Dr. Day is a cardiologist/electrophysiologist at the Intermountain Medical Center Heart Institute in Salt Lake City, Utah. He graduated from Johns Hopkins Medical School and completed his residency and fellowships in cardiology and electrophysiology at Stanford University. He is the former president of the Heart Rhythm Society and currently serves as the president of the Utah chapter of the American College of Cardiology.
9 Things I Would Do To Prevent Atrial Fibrillation Strokes
Everyone fears an atrial fibrillation stroke. Fortunately, most of these strokes are preventable. As blood thinners are a scary prospect, patients always ask me what I would do. In this article, I share the nine things I personally would do to prevent atrial fibrillation strokes.
Before we jump in with the nine things I would do to prevent atrial fibrillation strokes, I need to confess that I don’t have atrial fibrillation. While my grandmother had it, so far I have escaped it.
However, every week someone asks, would you take a blood thinner? Based on a career of helping tens of thousands of patients prevent atrial fibrillation strokes, here is what I would do.
Please be warned, every case of atrial fibrillation is different. What I would personally do may be completely different than what your doctor recommends (please listen to your doctor first). My passion for extreme skiing and mountain biking doesn’t fit well with prescription blood thinners. Thus, these are the nine things I would do to minimize my stroke risk and the need for daily pharmaceutical blood thinners.
This article is not medical advice. I am not giving any recommendations. As atrial fibrillation strokes can be catastrophic, please follow your doctor’s advice when it comes to atrial fibrillation stroke prevention.
A CHADS-VASc Primer
To understand the nine things I would do to prevent atrial fibrillation strokes, you have to follow the CHADS-VASc scoring system. CHADS-VASc is an acronym. Each letter stands for a medical condition that increases your risk of an atrial fibrillation stroke. The higher the score, the higher your stroke risk.
The essence of this scoring system is that if you have congestive heart failure, hypertension, an age of 65 to 74, diabetes, vascular disease, or are of the female sex you get one point. If your age has reached 75, or you have had a stroke or TIA, you get two points. Once you have hit a score of two, the atrial fibrillation guidelines then recommend life-long blood thinners.
As this scoring system can be confusing, here is an article I wrote that explains things in detail.
9 Things I Would Do To Prevent Atrial Fibrillation Strokes
Blood thinners don’t work for my lifestyle. I ski or mountain bike almost every day of the year. Usually, I am climbing the mountain alone in the dark before work as that is often the only time I can find to exercise.
Even though I do everything possible to mitigate risk, I have still had many bad crashes over the years. Crashes that I’m sure, had I been on blood thinners, could have resulted in life-threatening internal bleeding.
So here are the nine things I would do to prevent atrial fibrillation strokes:
1. Reverse Atrial Fibrillation
As the very best thing you can do to prevent atrial fibrillation strokes is to eliminate atrial fibrillation, I would do everything possible to fix it naturally. Most of my patients are surprised to learn that optimizing your lifestyle has a fifty-fifty chance of putting your atrial fibrillation into remission without drugs or procedures. This is a fifty-fifty chance that I would definitely take.
As my willpower weakens through the day, I would track my food, weight, workouts, sleep, etc. even more closely than what I am doing today. Despite the best of intentions, I know that if I don’t have systems and rules in place, my willpower will never stand a chance. If you want to read more on how to beat atrial fibrillation, here is an excellent article I wrote: How to Get Rid of Atrial Fibrillation Once and For All
2. Natural Blood Thinners for a CHADS-VASc Score of 0 to 1
Even though the atrial fibrillation stroke risk is low with a CHADS-VASc score of zero or one, I would still look for additional ways to possibly mitigate risk. Personally, I am fascinated by the data on nattokinase.
While nattokinase is not a strong enough blood thinner for a CHADS-VASc score of two or higher, there may be a role for the CHADS-VASc zero to one person. As I worry about the long-term safety of supplements, I would stick to eating natto to get my nattokinase. To learn more, please read the following article I wrote:
Other natural blood thinners include fish oil, turmeric, ginger, ginkgo, or vitamin E. Sadly, aspirin is increasingly falling out of favor for atrial fibrillation stroke prevention.
I should point out that natural blood thinners have are totally unproven for atrial fibrillation. Also, natural blood thinners should never be a substitute for the proven atrial fibrillation blood thinners like warfarin, Pradaxa, Xarelto, Eliquis, or Savaysa. However, as blood thinners are not indicated for a CHADS-VASc score of zero, and are not mandatory for a CHADS-VASc score of one, there just might be a role for natural blood thinners in the CHADS-VASc 0 to 1 patient.
3. Hack My CHADS-VASc Score
If I couldn’t put my atrial fibrillation into remission naturally, I would “hack” my CHADS-VASc score to avoid pharmaceutical blood thinners. By “hack,” I mean optimizing my lifestyle so that I could drop my CHADS-VASc score by up to four points.
If you can get your CHADS-VASc score below two, then your stroke risk is very low, and prescription blood thinners are no longer required. To learn how to “hack” your CHADS-VASc score, here is an article I wrote on the topic: 4 Best Ways to Lower Your CHADS-VASc Score
4. Hack Virchow’s Triad
Dr. Virchow was a brilliant German physician who lived in the 1800s. Even back in the 1800s, he correctly identified the three leading causes of blood clotting. People still refer to this as Virchow’s Triad. The three components of Virchow’s triad are hypercoagulability, stasis, and injury.
Hypercoagulability means that blood is more likely to clot. Obesity, smoking or taking female hormone replacement therapy all make blood more prone to clotting. Likewise, studies show that atrial fibrillation also causes a hypercoagulable state. It is for this reason that I would explore natural blood thinners, even though they are completely unproven for atrial fibrillation, if my CHADS-VASc score was less than two. For a CHADS-VASc score of two or higher, and there was no way to lower my score, I would have to consider a prescription blood thinner.
If blood isn’t moving, it is likely to clot. Thus, to hack Virchow’s Triad, you have to avoid blood stasis. And the best thing I can think of to avoid stasis is to keep your body moving. By continually moving throughout the day, you can minimize any potential blood stasis.
The final component to Virchow’s Triad is vessel injury. If atherosclerosis injures an artery, it is more likely to clot. Fortunately, in at least 80% of people, atherosclerosis is entirely preventable. By only eating the healthiest of foods, keeping your weight in check, exercising daily, and optimizing sleep and stress levels you can keep your arteries clean.
5. Track My Rhythm with a Smartphone EKG App
In addition to tracking my blood pressure, food, weight, workouts, sleep, stress, etc., I would also monitor my heart rhythm with a smartphone EKG app. Twice a day I would confirm sinus rhythm. If there ever were a question, I would quickly do my own EKG to verify the rhythm.
Personally, I like the FDA-approved Alivecor system. Even though I don’t have atrial fibrillation, I still bought this device to track my heart rhythm.
6. Keep Any Atrial Fibrillation Episodes Under 24 Hours
No one knows how long it takes blood for blood to clot in atrial fibrillation. However, based on a recent study, 24 hours may be the number. Please note that in some people, atrial fibrillation clots could form in just a few minutes whereas for other people clots may never occur.
After confirming an atrial fibrillation attack with my smartphone EKG app, I would take a “pill-in-the-pocket” antiarrhythmic as soon as possible to minimize the time my heart was out of rhythm. For those unfamiliar with a “pill-in-the-pocket,” antiarrhythmic approach, it is a heart rhythm medication that you only take if your heart goes out of rhythm. If this didn’t do the trick, I would get a cardioversion (heart shock) before the 24-hour mark.
7. Pill-in-the-Pocket Blood Thinner
Taking a prescription blood thinner every day would require me to give up what I enjoy doing most (extreme skiing and mountain biking). However, I would be open to taking a blood thinner on an as-needed basis.
While the pill-in-the-pocket blood thinner approach is unproven, small studies suggest that it might work. Please be aware though that the people in this study all had their own smartphone EKG apps and were well-trained in monitoring for atrial fibrillation. Thus, if you aren’t prepared to learn how to read your own EKG, this probably isn’t the best option for you.
8. Have it Ablated
If you can’t tell, I’m not a medicine person. I have been on many prescription medications in the past, and I didn’t like the way they made me feel. Fortunately, I was able to reverse all of my chronic medical conditions by lifestyle optimization. If you want to learn more about this journey, it was all described in our book, The Longevity Plan.
If I couldn’t reverse my atrial fibrillation naturally, like I did my other conditions, I would choose an ablation over life-long medications. One possible benefit of ablation is that in our experience patients who have had an ablation had a lower stroke risk.
9. Consider Left Atrial Appendage Occlusion
In the event, an atrial fibrillation cure was impossible for me, and my CHADS-VASc score was two or higher, I would consider having my left atrial appendage occluded. As approximately 90% of atrial fibrillation strokes arise from a little pouch in the heart, the left atrial appendage, it would be very tempting to get rid of this pouch.
Getting rid of the left atrial appendage is something that is easy to do. While most experts agree that left atrial appendage occlusion is an excellent option for people with a high stroke risk who can’t take blood thinners, it is still hotly debated for those people who don’t want to take pharmaceutical blood thinners.
The Big Picture
The bottom line is that the lifestyle I love isn’t in alignment with taking a daily pharmaceutical blood thinner. Everything I shared is what I would do to avoid a stroke and blood thinners. This approach isn’t appropriate for 99% of atrial fibrillation patients.
There is also no guarantee that what I would do to prevent atrial fibrillation strokes would even work. However, in the 23 years since I graduated from medical school, I have yet to see an atrial fibrillation stroke in someone with a 100% optimized lifestyle who was also tracking their daily heart rhythm.
Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.