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Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?
You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?
1Get the |
2Compare |
3Your |
4Get the |
5Quiz |
6Your Summary |
Get the facts
Your options
- Take an anticoagulant medicine to reduce the risk of stroke.
- Don’t take an anticoagulant.
An implanted device (such as Watchman) may be an option for some people who cannot take an anticoagulant long-term.
Key points to remember
- Atrial fibrillation increases your risk of stroke. Other things that raise your risk include heart failure, high blood pressure, a previous stroke, and diabetes. Your doctor can help you know your risk. Taking an anticoagulant lowers that risk.
- When you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries.
- Depending on the type of anticoagulant you take, you may have to get regular blood tests and watch how much vitamin K you eat or drink.
- If you have a low risk of having a stroke, you may choose to not take an anticoagulant.
What are anticoagulants?
Anticoagulants are medicines that help prevent blood clots. Blood clots can lead to stroke. These medicines are often called blood thinners, but they don’t actually thin your blood. Instead, they increase the time it takes for a blood clot to form.
Anticoagulants used for atrial fibrillation are apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), and warfarin (Coumadin).
How can medicine help if you have atrial fibrillation?
Atrial fibrillation increases your risk of stroke. Taking an anticoagulant can reduce that risk.
The risk of stroke isn’t the same for everyone who has atrial fibrillation. But on average, people who have atrial fibrillation are 5 times more likely to have a stroke than people who don’t have atrial fibrillation.footnote 1 Anything that increases your risk for a disease or problem is called a risk factor. The more risk factors you have, the greater your chance of having a stroke.
Anticoagulants can help protect against stroke. Your doctor may recommend that you take an anticoagulant if you are at high risk for stroke based on your risk factors.
Your doctor can check your risk of a stroke. Things that can raise your risk include:
- Age. Being older than 65 raises your risk.
- Gender. Being a woman raises your risk.
- Heart failure.
- High blood pressure.
- A previous stroke or transient ischemic attack (TIA).
- Heart attack, peripheral arterial disease, or other blood vessel disease.
- Diabetes.
What are the risks of taking an anticoagulant?
When you take an anticoagulant, your blood clots more slowly than normal. This increases your risk of bleeding problems in and around the brain, bleeding in the stomach and intestines, bruising and bleeding if you are hurt, and serious skin rash.
Some people can’t take anticoagulants, because they have a higher risk of having a serious problem if bleeding occurs. For example, you may have a higher risk of bleeding if you have uncontrolled high blood pressure, have kidney or liver disease, or drink large amounts of alcohol.
When you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. With the anticoagulant warfarin, you also need to have regular blood tests to make sure you are taking the right dose. And you need to watch how much vitamin K you eat or drink.
You will want to weigh the benefits of reducing your risk of stroke against the risks of taking an anticoagulant, such as an increased risk of bleeding. For example, each year about 1 to 3 out of 100 people (or 10 to 30 out of 1,000 people) who take an anticoagulant will have a problem with severe bleeding. This means that 97 to 99 out of 100 people (or 970 to 990 out of 1,000 people) will not have a bleeding problem.footnote 2, footnote 3, footnote 4, footnote 5 But these are average risks. Your own risk may be higher or lower than average based on your age and your own health. For example, your risk may be higher if you have kidney or liver disease.
How well do anticoagulants work?
Anticoagulants lower the risk of stroke in people who have atrial fibrillation. But how much your risk will be lowered depends on how high your risk was to start with. Not everyone with atrial fibrillation has the same risk of stroke. It’s a good idea to talk with your doctor about your risk.
What can you do instead of taking an anticoagulant?
No medicine
If you have a low risk of stroke, you can choose to not take an anticoagulant.
Device
A device (such as Watchman) may be implanted to try to lower the risk of stroke. Doctors call the device a left atrial appendage closure device. The device may prevent blood clots from moving out of the heart and causing a stroke. The device is placed inside of the heart with a procedure that uses catheters in blood vessels.
This device is not right for everyone. It might be used for a person who cannot take an anticoagulant long-term. Research shows that the device may work as well as the anticoagulant called warfarin to prevent stroke. It is not known how the device compares to other anticoagulants. There is a chance of harm from the procedure and the device, including bleeding and blood clots. You and your doctor can decide if the device is right for you.
Why might your doctor recommend taking an anticoagulant?
Your doctor may advise you to take an anticoagulant if:
- Your risk of stroke is high.
- You are willing and able to take the medicine as directed. This includes taking care to prevent falls and getting regular blood tests if needed.
Compare your options
Compare
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What is usually involved? |
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|---|---|---|
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What are the benefits? |
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What are the risks and side effects? |
- You take a pill once or twice a day.
- If you take warfarin, you will have regular blood tests to make sure that you are taking the right dose.
- If you take warfarin, you will try to eat and drink about the same amount of vitamin K each day.
- You’ll need to let your doctor know of any new medicines you start taking while you are taking an anticoagulant.
- Anticoagulants lower the risk of stroke in people who have atrial fibrillation.
- Anticoagulants increase your risk of bleeding problems.
- Anticoagulants lower your risk of stroke, but you could still have a stroke.
- You do not take an anticoagulant.
- You do not take a medicine that raises your risk of bleeding problems.
- If you have atrial fibrillation and don’t take an anticoagulant, you might have a stroke.
Personal stories about taking anticoagulants
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I have other risk factors for stroke besides atrial fibrillation. My doctor and I decided that it is important for me to take an anticoagulant to help reduce my risk for having a stroke.
Monty, age 72
My doctor says I’m healthy and that my stroke risk is low. I don’t want to take an anticoagulant now. In the future, if my risk gets higher, I can decide to take one then.
Juan, age 67
I am not overly concerned about bleeding problems from taking a blood thinner, and I’m motivated to follow the instructions to take it as directed.
Martha, age 64
I have a bleeding ulcer that I am caring for, so I can’t take an anticoagulant.
Geraldo, age 52
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take an anticoagulant
Reasons not to take an anticoagulant
I worry about my risk of stroke.
My risk of stroke is low.
I’m confident that I can take an anticoagulant as directed.
I’m worried that I can’t take an anticoagulant as directed.
Lowering my risk of stroke is more important to me than the risk of a bleeding problem.
I’m more worried about my risk of a bleeding problem than my risk of stroke.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking an anticoagulant
NOT taking an anticoagulant
What else do you need to make your decision?
Check the facts
Decide what’s next
Certainty
1. How sure do you feel right now about your decision?
Your Summary
Here’s a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
Your decision
Next steps
Which way you’re leaning
How sure you are
Your comments
Your knowledge of the facts
Key concepts that you understood
Key concepts that may need review
Getting ready to act
Patient choices
Credits and References
| Author | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology |
| Primary Medical Reviewer | E. Gregory Thompson MD – Internal Medicine |
| Primary Medical Reviewer | Martin J. Gabica MD – Family Medicine |
| Primary Medical Reviewer | Adam Husney MD – Family Medicine |
| Primary Medical Reviewer | John M. Miller MD, FACC – Cardiology, Electrophysiology |
| Primary Medical Reviewer | Steven J. Atlas MD, MPH – Internal Medicine |
| Primary Medical Reviewer | Heather Quinn MD – Family Medicine |
- Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313):41.
- Antithrombotic drugs (2014). Medical Letter on Drugs and Therapeutics,56(1454): 103–108. http://secure.medicalletter.org/TML-article-1454a. Accessed October 22,2014.
- Dabigatran etexilate (Pradaxa)—A new oral anticoagulant (2010). Medical Letter on Drugs and Therapeutics, 52(1351): 89–90.
- Patel MR, et al.(2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 365(10): 883–891.
- Granger CB, et al.(2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11): 981–992.
- MacLean S, et al.(2012). Patient values and preferences in decision making for antithrombotic therapy: A systematic review. Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl):e1S–e23S.
- Noelck N, et al.(2016). Effectiveness of left atrial appendage exclusion procedures to reduce the risk of stroke: A systematic review of the evidence. Circulation Cardiovascular Quality and Outcomes, 9(4): 395–405.DOI: 10.1161/CIRCOUTCOMES.115.002539. Accessed July 19, 2016.
- Ruff CT, et al. (2014). Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. The Lancet, 383(9921): 955–962. DOI: 10.1016/S0140-6736(13)62343-0. Accessed: April 15,2014.
- You JJ, et al. (2012). Antithrombotic therapy for atrial fibrillation: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl):e531S–e575S.
Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?
- Get the facts
- Compare your options
- What matters most to you?
- Where are you leaning now?
- What else do you need to make your decision?
1. Get the Facts
Your options
- Take an anticoagulant medicine to reduce the risk of stroke.
- Don’t take an anticoagulant.
An implanted device (such as Watchman) may be an option for some people who cannot take an anticoagulant long-term.
Key points to remember
- Atrial fibrillation increases your risk of stroke. Other things that raise your risk include heart failure, high blood pressure, a previous stroke, and diabetes. Your doctor can help you know your risk. Taking an anticoagulant lowers that risk.
- When you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries.
- Depending on the type of anticoagulant you take, you may have to get regular blood tests and watch how much vitamin K you eat or drink.
- If you have a low risk of having a stroke, you may choose to not take an anticoagulant.
What are anticoagulants?
Anticoagulants are medicines that help prevent blood clots. Blood clots can lead to stroke. These medicines are often called blood thinners, but they don’t actually thin your blood. Instead, they increase the time it takes for a blood clot to form.
Anticoagulants used for atrial fibrillation are apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), and warfarin (Coumadin).
How can medicine help if you have atrial fibrillation?
Atrial fibrillation increases your risk of stroke. Taking an anticoagulant can reduce that risk.
The risk of stroke isn’t the same for everyone who has atrial fibrillation. But on average, people who have atrial fibrillation are 5 times more likely to have a stroke than people who don’t have atrial fibrillation.1 Anything that increases your risk for a disease or problem is called a risk factor. The more risk factors you have, the greater your chance of having a stroke.
Anticoagulants can help protect against stroke. Your doctor may recommend that you take an anticoagulant if you are at high risk for stroke based on your risk factors.
Your doctor can check your risk of a stroke. Things that can raise your risk include:
- Age. Being older than 65 raises your risk.
- Gender. Being a woman raises your risk.
- Heart failure.
- High blood pressure.
- A previous stroke or transient ischemic attack (TIA).
- Heart attack, peripheral arterial disease, or other blood vessel disease.
- Diabetes.
What are the risks of taking an anticoagulant?
When you take an anticoagulant, your blood clots more slowly than normal. This increases your risk of bleeding problems in and around the brain, bleeding in the stomach and intestines, bruising and bleeding if you are hurt, and serious skin rash.
Some people can’t take anticoagulants, because they have a higher risk of having a serious problem if bleeding occurs. For example, you may have a higher risk of bleeding if you have uncontrolled high blood pressure, have kidney or liver disease, or drink large amounts of alcohol.
When you take an anticoagulant, also called a blood thinner, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. With the anticoagulant warfarin, you also need to have regular blood tests to make sure you are taking the right dose. And you need to watch how much vitamin K you eat or drink.
You will want to weigh the benefits of reducing your risk of stroke against the risks of taking an anticoagulant, such as an increased risk of bleeding. For example, each year about 1 to 3 out of 100 people (or 10 to 30 out of 1,000 people) who take an anticoagulant will have a problem with severe bleeding. This means that 97 to 99 out of 100 people (or 970 to 990 out of 1,000 people) will not have a bleeding problem.2, 3, 4, 5 But these are average risks. Your own risk may be higher or lower than average based on your age and your own health. For example, your risk may be higher if you have kidney or liver disease.
How well do anticoagulants work?
Anticoagulants lower the risk of stroke in people who have atrial fibrillation. But how much your risk will be lowered depends on how high your risk was to start with. Not everyone with atrial fibrillation has the same risk of stroke. It’s a good idea to talk with your doctor about your risk.
What can you do instead of taking an anticoagulant?
No medicine
If you have a low risk of stroke, you can choose to not take an anticoagulant.
Device
A device (such as Watchman) may be implanted to try to lower the risk of stroke. Doctors call the device a left atrial appendage closure device. The device may prevent blood clots from moving out of the heart and causing a stroke. The device is placed inside of the heart with a procedure that uses catheters in blood vessels.
This device is not right for everyone. It might be used for a person who cannot take an anticoagulant long-term. Research shows that the device may work as well as the anticoagulant called warfarin to prevent stroke. It is not known how the device compares to other anticoagulants. There is a chance of harm from the procedure and the device, including bleeding and blood clots. You and your doctor can decide if the device is right for you.
Why might your doctor recommend taking an anticoagulant?
Your doctor may advise you to take an anticoagulant if:
- Your risk of stroke is high.
- You are willing and able to take the medicine as directed. This includes taking care to prevent falls and getting regular blood tests if needed.
2. Compare your options
| Take an anticoagulant to reduce the risk of stroke | Don’t take an anticoagulant | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Personal stories about taking anticoagulants
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
“I have other risk factors for stroke besides atrial fibrillation. My doctor and I decided that it is important for me to take an anticoagulant to help reduce my risk for having a stroke.”
— Monty, age 72
“My doctor says I’m healthy and that my stroke risk is low. I don’t want to take an anticoagulant now. In the future, if my risk gets higher, I can decide to take one then.”
— Juan, age 67
“I am not overly concerned about bleeding problems from taking a blood thinner, and I’m motivated to follow the instructions to take it as directed.”
— Martha, age 64
“I have a bleeding ulcer that I am caring for, so I can’t take an anticoagulant.”
— Geraldo, age 52
3. What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to take an anticoagulant
Reasons not to take an anticoagulant
I worry about my risk of stroke.
My risk of stroke is low.
I’m confident that I can take an anticoagulant as directed.
I’m worried that I can’t take an anticoagulant as directed.
Lowering my risk of stroke is more important to me than the risk of a bleeding problem.
I’m more worried about my risk of a bleeding problem than my risk of stroke.
My other important reasons:
My other important reasons:
4. Where are you leaning now?
Now that you’ve thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Taking an anticoagulant
NOT taking an anticoagulant
5. What else do you need to make your decision?
Check the facts
1. If you have atrial fibrillation, are you at higher risk of stroke than someone who doesn’t have it?
- Yes
- No
- I’m not sure
2. Are anticoagulants safe for everyone to take?
- Yes
- No
- I’m not sure
Decide what’s next
1. Do you understand the options available to you?
2. Are you clear about which benefits and side effects matter most to you?
3. Do you have enough support and advice from others to make a choice?
Certainty
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
- I’m ready to take action.
- I want to discuss the options with others.
- I want to learn more about my options.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology |
| Primary Medical Reviewer | E. Gregory Thompson MD – Internal Medicine |
| Primary Medical Reviewer | Martin J. Gabica MD – Family Medicine |
| Primary Medical Reviewer | Adam Husney MD – Family Medicine |
| Primary Medical Reviewer | John M. Miller MD, FACC – Cardiology, Electrophysiology |
| Primary Medical Reviewer | Steven J. Atlas MD, MPH – Internal Medicine |
| Primary Medical Reviewer | Heather Quinn MD – Family Medicine |
- Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313):41.
- Antithrombotic drugs (2014). Medical Letter on Drugs and Therapeutics,56(1454): 103–108. http://secure.medicalletter.org/TML-article-1454a. Accessed October 22,2014.
- Dabigatran etexilate (Pradaxa)—A new oral anticoagulant (2010). Medical Letter on Drugs and Therapeutics, 52(1351): 89–90.
- Patel MR, et al.(2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 365(10): 883–891.
- Granger CB, et al.(2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11): 981–992.
- MacLean S, et al.(2012). Patient values and preferences in decision making for antithrombotic therapy: A systematic review. Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl):e1S–e23S.
- Noelck N, et al.(2016). Effectiveness of left atrial appendage exclusion procedures to reduce the risk of stroke: A systematic review of the evidence. Circulation Cardiovascular Quality and Outcomes, 9(4): 395–405.DOI: 10.1161/CIRCOUTCOMES.115.002539. Accessed July 19, 2016.
- Ruff CT, et al. (2014). Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: A meta-analysis of randomised trials. The Lancet, 383(9921): 955–962. DOI: 10.1016/S0140-6736(13)62343-0. Accessed: April 15,2014.
- You JJ, et al. (2012). Antithrombotic therapy for atrial fibrillation: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl):e531S–e575S.
Note: The “printer friendly” document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.
Current as of: April 9, 2019
Author: Healthwise Staff
Medical Review:Rakesh K. Pai MD, FACC – Cardiology, Electrophysiology & E. Gregory Thompson MD – Internal Medicine & Martin J. Gabica MD – Family Medicine & Adam Husney MD – Family Medicine & John M. Miller MD, FACC – Cardiology, Electrophysiology & Steven J. Atlas MD, MPH – Internal Medicine & Heather Quinn MD – Family Medicine