AFib and Stroke Risk: How to Protect Yourself and Stay Safe

jingxianquah
Mar 24
4 min read

Updated: Mar 26

Did you know that people with atrial fibrillation (AFib) are up to 5 times more likely to have a stroke? This alarming statistic highlights the importance of understanding and managing AFib to protect your heart health and overall well-being.

AFib isn’t just an irregular heartbeat—it’s a serious condition that can lead to life-threatening complications if left untreated. The good news? With the right knowledge and care, you can significantly reduce your stroke risk and live a healthier, safer life.

As an electrophysiologist practicing in Adelaide, I’ve helped countless patients manage their AFib and lower their risk of stroke. In this blog post, I’ll explain the connection between AFib and stroke, share practical steps to protect yourself, and highlight how you can get expert care right here in Adelaide.

Why Does AFib Increase Stroke Risk?

To understand the link between AFib and stroke, let’s take a closer look at how AFib affects your heart. In AFib, the heart’s upper chambers (atria) don’t beat effectively. Instead of pumping blood smoothly, they quiver, causing blood to pool and potentially form clots.

These clots can travel from the heart to the brain, blocking blood flow and causing a stroke. Think of it like a plumbing system: if the pump isn’t working properly, debris can build up and cause a blockage downstream.

This is why managing AFib isn’t just about controlling symptoms—it’s about protecting your brain and your life.

Who Is Most at Risk? Understanding Stroke Risk Stratification

Not all AFib patients have the same risk of stroke. To determine your individual risk, doctors use a tool called the CHA₂DS₂-VASc score. This score evaluates several factors:

Letter	Risk Factor	Points
C	Congestive heart failure	1
H	High blood pressure	1
A	Age ≥75 years	2
D	Diabetes	1
S	Stroke/TIA history	2
V	Vascular disease	1
A	Age 65–74 years	1

How It Works:

A score of 0 means low stroke risk, and anticoagulation may not be needed.
A score of 1 indicates moderate risk, and anticoagulation may be considered based on individual factors.
A score of 2 or higher means high stroke risk, and anticoagulation is usually recommended.

For example, a 70-year-old woman with high blood pressure and diabetes would have a CHA₂DS₂-VASc score of 4, indicating a high stroke risk.

Balancing Stroke Risk and Bleeding Risk: The HAS-BLED Score

While anticoagulants are highly effective at reducing stroke risk, they can increase the risk of bleeding. To assess this risk, doctors use the HAS-BLED score:

Letter	Risk Factor	Points
H	Hypertension	1
A	Abnormal liver/kidney function	1 or 2
S	Stroke history	1
B	Bleeding history	1
L	Labile INR (if on warfarin)	1
E	Elderly (age >65)	1
D	Drug/alcohol use	1 or 2

How It Works:

A score of 0–2 indicates low bleeding risk.
A score of 3 or higher suggests a higher risk of bleeding, but it doesn’t mean you can’t take anticoagulants—it just means your doctor will monitor you more closely.

The goal is to balance your stroke risk (CHA₂DS₂-VASc) with your bleeding risk (HAS-BLED) to determine the best treatment plan for you.

Types of Anticoagulation: Which One Is Right for You?

Anticoagulants, or blood thinners, are the cornerstone of stroke prevention in AFib. Here’s a closer look at the different types:

1. Warfarin (Coumadin)

How It Works: Warfarin reduces the production of clotting factors in the liver.
Pros: It’s been used for decades and is highly effective when managed properly.
Cons: Requires regular blood tests (INR monitoring) and dietary restrictions (e.g., limiting vitamin K-rich foods like leafy greens).

2. Direct Oral Anticoagulants (DOACs)

DOACs are newer medications that are easier to use than warfarin. They include:

Dabigatran (Pradaxa): A direct thrombin inhibitor.
Rivaroxaban (Xarelto), Apixaban (Eliquis), and Edoxaban (Lixiana): Factor Xa inhibitors.

Pros of DOACs:

No regular blood tests are needed.
Fewer dietary restrictions.
Lower risk of bleeding in the brain compared to warfarin.

Cons of DOACs:

They can be more expensive.
Not suitable for patients with severe kidney disease.
With the exception of dabigatran, there is no approved reversal agents for the DOACs in case of severe bleeding episodes.

3. Aspirin

Why It’s Not Enough: Aspirin is less effective than anticoagulants for stroke prevention in AFib and is no longer recommended as a standalone treatment.

Your doctor will help you choose the best anticoagulant based on your stroke risk, bleeding risk, and overall health.

Advanced Treatments for High-Risk Patients

For patients who cannot take anticoagulants or need additional protection, advanced treatments are available:

1. Left Atrial Appendage Closure (LAAC)

The left atrial appendage (LAA) is a small pouch in the heart where clots often form. The LAAC procedure seals off the LAA, reducing stroke risk for patients who can’t take blood thinners.

Recognizing the Signs of a Stroke

Even with the best prevention strategies, it’s important to know the signs of a stroke so you can act quickly if one occurs. Remember the FAST acronym:

Face drooping
Arm weakness
Speech difficulty
Time to call emergency services

If you or someone around you experiences these symptoms, don’t wait—call 000 immediately. Every minute counts when it comes to stroke treatment.

Conclusion

AFib increases your risk of stroke, but you don’t have to live in fear. By understanding your stroke risk (CHA₂DS₂-VASc), balancing it with your bleeding risk (HAS-BLED), and working with a specialist, you can protect yourself and stay safe.

Your heart health is too important to ignore. If you have AFib, take the first step toward reducing your stroke risk by contacting myself in Adelaide today. Together, we can create a plan to keep your heart—and your future—healthy.

Further reading materials

Heart Foundation stroke prevention: Clinical_Fact_Sheet_-_Stroke_AF.pdf

Australian Stroke Foundation: living-with-atrial-fibrillation.pdf

If you’re in Adelaide or South Australia and need personalized advice on AF ablation in Adelaide, contact us today to schedule a consultation with a heart rhythm specialist.

Link to further reading: What to Expect After AF Ablation Adelaide: Activity Restrictions, Driving, Medications, and Signs of Complications

Disclaimer: This post is for informational purposes only and should not replace professional medical advice. Always consult your healthcare provider for personalized guidance.