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Atrial Fibrillation: Should I Take an Anticoagulant to Prevent Stroke?

British Columbia Specific Information

A stroke is a brain injury caused by blood flow to the brain being blocked, or bleeding in the brain. After having a stroke you may experience physical, mental and emotional complications. These could include: weakness on one side of the body, joint pain, trouble walking, speech and language difficulties, trouble with memory or focusing, etc. Stroke rehabilitation programs can help you continue to live as independently as possible after a stroke, and to learn to adjust to the physical and mental changes caused by your stroke.

To find stroke recovery and rehabilitation programs in your area, search HealthLinkBC's FIND Services and Resources Directory. For more information on stroke recovery, visit Heart and Stroke Foundation or Stroke Recovery Association of British Columbia.

For more information on exercising to prevent a stroke or rehabilitation exercises after a stroke, call 8-1-1 to speak with a qualified exercise professional Monday to Friday 9am to 5pm PST. You may also call 8-1-1 to speak with a registered nurse 24 hours a day, 7 days a week.

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 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. 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.
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 apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Lixiana), rivaroxaban (Xarelto), and warfarin.

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 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. This includes taking care to prevent falls and getting regular blood tests if needed.

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

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.

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
2, Check what you need to do before you make this decision.

3. Use the following space to list questions, concerns, and next steps.

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

What matters to you 

Print Summary

Credits and References

Credits
AuthorHealthwise Staff
Primary Medical ReviewerRakesh K. Pai MD, FACC - Cardiology, Electrophysiology
Primary Medical ReviewerE. Gregory Thompson MD - Internal Medicine
Primary Medical ReviewerMartin J. Gabica MD - Family Medicine
Primary Medical ReviewerAdam Husney MD - Family Medicine
Primary Medical ReviewerJohn M. Miller MD, FACC - Cardiology, Electrophysiology
Primary Medical ReviewerSteven J. Atlas MD, MPH - Internal Medicine
Primary Medical ReviewerHeather Quinn MD - Family Medicine
Primary Medical ReviewerStephen Fort MD, MRCP, FRCPC - Interventional Cardiology
References
Citations
  1. Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313):41.
  2. Antithrombotic drugs (2014). Medical Letter on Drugs and Therapeutics,56(1454): 103–108. http://secure.medicalletter.org/TML-article-1454a. Accessed October 22,2014.
  3. Dabigatran etexilate (Pradaxa)—A new oral anticoagulant (2010). Medical Letter on Drugs and Therapeutics, 52(1351): 89–90.
  4. Patel MR, et al.(2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 365(10): 883–891.
  5. Granger CB, et al.(2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11): 981–992.
Other Works Consulted
  • 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.
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 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. 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.
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 apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Lixiana), rivaroxaban (Xarelto), and warfarin.

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 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. 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 strokeDon't take an anticoagulant
What is usually involved?
  • 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.
  • 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

"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.

       
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. Anticoagulants may not be safe for you if you can't control your blood pressure, have stomach bleeding, or drink large amounts of alcohol.

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
ByHealthwise Staff
Primary Medical ReviewerRakesh K. Pai MD, FACC - Cardiology, Electrophysiology
Primary Medical ReviewerE. Gregory Thompson MD - Internal Medicine
Primary Medical ReviewerMartin J. Gabica MD - Family Medicine
Primary Medical ReviewerAdam Husney MD - Family Medicine
Primary Medical ReviewerJohn M. Miller MD, FACC - Cardiology, Electrophysiology
Primary Medical ReviewerSteven J. Atlas MD, MPH - Internal Medicine
Primary Medical ReviewerHeather Quinn MD - Family Medicine
Primary Medical ReviewerStephen Fort MD, MRCP, FRCPC - Interventional Cardiology
References
Citations
  1. Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313):41.
  2. Antithrombotic drugs (2014). Medical Letter on Drugs and Therapeutics,56(1454): 103–108. http://secure.medicalletter.org/TML-article-1454a. Accessed October 22,2014.
  3. Dabigatran etexilate (Pradaxa)—A new oral anticoagulant (2010). Medical Letter on Drugs and Therapeutics, 52(1351): 89–90.
  4. Patel MR, et al.(2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 365(10): 883–891.
  5. Granger CB, et al.(2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11): 981–992.
Other Works Consulted
  • 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.
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