due to arrhythmia. Additionally, stroke due to arrhythmia has a more severe course and is more fatal. The frequency of stroke in arrhythmia increases with age. Many factors other than age increase the risk of stroke along with arrhythmia. For example, conditions such as arrhythmia along with diabetes, hypertension, heart failure, previous history of stroke, transient ischemic attack or another vascular disease, and female gender are the most important risk factors that increase this risk.
“Paroxysmal”, that is, The risk of stroke in patients with intermittent arrhythmia is similar to the risk of stroke in patients with permanent arrhythmia. There is no difference between the two conditions in terms of preventive treatment.
It is possible to prevent stroke due to arrhythmia
The most effective approach today to prevent strokes due to arrhythmia is oral anticoagulant (OAC). that is, the use of blood thinners. Today, instead of finding and selecting patients who need preventive treatment, finding truly low-risk patients who do not require treatment has come to the fore as an approach. Accordingly, there is no need for treatment in patients under the age of 65 who only have arrhythmia, that is, those who have no other risk factors. Practically all other patients need to resort to OAC treatment.
Is aspirin sufficient to prevent stroke in arrhythmia?
Currently, the evidence for effective stroke protection with aspirin in arrhythmia is weak. Aspirin's stroke-protective effect is much less than blood-thinning drug therapy. There is a misconception that aspirin carries less risk of bleeding when used alone. Anc It should not be forgotten that white aspirin may carry a risk of intracranial bleeding almost similar to oral anticoagulants, especially in our elderly patients. For this reason, aspirin should be limited to stroke protection due to arrhythmia only to patients who refuse the use of blood-thinning medications.
Is there a risk of blood-thinning medications?
When deciding on medicated protection, the risk of severe bleeding, including brain hemorrhage, which is the most feared complication of blood thinner drug treatment due to the high risk of death and limitation, and the danger of stroke should be taken into consideration. A bleeding risk assessment should be performed before initiating medicated prophylaxis. Uncontrolled hypertension, abnormal kidney/liver function, bleeding history or tendency, and concurrent drug/alcohol use can be given as examples of these risks. The aim is to try to eliminate modifiable bleeding risks in order to administer preventive medication. It should be taken into consideration that the benefits of blood thinning drug therapy outweigh the potential harms. When deciding on treatment, the important behavior for the physician and the patient should be to prevent stroke rather than fear of bleeding risk.
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