Atrial Fibrillation: Which Anticoagulant Should I Take to Prevent Stroke?
Atrial Fibrillation: Which Anticoagulant Should I Take to Prevent Stroke?Skip to the navigationYou 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: Which Anticoagulant Should I Take to Prevent Stroke?Get the factsYour options- Take warfarin to prevent stroke.
- Take a different type of anticoagulant to prevent stroke.
Is this decision for you? This could be a decision for you if you are newly diagnosed with atrial fibrillation or if you are already taking warfarin. You may first want to decide whether to take an anticoagulant at all. Key points to remember- Atrial fibrillation increases your risk of
stroke.
Taking an anticoagulant lowers that risk. Anticoagulants used for atrial fibrillation are warfarin (Coumadin), apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).
- Your doctor can help you understand which medicine might be best for you. This may depend on your health and your preferences about taking medicine.
- Warfarin has been used for many years to reduce the risk of stroke in people with atrial fibrillation. The medicine is low-cost, and doctors understand its long-term side effects.
- Newer anticoagulants also lower the risk of stroke. These medicines are apixaban, dabigatran, edoxaban, and rivaroxaban. They work as well as or slightly better than warfarin. But these newer anticoagulants cost more than warfarin.
- A newer anticoagulant may be a good choice if you cannot take warfarin safely. But you cannot take a newer anticoagulant if you have an artificial heart valve, severe kidney or liver disease, or certain types of heart valve disease.
- When you take warfarin, you need
to have regular blood tests to make sure that you are taking the right dose.
And you need to watch how much vitamin K you eat and drink. With other types of anticoagulants, you don't need regular blood tests to check the dose and you don't have to watch your vitamin K intake.
- Anticoagulants work by increasing the time it takes for a blood clot to form, so they increase your risk of problems from bleeding. If you take any anticoagulant, you need to be careful to avoid serious bleeding by preventing falls and injuries.
FAQs Atrial fibrillation increases your risk
of
stroke. 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 Taking an anticoagulant lowers that
risk. These medicines are also called blood thinners, but they don't really thin your blood. Instead, they increase the time it takes for a blood clot to form. Anticoagulants used for atrial fibrillation are warfarin (Coumadin), apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto). Lowering the risk of strokeAll of these medicines can lower the risk of stroke. How much they can lower your stroke risk depends on how high your risk is to start with. Warfarin has been used for many years to lower the risk of stroke in people who have atrial fibrillation. Anticoagulants other than warfarin are newer. These medicines include apixaban, dabigatran, edoxaban, and rivaroxaban. They work as well as or slightly better than warfarin to lower the risk of stroke.footnote 2, footnote 3, footnote 4, footnote 5, footnote 6 Experts have not compared these newer medicines to each other in research studies. Raising the risk of bleedingAnticoagulants make your blood clot slower than normal. This raises your risk of bleeding problems in and around the brain, bleeding
in the stomach and intestines, and bruising and bleeding if you are hurt. So when you take any anticoagulant, you need to take extra care to prevent bleeding, such as by preventing falls and injuries. Each year about 1 to 3 out of 100 people who take
an anticoagulant will have a problem with severe bleeding inside the body. This means that 97 to 99 out of 100 people will not have a bleeding problem.footnote 6, footnote 3, footnote 4, footnote 5 Your own risk of bleeding 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. All of these medicines raise the risk of bleeding. But there are differences in the amount of risk. The newer anticoagulants have a slightly higher risk of causing bleeding in the stomach and intestines.footnote 2 Warfarin has a higher risk of causing bleeding in the brain.footnote 7 Warfarin has been used for many years, so doctors understand the bleeding risks and long-term side effects. Since apixaban, dabigatran, edoxaban, and rivaroxaban are newer, the bleeding risks are known from research studies. Over time, as these anticoagulants are used, doctors will learn more about the bleeding risks and any other side effects. These medicines are different in a few ways that may play a role in your decision. Your health also plays a role in which medicine is best for you. Your doctor can help you understand the benefits and risks of each medicine based on your health. If you have certain health conditions, warfarin may be the only anticoagulant you can take safely. For example, if you have an artificial heart valve, severe kidney or liver disease, or rheumatic mitral valve stenosis, you can't take one of the newer anticoagulants.footnote 8 Long-term effectsWarfarin has been used for many years to reduce the risk of stroke in people who have atrial fibrillation. The medicine is low-cost, and doctors understand its long-term effects. Anticoagulants other than warfarin are newer. Their long-term effects aren't known. Risk of bleeding in the brainAll anticoagulants have a risk of causing bleeding in different parts of the body, including the brain. Bleeding in the brain is very serious. Compared with warfarin, the newer anticoagulants have a lower risk of causing bleeding in the brain. Research studies show that about 6 out of 1000 people who take a newer anticoagulant may have bleeding in the brain. This means that 994 out of 1000 people may not have this bleeding problem. About 12 out of 1000 people who take warfarin may have bleeding in the brain. This means that 988 out of 1000 people may not have this bleeding problem.footnote 7 Blood tests and vitamin K monitoringWhen you take warfarin, you'll need to get regular blood tests to make sure you are taking the right dose. And you will need to watch how much vitamin K you eat and drink. When you take a different type of anticoagulant, you don't need to have regular blood tests to check if you are taking the right dose and you don't need to watch your vitamin K intake. CostWarfarin costs less than the other anticoagulants. Warfarin costs about $100 for a 1-year supply. Anticoagulants other than warfarin can cost about $3,500 for a 1-year supply.footnote 9 If you have health insurance, some or all of this cost may be covered. Stopping bleedingIf you have a bleeding problem or need surgery right away, your doctor may need to quickly reverse the effects of an anticoagulant. Dabigatran and warfarin. Doctors know how to quickly reverse the effects of dabigatran and warfarin to stop or prevent bleeding. Apixaban, edoxaban, and rivaroxaban. Doctors do not have a medicine that has been proved to quickly reverse the effects of these anticoagulants. Your doctor may recommend that you take or stay on warfarin if: - You have an artificial heart valve, severe kidney or liver disease, or certain types of heart valve disease. If you have these health problems, you can't take a different type of anticoagulant.
- You are already taking warfarin and aren't having any problems keeping a safe level of medicine in your blood.
Your doctor may recommend that you try a different type of anticoagulant if: - You've been taking warfarin and have problems keeping a safe level of medicine in your blood.
- You are already taking warfarin and are having a problem with side effects.
- You are able to take the other anticoagulant as directed. For example, you are willing to take dabigatran twice a day.
Compare your options | |
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What is usually involved? |
| |
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What are the benefits? |
| |
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What are the risks and side effects? |
| |
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Take warfarin to prevent strokeTake warfarin to prevent stroke- You take a
pill once a day.
- You have regular blood tests to make sure you are taking the right dose.
- You take extra care to avoid bleeding by preventing falls and injuries.
- You let your doctor know about any new medicines you start taking while you are taking warfarin.
- You will try to eat and drink about the same amount of vitamin K each day.
- Warfarin has been used for many years to reduce the risk of stroke in people who have atrial fibrillation.
- It is low-cost. A 1-year supply of warfarin costs about $100.footnote 9
- Warfarin increases your risk of bleeding problems. Compared with the newer anticoagulants, it has a lower risk of causing bleeding in the stomach but a higher risk of causing bleeding in the brain.
- Side effects include skin rash.
- Warfarin lowers your risk of stroke, but you could still have a stroke.
Take a different anticoagulant to prevent strokeTake a different anticoagulant to prevent stroke- With apixaban and dabigatran, you take a pill twice a day. With edoxaban and rivaroxaban, you take a pill once a day.
- You take extra care to avoid bleeding by preventing falls and injuries.
- You let your doctor know about any new medicines you start taking while you are taking the anticoagulant.
- These anticoagulants lower the
risk of stroke in people who have atrial fibrillation. Dabigatran works slightly better than warfarin.footnote 3 Apixaban, edoxaban, and rivaroxaban work about the same as warfarin.footnote 6, footnote 5, footnote 4
- You don't need regular blood tests to make sure you are taking the right dose.
- You don't need to watch how much vitamin K you eat or drink.
- These anticoagulants increase your risk of bleeding problems. Compared with warfarin, they have a lower risk of causing bleeding in the brain but a higher risk of causing bleeding in the stomach.
- Apixaban and edoxaban may cause a skin rash. Edoxaban may cause anemia. Dabigatran may cause stomach upset or stomach pain. Rivaroxaban does not seem to cause other side effects.
- These anticoagulants can be expensive. A 1-year supply can cost about $3,500.footnote 9
- The anticoagulants lower your risk for stroke, but you could still have a stroke.
I live on a ranch more than 100 miles from
my doctor's office. I don't plan on checking in with him every month to have my
blood tested. So I'm going to try a blood thinner that doesn't need regular blood testing. I've been taking warfarin for a long time. I guess I'm just used to it. I haven't had any problems with it. I think I'll just keep taking it. The high cost of medicines is a concern. But I'd rather pay more and not have to watch what I eat or go to the doctor so often. I think I'll try an anticoagulant that is different from warfarin. I like knowing that my doctor is checking my blood regularly. I think I'll try warfarin first and see how it works. 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 warfarin Reasons to take a different anticoagulant I don't mind watching how much vitamin K I eat and drink. I don't want to have to track my vitamin K intake. More important Equally important More important I'd rather take a familiar medicine with a long record of use, like warfarin. I'm comfortable taking a newer medicine. More important Equally important More important I don't mind going to the doctor for regular blood tests. I don't want to have to take regular blood tests. More important Equally important More important I'd rather take a blood thinner with known long-term side effects. I'm not worried about long-term side effects of a newer medicine. More important Equally important More important I prefer to take a less expensive medicine. I'm not worried about the cost of my medicine. 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.
Take warfarin Take a different type of anticoagulant Leaning toward Undecided Leaning toward What else do you need to make your decision?1.
How sure do you feel right now about your decision? Not sure at all Somewhat sure Very sure Your SummaryHere's a record of your answers. You can use it to talk with your doctor or loved ones about your decision. Next stepsWhich way you're leaningHow sure you areYour commentsKey concepts that you understoodKey concepts that may need reviewCredits | Author | Healthwise Staff |
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| Primary Medical Reviewer | Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
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| Primary Medical Reviewer | E. Gregory Thompson, MD - Internal Medicine |
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| Primary Medical Reviewer | Kathleen Romito, MD - Family Medicine |
|---|
| Primary Medical Reviewer | Martin J. Gabica, MD - Family Medicine |
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| Specialist Medical Reviewer | John M. Miller, MD, FACC - Cardiology, Electrophysiology |
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References Citations - Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313): 41.
- 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.
- Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12): 1139-1151.
- Patel MR, et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 365(10): 883-891.
- Giugliano RP, et al. (2013). Edoxaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 369(22): 2093-2104. DOI:0.1056/NEJMoa1310907. Accessed February 27, 2015.
- Granger CB, et al. (2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11): 981-992.
- Chatterjee S, et al. (2013). New oral anticoagulants and the risk of intracranial hemorrhage. JAMA Neurology, 70(12): 1486-1490. DOI: 10.1001/jamaneurol2013.4021. Accessed March 28, 2014.
- 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.
- Which oral anticoagulant for atrial fibrillation? (2016). Medical Letter on Drugs and Therapeutics, 58(1492): 45-46. Accessed April 10, 2016.
Other Works Consulted - Ageno W, et al. (2012). Oral anticoagulant therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed.-American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): e44S-E88S.
- Bruins Slot KMH, Berge E (2013). Factor Xa inhibitors versus vitamin K antagonists for prevention cerebral or systemic embolism in patients with atrial fibrillation. Cochrane Database of Systematic Reviews (8). DOI: 10.1002/14651858.CD008980.pub2. Accessed April 4, 2014.
- Furie KL, et al. (2012). Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation: A science advisory for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 43(12): 3442-3453.
- Hankey GJ, Eikelboom JW (2011). Dabigatran etexilate: A new oral thrombin inhibitor. Circulation, 123(13): 1436-1450.
- Raval AN, et al. (2017). Management of patients on non-vitamin K antagonist oral anticoagulants in the acute and periprocedural setting: A scientific statement from the American Heart Association. Circulation, 135(10): e604-e633. DOI: 10.1161/CIR.0000000000000477. Accessed March 9, 2017.
- 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.
- Spinler SA, Willey VJ (2011). A patient's guide to taking dabigatran etexilate. Circulation, 124(8): e209-e211.
- 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.
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: Which Anticoagulant Should I Take 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. - 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 FactsYour options- Take warfarin to prevent stroke.
- Take a different type of anticoagulant to prevent stroke.
Is this decision for you? This could be a decision for you if you are newly diagnosed with atrial fibrillation or if you are already taking warfarin. You may first want to decide whether to take an anticoagulant at all. Key points to remember- Atrial fibrillation increases your risk of
stroke.
Taking an anticoagulant lowers that risk. Anticoagulants used for atrial fibrillation are warfarin (Coumadin), apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).
- Your doctor can help you understand which medicine might be best for you. This may depend on your health and your preferences about taking medicine.
- Warfarin has been used for many years to reduce the risk of stroke in people with atrial fibrillation. The medicine is low-cost, and doctors understand its long-term side effects.
- Newer anticoagulants also lower the risk of stroke. These medicines are apixaban, dabigatran, edoxaban, and rivaroxaban. They work as well as or slightly better than warfarin. But these newer anticoagulants cost more than warfarin.
- A newer anticoagulant may be a good choice if you cannot take warfarin safely. But you cannot take a newer anticoagulant if you have an artificial heart valve, severe kidney or liver disease, or certain types of heart valve disease.
- When you take warfarin, you need
to have regular blood tests to make sure that you are taking the right dose.
And you need to watch how much vitamin K you eat and drink. With other types of anticoagulants, you don't need regular blood tests to check the dose and you don't have to watch your vitamin K intake.
- Anticoagulants work by increasing the time it takes for a blood clot to form, so they increase your risk of problems from bleeding. If you take any anticoagulant, you need to be careful to avoid serious bleeding by preventing falls and injuries.
FAQs How do anticoagulants lower your risk of stroke?Atrial fibrillation increases your risk
of
stroke. 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 Taking an anticoagulant lowers that
risk. These medicines are also called blood thinners, but they don't really thin your blood. Instead, they increase the time it takes for a blood clot to form. Anticoagulants used for atrial fibrillation are warfarin (Coumadin), apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto). How are these medicines the same?Lowering the risk of strokeAll of these medicines can lower the risk of stroke. How much they can lower your stroke risk depends on how high your risk is to start with. Warfarin has been used for many years to lower the risk of stroke in people who have atrial fibrillation. Anticoagulants other than warfarin are newer. These medicines include apixaban, dabigatran, edoxaban, and rivaroxaban. They work as well as or slightly better than warfarin to lower the risk of stroke.2, 3, 4, 5, 6 Experts have not compared these newer medicines to each other in research studies. Raising the risk of bleedingAnticoagulants make your blood clot slower than normal. This raises your risk of bleeding problems in and around the brain, bleeding
in the stomach and intestines, and bruising and bleeding if you are hurt. So when you take any anticoagulant, you need to take extra care to prevent bleeding, such as by preventing falls and injuries. Each year about 1 to 3 out of 100 people who take
an anticoagulant will have a problem with severe bleeding inside the body. This means that 97 to 99 out of 100 people will not have a bleeding problem.6, 3, 4, 5 Your own risk of bleeding 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. All of these medicines raise the risk of bleeding. But there are differences in the amount of risk. The newer anticoagulants have a slightly higher risk of causing bleeding in the stomach and intestines.2 Warfarin has a higher risk of causing bleeding in the brain.7 Warfarin has been used for many years, so doctors understand the bleeding risks and long-term side effects. Since apixaban, dabigatran, edoxaban, and rivaroxaban are newer, the bleeding risks are known from research studies. Over time, as these anticoagulants are used, doctors will learn more about the bleeding risks and any other side effects. How are these medicines different?These medicines are different in a few ways that may play a role in your decision. Your health also plays a role in which medicine is best for you. Your doctor can help you understand the benefits and risks of each medicine based on your health. If you have certain health conditions, warfarin may be the only anticoagulant you can take safely. For example, if you have an artificial heart valve, severe kidney or liver disease, or rheumatic mitral valve stenosis, you can't take one of the newer anticoagulants.8 Long-term effectsWarfarin has been used for many years to reduce the risk of stroke in people who have atrial fibrillation. The medicine is low-cost, and doctors understand its long-term effects. Anticoagulants other than warfarin are newer. Their long-term effects aren't known. Risk of bleeding in the brainAll anticoagulants have a risk of causing bleeding in different parts of the body, including the brain. Bleeding in the brain is very serious. Compared with warfarin, the newer anticoagulants have a lower risk of causing bleeding in the brain. Research studies show that about 6 out of 1000 people who take a newer anticoagulant may have bleeding in the brain. This means that 994 out of 1000 people may not have this bleeding problem. About 12 out of 1000 people who take warfarin may have bleeding in the brain. This means that 988 out of 1000 people may not have this bleeding problem.7 Blood tests and vitamin K monitoringWhen you take warfarin, you'll need to get regular blood tests to make sure you are taking the right dose. And you will need to watch how much vitamin K you eat and drink. When you take a different type of anticoagulant, you don't need to have regular blood tests to check if you are taking the right dose and you don't need to watch your vitamin K intake. CostWarfarin costs less than the other anticoagulants. Warfarin costs about $100 for a 1-year supply. Anticoagulants other than warfarin can cost about $3,500 for a 1-year supply.9 If you have health insurance, some or all of this cost may be covered. Stopping bleedingIf you have a bleeding problem or need surgery right away, your doctor may need to quickly reverse the effects of an anticoagulant. Dabigatran and warfarin. Doctors know how to quickly reverse the effects of dabigatran and warfarin to stop or prevent bleeding. Apixaban, edoxaban, and rivaroxaban. Doctors do not have a medicine that has been proved to quickly reverse the effects of these anticoagulants. Why might your doctor recommend taking either warfarin or a different anticoagulant?Your doctor may recommend that you take or stay on warfarin if: - You have an artificial heart valve, severe kidney or liver disease, or certain types of heart valve disease. If you have these health problems, you can't take a different type of anticoagulant.
- You are already taking warfarin and aren't having any problems keeping a safe level of medicine in your blood.
Your doctor may recommend that you try a different type of anticoagulant if: - You've been taking warfarin and have problems keeping a safe level of medicine in your blood.
- You are already taking warfarin and are having a problem with side effects.
- You are able to take the other anticoagulant as directed. For example, you are willing to take dabigatran twice a day.
2. Compare your options| | Take warfarin to prevent stroke | Take a different anticoagulant to prevent stroke |
|---|
| What is usually involved? | - You take a
pill once a day.
- You have regular blood tests to make sure you are taking the right dose.
- You take extra care to avoid bleeding by preventing falls and injuries.
- You let your doctor know about any new medicines you start taking while you are taking warfarin.
- You will try to eat and drink about the same amount of vitamin K each day.
| - With apixaban and dabigatran, you take a pill twice a day. With edoxaban and rivaroxaban, you take a pill once a day.
- You take extra care to avoid bleeding by preventing falls and injuries.
- You let your doctor know about any new medicines you start taking while you are taking the anticoagulant.
|
|---|
| What are the benefits? | - Warfarin has been used for many years to reduce the risk of stroke in people who have atrial fibrillation.
- It is low-cost. A 1-year supply of warfarin costs about $100.9
| - These anticoagulants lower the
risk of stroke in people who have atrial fibrillation. Dabigatran works slightly better than warfarin.3 Apixaban, edoxaban, and rivaroxaban work about the same as warfarin.6, 5, 4
- You don't need regular blood tests to make sure you are taking the right dose.
- You don't need to watch how much vitamin K you eat or drink.
|
|---|
| What are the risks and side effects? | - Warfarin increases your risk of bleeding problems. Compared with the newer anticoagulants, it has a lower risk of causing bleeding in the stomach but a higher risk of causing bleeding in the brain.
- Side effects include skin rash.
- Warfarin lowers your risk of stroke, but you could still have a stroke.
| - These anticoagulants increase your risk of bleeding problems. Compared with warfarin, they have a lower risk of causing bleeding in the brain but a higher risk of causing bleeding in the stomach.
- Apixaban and edoxaban may cause a skin rash. Edoxaban may cause anemia. Dabigatran may cause stomach upset or stomach pain. Rivaroxaban does not seem to cause other side effects.
- These anticoagulants can be expensive. A 1-year supply can cost about $3,500.9
- The anticoagulants lower your risk for stroke, but you could still have a stroke.
|
|---|
Personal storiesPersonal 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 live on a ranch more than 100 miles from my doctor's office. I don't plan on checking in with him every month to have my blood tested. So I'm going to try a blood thinner that doesn't need regular blood testing." "I've been taking warfarin for a long time. I guess I'm just used to it. I haven't had any problems with it. I think I'll just keep taking it." "The high cost of medicines is a concern. But I'd rather pay more and not have to watch what I eat or go to the doctor so often. I think I'll try an anticoagulant that is different from warfarin." "I like knowing that my doctor is checking my blood regularly. I think I'll try warfarin first and see how it works." 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 warfarin Reasons to take a different anticoagulant I don't mind watching how much vitamin K I eat and drink. I don't want to have to track my vitamin K intake. More important Equally important More important I'd rather take a familiar medicine with a long record of use, like warfarin. I'm comfortable taking a newer medicine. More important Equally important More important I don't mind going to the doctor for regular blood tests. I don't want to have to take regular blood tests. More important Equally important More important I'd rather take a blood thinner with known long-term side effects. I'm not worried about long-term side effects of a newer medicine. More important Equally important More important I prefer to take a less expensive medicine. I'm not worried about the cost of my medicine. 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.
Take warfarin Take a different type of anticoagulant Leaning toward Undecided Leaning toward 5. What else do you need to make your decision?
Check the facts
1.
Do all of the medicines lower your risk of stroke? That's right. All of the medicines can lower your risk of stroke if you have atrial fibrillation. 2.
Do I need to have regular blood tests to check the medicine dose if I'm taking an anticoagulant that is different from warfarin (apixaban, dabigatran, edoxaban, or rivaroxaban)? That's right. With an anticoagulant that is different from warfarin, there are no regular blood tests to check the medicine dose. But if you take warfarin, it's important to have regular blood tests to make sure that your medicine is working the way it should. 3.
Do all of the medicines increase your risk of bleeding? That's right. All of the medicines increase your risk of bleeding, so it's important to take care to prevent falls and injuries. Decide what's next1.
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? Certainty1.
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. Credits | 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 | Kathleen Romito, MD - Family Medicine |
|---|
| Primary Medical Reviewer | Martin J. Gabica, MD - Family Medicine |
|---|
| Specialist Medical Reviewer | John M. Miller, MD, FACC - Cardiology, Electrophysiology |
|---|
References Citations - Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313): 41.
- 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.
- Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12): 1139-1151.
- Patel MR, et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 365(10): 883-891.
- Giugliano RP, et al. (2013). Edoxaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 369(22): 2093-2104. DOI:0.1056/NEJMoa1310907. Accessed February 27, 2015.
- Granger CB, et al. (2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11): 981-992.
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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 13, 2017 Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313): 41. 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. Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12): 1139-1151. Patel MR, et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 365(10): 883-891. Giugliano RP, et al. (2013). Edoxaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 369(22): 2093-2104. DOI:0.1056/NEJMoa1310907. Accessed February 27, 2015. Granger CB, et al. (2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11): 981-992. Chatterjee S, et al. (2013). New oral anticoagulants and the risk of intracranial hemorrhage. JAMA Neurology, 70(12): 1486-1490. DOI: 10.1001/jamaneurol2013.4021. Accessed March 28, 2014. 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. Which oral anticoagulant for atrial fibrillation? (2016). Medical Letter on Drugs and Therapeutics, 58(1492): 45-46. Accessed April 10, 2016. Last modified on: 8 September 2017
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