Atrial fibrillation: Should I take anticoagulants 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.
Don't take anticoagulants. You may try other medicines.
Key points to remember
Atrial fibrillation increases your risk of
stroke.
High blood pressure,
heart failure, a previous
stroke, or being 75 or older can also put you at high
risk for stroke. Taking
anticoagulants, such as warfarin, lowers that risk.
Warfarin may not be safe for you if you fall often, can't control
your blood pressure, have stomach bleeding, or drink large amounts of alcohol.
Aspirin may be a good choice if you are young and have no other
heart or health problems or if you can't take warfarin safely. Aspirin doesn't
work as well as warfarin to reduce your stroke risk. But aspirin is less likely
to cause bleeding problems.
When you take anticoagulants, you need
to have regular blood tests to make sure that you are taking the right dose.
You'll need to take enough medicine to lower your risk of stroke, but not so
much that you have a problem with bleeding.
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.
The most commonly used
anticoagulants are warfarin and heparin.
Atrial fibrillation increases your risk
of
stroke. Anticoagulants, such as warfarin, reduce that
risk.
The risk of stroke isn't the same for everyone with atrial
fibrillation. But people who have atrial fibrillation are 5 to 6 times more
likely to have a stroke than are people who don't have atrial
fibrillation.1
Anticoagulants provide
the best protection against stroke, if you can take them safely. Your doctor
may recommend that you take them if you are at high risk for stroke based on
your risk factors. 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.
Risk factors for stroke besides atrial
fibrillation include:
Anticoagulants slow the amount of time it takes for your blood to clot.
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. You
shouldn't take anticoagulants if:
You aren't able or willing to have
regular blood tests.
When you take anticoagulants, you need to have regular
blood tests to make sure that you are taking the right dose. You'll need to
take enough medicine to lower your risk of stroke, but not so much that you
have a bleeding problem.
If you have atrial fibrillation and are
pregnant or are thinking about getting pregnant, talk with your doctor before
taking warfarin. It may cause birth defects and problems during pregnancy.
Anticoagulants significantly reduce the risk of stroke in people
who have atrial fibrillation.2 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.
You will want to weigh the
benefits of reducing your risk of stroke with the risks of taking
anticoagulants. Warfarin works well to prevent stroke. But warfarin also
increases the risk of bleeding. Each year about 2 out of 100 people who take
warfarin will have a problem with severe bleeding, and 98 will not.3 But this is an average risk. Your own risk may be higher or
lower than average based on your own health.
Aspirin may be a good choice if you are young and have
no other heart or health problems or if you can't take warfarin safely. Aspirin
doesn't work as well as warfarin to reduce your stroke risk. But aspirin is
less likely to cause bleeding problems.
If you are at low risk
for stroke or can't take warfarin, your doctor may recommend that you take
aspirin. Aspirin is an
antiplatelet medicine. It decreases the risk of blood
clotting by preventing the smallest blood cells (platelets) from sticking
together and making a clot.
Aspirin lowers the risk of stroke in
people with atrial fibrillation but not nearly as much as warfarin does. How
much your risk will be reduced depends on how high your risk was to start with.
Aspirin
is less likely than anticoagulants to cause bleeding problems. Bleeding that is
bad enough to need treatment in a hospital happens in 1 or 2 out of 1,000
people who take aspirin.4 This means that 998 or 999
out of 1,000 people who take aspirin don't have serious bleeding.
Other antiplatelet
medicines, such as clopidogrel (Plavix), may be used. You may take
them with aspirin or instead of aspirin. When aspirin and clopidogrel are used
together, they may reduce the risk for stroke more than aspirin alone. But this
combination is also more likely to cause bleeding than aspirin
alone.
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 anticoagulants to help reduce my risk for
having a stroke.
Monty,
age 72
I live on a ranch more than 100 miles from
my doctor's office. I don't plan on checking in with him every week to have my
blood tested. Other than my atrial fibrillation, my doctor says my heart is
strong as an ox and I'm healthy as a horse. I'm not worried about having a
stroke, but I'm going to take aspirin every day.
Chuck, age 48
I am not
overly concerned about bleeding problems from taking anticoagulants, and I am
comfortable having my blood tested regularly to make sure the medications are
working correctly.
Martha, age 64
I have a bleeding ulcer that I am caring
for, so I am not a good candidate for blood thinners.
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 anticoagulants
Reasons not to take anticoagulants
I worry about my risk of stroke.
I think that my risk of stroke is low.
More important
Equally important
More important
I don't mind having regular blood tests.
I'm don't want to get my blood tested regularly.
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 anticoagulants
NOT taking anticoagulants
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 does not have it?
YesYou're right. Atrial fibrillation increases your risk of stroke, but anticoagulants such as warfarin can reduce that risk.
NoSorry, that's not right. Atrial fibrillation increases your risk of stroke, but anticoagulants such as warfarin can reduce that risk.
I'm not sureIt may help to go back and read "Why is it important to take medicine if you have atrial fibrillation?" Atrial fibrillation increases your risk of stroke, but anticoagulants such as warfarin can reduce that risk.
2.
Are anticoagulants safe for everyone to take?
YesSorry, that's not right. Anticoagulants like warfarin may not be safe for you if you fall often, can't control your blood pressure, have stomach bleeding, or drink large amounts of alcohol.
NoYou're right. Anticoagulants such as warfarin may not be safe for you if you fall often, can't control your blood pressure, have stomach bleeding, or drink large amounts of alcohol.
I'm not sureIt may help to go back and read "What are the risks of taking anticoagulants?" Anticoagulants may not be safe for you if you fall often, can't control your blood pressure, have stomach bleeding, or drink large amounts of alcohol.
3.
Does aspirin work as well as warfarin to reduce the risk of stroke?
YesSorry, that's not right. Aspirin doesn't work as well as warfarin to reduce the risk of stroke, but it is less likely to cause bleeding problems.
NoYou are right. Aspirin doesn't work as well as warfarin to reduce your risk of stroke, but it is less likely to cause bleeding problems.
I'm not sureIt may help to go back and read "What can you do instead of taking anticoagulants?" Aspirin doesn't work as well as warfarin to reduce your risk of stroke, but it is less likely to cause bleeding problems.
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.
Wang TJ, et al. (2003). A risk score for predicting
stroke or death in individuals with new-onset atrial fibrillation in the
community: The Framingham heart study. JAMA, 290(8):
1049–1056.
Hart R, et al. (2007). Meta-analysis: Antithrombotic
therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.
Annals of Internal Medicine, 146: 857–867.
Antiplatelet and anticoagulant drugs (2008).
Treatment Guidelines From The Medical Letter, 6(69):
29–36.
Patrono C, et al. (2008). Antiplatelet drugs: American
College of Chest Physicians evidence-based clinical practice guidelines (8th
edition). Chest, 133(6): 199S–233S.
Atrial fibrillation: Should I take anticoagulants to prevent stroke?
You can use this information to talk with your
doctor or loved ones about your decision.
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 anticoagulants to reduce the risk of stroke.
Don't take anticoagulants. You may try other medicines.
Key points to remember
Atrial fibrillation increases your risk of
stroke.
High blood pressure,
heart failure, a previous
stroke, or being 75 or older can also put you at high
risk for stroke. Taking
anticoagulants, such as warfarin, lowers that risk.
Warfarin may not be safe for you if you fall often, can't control
your blood pressure, have stomach bleeding, or drink large amounts of alcohol.
Aspirin may be a good choice if you are young and have no other
heart or health problems or if you can't take warfarin safely. Aspirin doesn't
work as well as warfarin to reduce your stroke risk. But aspirin is less likely
to cause bleeding problems.
When you take anticoagulants, you need
to have regular blood tests to make sure that you are taking the right dose.
You'll need to take enough medicine to lower your risk of stroke, but not so
much that you have a problem with bleeding.
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.
The most commonly used
anticoagulants are warfarin and heparin.
Atrial fibrillation increases your risk
of
stroke. Anticoagulants, such as warfarin, reduce that
risk.
The risk of stroke isn't the same for everyone with atrial
fibrillation. But people who have atrial fibrillation are 5 to 6 times more
likely to have a stroke than are people who don't have atrial
fibrillation.1
Anticoagulants provide
the best protection against stroke, if you can take them safely. Your doctor
may recommend that you take them if you are at high risk for stroke based on
your risk factors. 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.
Risk factors for stroke besides atrial
fibrillation include:
Anticoagulants slow the amount of time it takes for your blood to clot.
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. You
shouldn't take anticoagulants if:
You aren't able or willing to have
regular blood tests.
When you take anticoagulants, you need to have regular
blood tests to make sure that you are taking the right dose. You'll need to
take enough medicine to lower your risk of stroke, but not so much that you
have a bleeding problem.
If you have atrial fibrillation and are
pregnant or are thinking about getting pregnant, talk with your doctor before
taking warfarin. It may cause birth defects and problems during pregnancy.
Anticoagulants significantly reduce the risk of stroke in people
who have atrial fibrillation.2 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.
You will want to weigh the
benefits of reducing your risk of stroke with the risks of taking
anticoagulants. Warfarin works well to prevent stroke. But warfarin also
increases the risk of bleeding. Each year about 2 out of 100 people who take
warfarin will have a problem with severe bleeding, and 98 will not.3 But this is an average risk. Your own risk may be higher or
lower than average based on your own health.
Aspirin may be a good choice if you are young and have
no other heart or health problems or if you can't take warfarin safely. Aspirin
doesn't work as well as warfarin to reduce your stroke risk. But aspirin is
less likely to cause bleeding problems.
If you are at low risk
for stroke or can't take warfarin, your doctor may recommend that you take
aspirin. Aspirin is an
antiplatelet medicine. It decreases the risk of blood
clotting by preventing the smallest blood cells (platelets) from sticking
together and making a clot.
Aspirin lowers the risk of stroke in
people with atrial fibrillation but not nearly as much as warfarin does. How
much your risk will be reduced depends on how high your risk was to start with.
Aspirin
is less likely than anticoagulants to cause bleeding problems. Bleeding that is
bad enough to need treatment in a hospital happens in 1 or 2 out of 1,000
people who take aspirin.4 This means that 998 or 999
out of 1,000 people who take aspirin don't have serious bleeding.
Other antiplatelet
medicines, such as clopidogrel (Plavix), may be used. You may take
them with aspirin or instead of aspirin. When aspirin and clopidogrel are used
together, they may reduce the risk for stroke more than aspirin alone. But this
combination is also more likely to cause bleeding than aspirin
alone.
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 anticoagulants to help reduce my risk for
having a stroke. "
— Monty,
age 72
"I live on a ranch more than 100 miles from
my doctor's office. I don't plan on checking in with him every week to have my
blood tested. Other than my atrial fibrillation, my doctor says my heart is
strong as an ox and I'm healthy as a horse. I'm not worried about having a
stroke, but I'm going to take aspirin every day. "
— Chuck, age 48
"I am not
overly concerned about bleeding problems from taking anticoagulants, and I am
comfortable having my blood tested regularly to make sure the medications are
working correctly. "
— Martha, age 64
"I have a bleeding ulcer that I am caring
for, so I am not a good candidate for blood thinners. "
— Geraldo, age 52
3. Your Feelings
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 anticoagulants
Reasons not to take anticoagulants
I worry about my risk of stroke.
I think that my risk of stroke is low.
More important
Equally important
More important
I don't mind having regular blood tests.
I'm don't want to get my blood tested regularly.
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. Your Decision
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 anticoagulants
NOT taking anticoagulants
Leaning toward
Undecided
Leaning toward
5. Quiz Yourself
Check the facts
1.
If you have atrial fibrillation, are you at higher risk of stroke than someone who does not have it?
Yes
No
I'm not sure
You're right. Atrial fibrillation increases your risk of stroke, but anticoagulants such as warfarin can reduce that risk.
2.
Are anticoagulants safe for everyone to take?
Yes
No
I'm not sure
You're right. Anticoagulants such as warfarin may not be safe for you if you fall often, can't control your blood pressure, have stomach bleeding, or drink large amounts of alcohol.
3.
Does aspirin work as well as warfarin to reduce the risk of stroke?
Yes
No
I'm not sure
You are right. Aspirin doesn't work as well as warfarin to reduce your risk of stroke, but it is less likely to cause bleeding problems.
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.
3.
Use the following space to list questions, concerns, and next steps.
Credits and references
Credits
Author
Robin Parks, MS
Editor
Kathleen M. Ariss, MS
Associate Editor
Pat Truman, MATC
Primary Medical Reviewer
Caroline S. Rhoads, MD - Internal Medicine
Specialist Medical Reviewer
John M. Miller, MD - Electrophysiology
References
Citations
Wang TJ, et al. (2003). A risk score for predicting
stroke or death in individuals with new-onset atrial fibrillation in the
community: The Framingham heart study. JAMA, 290(8):
1049–1056.
Hart R, et al. (2007). Meta-analysis: Antithrombotic
therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.
Annals of Internal Medicine, 146: 857–867.
Antiplatelet and anticoagulant drugs (2008).
Treatment Guidelines From The Medical Letter, 6(69):
29–36.
Patrono C, et al. (2008). Antiplatelet drugs: American
College of Chest Physicians evidence-based clinical practice guidelines (8th
edition). Chest, 133(6): 199S–233S.
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.
Wang TJ, et al. (2003). A risk score for predicting
stroke or death in individuals with new-onset atrial fibrillation in the
community: The Framingham heart study. JAMA, 290(8):
1049–1056.
Hart R, et al. (2007). Meta-analysis: Antithrombotic
therapy to prevent stroke in patients who have nonvalvular atrial fibrillation.
Annals of Internal Medicine, 146: 857–867.
Antiplatelet and anticoagulant drugs (2008).
Treatment Guidelines From The Medical Letter, 6(69):
29–36.
Patrono C, et al. (2008). Antiplatelet drugs: American
College of Chest Physicians evidence-based clinical practice guidelines (8th
edition). Chest, 133(6): 199S–233S.
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