Health Library Should I Take Anticoagulants to Prevent Stroke?From Healthwise

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

Anticoagulant medication, such as warfarin (Coumadin, for example), is highly effective in preventing stroke and death due to stroke in people with atrial fibrillation. However, it may not be suitable for everyone. Consider the following when making your decision:

• Anticoagulant medication, such as warfarin, provides the best protection against stroke, if you can take it.
• Almost everyone who has atrial fibrillation should take warfarin. The only people with atrial fibrillation who may not benefit from taking warfarin are people with lone atrial fibrillation who are younger than 65 and have no other risk factors for stroke, or people with chronic kidney disease, recent surgery or head trauma, a history of gastrointestinal bleeding, or alcoholism.
• If you are going to have cardioversion, your doctor will recommend that you take anticoagulant medication for 3 weeks before and for at least 4 weeks after cardioversion, to reduce the risk of stroke.¹
• If you have lone atrial fibrillation and are younger than 60, you can take 325 mg of aspirin daily instead of warfarin.
• If you are at risk for a stroke, aspirin can help prevent a stroke. But aspirin does not work as well as warfarin.
• When taking anticoagulants, you are required to have regular blood tests to assess your risk for problem bleeding.

What is an anticoagulant medication?

Anticoagulants are medications that help prevent blood clots. They are often called blood thinners, but they do not actually thin the blood. Instead, anticoagulants work by increasing the time it takes a blood clot to form.

Why is it important to take anticoagulant medications?

Atrial fibrillation increases your risk of stroke. People with atrial fibrillation and an otherwise normal heart are 5 to 6 times more likely to have a stroke than people who do not have atrial fibrillation.² People who have heart valve damage along with atrial fibrillation have an even higher risk. Taking anticoagulant medications significantly reduces your risk. The most commonly used anticoagulants are warfarin and heparin.

What are the risks of taking anticoagulant medications?

Anticoagulants slow the amount of time it takes for your blood to clot. This increases your risk of developing problems with bleeding within and around the brain, bleeding in the stomach and intestines, bruising and bleeding if injured, and serious skin rash.

You should not take anticoagulants if you:

• Have unexplained blood in the stool.
• Have uncontrolled high blood pressure.
• Are at high risk for falling.
• Are unable to take the medication as directed.
• Drink large amounts of alcohol.
• Are unable or unwilling to have regular blood tests.

Women with atrial fibrillation who are pregnant or plan to become pregnant should talk with their doctor about the potential benefits and risks of taking anticoagulants. In particular, these women should not take warfarin (such as Coumadin) because it can cause birth defects. Use of some anticoagulants, such as heparin, may complicate pregnancy and childbirth and can increase the risk of developing osteoporosis or thrombocytopenia if taken over the long term.

How effective are anticoagulants in reducing stroke?

Anticoagulants have been shown to reduce the risk of stroke in people who have atrial fibrillation.³

While the percentages in the above table may seem small, try thinking about the risk in this way: If you take aspirin instead of warfarin, you are 2 times more likely to have a stroke. So, your risk of stroke is lower with warfarin. But, if you take warfarin instead of aspirin, you are 3 times more likely to have severe bleeding. So, your risk of severe bleeding is higher with warfarin. Talk to your doctor about which medication is right for you.

For more information, see the topic Atrial Fibrillation.

Your choices are:

• Take anticoagulants to reduce the risk of stroke.
• Do not take anticoagulants—take aspirin instead.

The decision about whether to take anticoagulants takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about taking anticoagulants. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to take or not to take anticoagulants.

Check the box below that represents your overall impression about your decision.

Return to the topic Atrial Fibrillation.

Citations

1. Fuster V, et al. (2006). ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation—Executive Summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing committee to revise the 2001 guidelines for the management of patients with atrial fibrillation). Circulation, 114(7): 700–752.

2. 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.

3. Albers GW, et al. (2001). Antithrombotic therapy in atrial fibrillation. Chest, 119(Suppl 1): 194S–206S.

Author:	Robin Parks, MS	Last Updated: January 18, 2007
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Laurence Epstein, MD - Cardiac Electrophysiologist
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