Do I Really Need a Blood Thinner for My AFib ?

Q: I’m 69, female and an avid runner. Must I take a blood thinner for my AFib?

A: Because atrial fibrillation (AFib) increases your risk of blood clots forming in the left atrium, anticoagulation — taking blood thinners — can reduce your risk of stroke. Your CHA2DS2Vasc score helps determine your stroke risk. Most guidelines recommend that patients with atrial fibrillation and a CHA2DS2Vasc score of 2 or more are usually better off with anticoagulation, unless they have a high risk profile for bleeding. CHA2DS2Vasc awards points in this way:

• Congestive heart failure = 1 point.
• Hypertension = 1 point.
• Age of 75 or more = 2 points; age over 65 = 1 point.
• Diabetes = 1 point.
• Stroke or transient ischemic attack (TIA) in the past = 2 points.
• Vascular disease (any type, including coronary artery disease) = 1 point.
• Sex, female = 1 point (but only if you have at least 1 other point on the scale).

You already have 1 point for being over 65 years, and 1 point for being a female, and you’ll get a third point when you turn 75. So overall, your risk/benefit ratio would likely be in favor of anticoagulation — especially if you do not have any previous history of bleeding or predisposition toward bleeding. (For example, liver, kidney or platelet problems must be factored in, as they increase your risk of bleeding.) The decision to take blood thinners is an individual one, so talk it over with your doctor, who knows your health history. — Cardiologist Mandeep Bhargava, MD