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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?

Get the facts

Your options

  • Take an anticoagulant medicine to reduce the risk of stroke.
  • Don't take an anticoagulant.

An implanted device, which closes the left atrial appendage, may be an option for some people who cannot take an anticoagulant.

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. The risk of stroke isn't the same for everyone. Your doctor can help you know your risk.
  • Taking an anticoagulant lowers the risk of stroke. But how much your risk will be lowered depends on how high your risk was to start with.
  • Taking an anticoagulant raises your risk of bleeding problems. This risk isn't the same for everyone. Your doctor can help you understand your risk of bleeding.
  • 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.
  • There are different types of anticoagulants. You and your doctor can choose the medicine that is right for you.
FAQs

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 direct oral anticoagulants (DOACs) and warfarin. DOACs include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).

You and your doctor can decide which medicine is right for you. This decision may depend on the cost, your health, and your preferences about taking medicine. Talk with your doctor about any concerns you have about the cost of your medicine. Your doctor can let you know if certain anticoagulants are safer than others based on your health.

Doctors usually recommend DOACs first. They work as well as or slightly better than warfarin. They are less likely to cause bleeding in the brain.footnote 2

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:

  • Being older than 65.
  • Being female.
  • Heart failure.
  • High blood pressure.
  • A previous stroke or transient ischemic attack (TIA).
  • Heart attack, peripheral artery 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.

The risk of bleeding isn't the same for everyone. Your doctor can help you understand your risk. Your doctor can check things that can raise your risk of serious bleeding. Examples of these things are having very high blood pressure, kidney disease, or liver disease or having had a stroke. Serious bleeding includes any bleeding that requires a blood transfusion or being in the hospital.

Over 2 to 3 years, about 6 people out of 100 will have a problem with serious bleeding. This means that about 94 out of 100 will not.footnote 3 But these are average risks. Your own risk may be higher or lower.

You will want to weigh the benefits of reducing your risk of stroke against your risk of bleeding.

Some people can't take anticoagulants, because they have a higher risk of having a serious problem if bleeding occurs.

When you take an anticoagulant, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also need to have regular blood tests and watch how much vitamin K you eat or drink.

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. Your doctor can help you know your risk based on your age, sex, and health.

What can you do instead of taking an anticoagulant?

No medicine

You can choose to not take an anticoagulant. For example, some people who have a low risk of stroke may decide that the possible stroke prevention does not outweigh the risk of bleeding.

Left atrial appendage closure

A device may be implanted to lower the risk of stroke. Doctors call the device a left atrial appendage closure device. The device can 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. 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.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Take an anticoagulant to reduce the risk of strokeTake an anticoagulant to reduce the risk of stroke
  • You take a pill once or twice a day.
  • You try to avoid injuries and falls that could cause bleeding.
  • You'll need to let your doctor know of any new medicines you start taking while you are taking an anticoagulant.
  • If you take warfarin, you will have regular blood tests and you will try to eat and drink about the same amount of vitamin K each day.
  • 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.
Don't take an anticoagulantDon't take an anticoagulant
  • 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

My doctor says I have a very high risk of bleeding. 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.

I don't worry much about my risk of stroke.

More important
Equally important
More important

I'm confident that I can take an anticoagulant as directed.

I'm worried that I can't take an anticoagulant as directed.

More important
Equally important
More important

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.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

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

Leaning toward
Undecided
Leaning toward

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?
2, Are anticoagulants safe for everyone to take?

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?

Not sure at all
Somewhat sure
Very sure

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

Credits
AuthorHealthwise Staff
Clinical Review BoardClinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

References
Citations
  1. January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/?CIR.0000000000000041. Accessed April 18, 2014.
  2. January CT, et al. (2019). 2019 AHA/ACC/HRS Focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation, published online January 28, 2019. DOI: 10.1161/CIR.0000000000000665. Accessed January 31, 2019.
  3. 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 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?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. 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, which closes the left atrial appendage, may be an option for some people who cannot take an anticoagulant.

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. The risk of stroke isn't the same for everyone. Your doctor can help you know your risk.
  • Taking an anticoagulant lowers the risk of stroke. But how much your risk will be lowered depends on how high your risk was to start with.
  • Taking an anticoagulant raises your risk of bleeding problems. This risk isn't the same for everyone. Your doctor can help you understand your risk of bleeding.
  • 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.
  • There are different types of anticoagulants. You and your doctor can choose the medicine that is right for you.
FAQs

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 direct oral anticoagulants (DOACs) and warfarin. DOACs include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).

You and your doctor can decide which medicine is right for you. This decision may depend on the cost, your health, and your preferences about taking medicine. Talk with your doctor about any concerns you have about the cost of your medicine. Your doctor can let you know if certain anticoagulants are safer than others based on your health.

Doctors usually recommend DOACs first. They work as well as or slightly better than warfarin. They are less likely to cause bleeding in the brain.2

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:

  • Being older than 65.
  • Being female.
  • Heart failure.
  • High blood pressure.
  • A previous stroke or transient ischemic attack (TIA).
  • Heart attack, peripheral artery 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.

The risk of bleeding isn't the same for everyone. Your doctor can help you understand your risk. Your doctor can check things that can raise your risk of serious bleeding. Examples of these things are having very high blood pressure, kidney disease, or liver disease or having had a stroke. Serious bleeding includes any bleeding that requires a blood transfusion or being in the hospital.

Over 2 to 3 years, about 6 people out of 100 will have a problem with serious bleeding. This means that about 94 out of 100 will not.3 But these are average risks. Your own risk may be higher or lower.

You will want to weigh the benefits of reducing your risk of stroke against your risk of bleeding.

Some people can't take anticoagulants, because they have a higher risk of having a serious problem if bleeding occurs.

When you take an anticoagulant, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also need to have regular blood tests and watch how much vitamin K you eat or drink.

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. Your doctor can help you know your risk based on your age, sex, and health.

What can you do instead of taking an anticoagulant?

No medicine

You can choose to not take an anticoagulant. For example, some people who have a low risk of stroke may decide that the possible stroke prevention does not outweigh the risk of bleeding.

Left atrial appendage closure

A device may be implanted to lower the risk of stroke. Doctors call the device a left atrial appendage closure device. The device can 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. 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.

2. Compare your options

Take an anticoagulant to reduce the risk of strokeDon't take an anticoagulant
What is usually involved?
  • You take a pill once or twice a day.
  • You try to avoid injuries and falls that could cause bleeding.
  • You'll need to let your doctor know of any new medicines you start taking while you are taking an anticoagulant.
  • If you take warfarin, you will have regular blood tests and you will try to eat and drink about the same amount of vitamin K each day.
  • You do not take an anticoagulant.
What are the benefits?
  • Anticoagulants lower the risk of stroke in people who have atrial fibrillation.
  • You do not take a medicine that raises your risk of bleeding problems.
What are the risks and side effects?
  • Anticoagulants increase your risk of bleeding problems.
  • Anticoagulants lower your risk of stroke, but you could still have a stroke.
  • If you have atrial fibrillation and don't take an anticoagulant, you might have a stroke.

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

"My doctor says I have a very high risk of bleeding. 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.

I don't worry much about my risk of stroke.

More important
Equally important
More important

I'm confident that I can take an anticoagulant as directed.

I'm worried that I can't take an anticoagulant as directed.

More important
Equally important
More important

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.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

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

Leaning toward
Undecided
Leaning toward

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
You're right. Atrial fibrillation increases your risk of stroke, but anticoagulants can reduce that risk.

2. Are anticoagulants safe for everyone to take?

  • Yes
  • No
  • I'm not sure
You're right. The risk of bleeding from an anticoagulant can be higher for some people. Examples of things that raise your risk are having very high blood pressure, kidney disease, or liver disease or having had a stroke.

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?

Not sure at all
Somewhat sure
Very sure

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.
Credits
ByHealthwise Staff
Clinical Review BoardClinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

References
Citations
  1. January CT, et al. (2014). 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, published online March 28, 2014. DOI: 10.1161/?CIR.0000000000000041. Accessed April 18, 2014.
  2. January CT, et al. (2019). 2019 AHA/ACC/HRS Focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation, published online January 28, 2019. DOI: 10.1161/CIR.0000000000000665. Accessed January 31, 2019.
  3. 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.

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