“Prescribing anticoagulants is part of the treatment for atrial fibrillation.” Prof. François Schiele is categorical: it is difficult, apart from cases affecting young people and without any other disease, to dispense with this treatment in the face of atrial fibrillation. Why ? Because this disease which causes a dysfunction of the cardiac contractions generates a stagnation of the blood in the atrium which no longer normally fulfills its role of evacuating the blood through the ventricle. There is therefore a risk of blood stagnation and consequently of the formation of clots. And the major danger with a blood clot is that it will be passed to the cerebral circulation causing a stroke. This is the greatest risk of a serious complication associated with atrial fibrillation.
Stroke, a “devastating event”
The problem is that atrial fibrillation, which concerns more than 750,000 people in France with a particularly high prevalence among those over 65 (they represent two thirds of patients) is a so-called “silent” disease, that is to say that its symptoms may be mild and go completely unnoticed. But mixed in the case where the AF does not manifest itself by palpitations, shortness of breath or abnormal fatigue, the risk of stroke is present. “This risk of a devastating event is not always perceived, insists Professor François Schiele, and it is indeed treatment with anticoagulants that can reduce it very significantly”.
A hemorrhagic risk linked to anticoagulant treatments
But who says anticoagulants also means increased risk of bleeding, especially in older patients whose circulatory system is already weakened. “Despite the existence of what are called new anticoagulants which are much more stable and which are accompanied by fewer constraints, the risk of hemorrhage still exists and we cannot rule out the complications which are linked to it”, admits Prof. Schiele.
So what’s the greater risk, that of a stroke or that of a bleeding complication? “The risk of bleeding is less frequent and less serious than that of having a stroke when one suffers from atrial fibrillation,” says François Shiele. He even insists on the case of patients aged 80 and over in whom the risk of hemorrhage is high and who would be tempted to interrupt their treatment with anticoagulants: “in this case, the risk of stroke increases much more than the risk of hemorrhage. , this is the reason why it is therefore imperative to continue the treatment! “.
Below is the interview of Prof. François Schiele:
Our Questions to Experts program on atrial fibrillation:
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