Health Library Atrial Fibrillation: Which Anticoagulant Should I Take To Prevent Stroke?From Healthwise
Atrial Fibrillation: Which Anticoagulant Should I Take 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: Which Anticoagulant Should I Take To Prevent Stroke?
Get the facts
Your options
- Take warfarin to prevent stroke.
- Take dabigatran 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 either warfarin (Coumadin) or dabigatran (Pradaxa) lowers that risk.
- 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.
- Dabigatran is a newer medicine that also lowers the risk of stroke. It works as well as warfarin, but it costs more. It may be a good choice if you cannot take warfarin safely.
- 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 dabigatran, there are no regular blood tests and you don't have to watch your vitamin K intake.
- Both medicines work by increasing the time it takes for a blood clot to form, so they increase your risk of problems from bleeding. Whether you take warfarin or dabigatran, you need to be careful to avoid serious bleeding by preventing falls and injuries.
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 people who have atrial fibrillation are 5 times more likely to have a stroke than are people who don't have atrial fibrillation.1
Taking an anticoagulant such as warfarin (Coumadin) or dabigatran (Pradaxa) 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.
How are these medicines the same?
Lowering risk of stroke
Warfarin and dabigatran work about the same to lower your risk of stroke if you have atrial fibrillation.2
Raising risk of bleeding
Anticoagulants make your blood clot slower than normal. Both warfarin and dabigatran increase 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 either medicine, you need to take extra care to prevent bleeding, such as preventing falls and injuries.
The risks of bleeding are about the same for warfarin and dabigatran. Each year about 2 out of 100 people who take warfarin will have a problem with severe bleeding, and 98 will not.3 And each year about 3 out of 100 people who take dabigatran have a problem with severe bleeding, while 97 do not.2 Your own risk of bleeding may be higher or lower than average, based on your own health. Ask your doctor to help you understand your risk.
Some people can't take warfarin or dabigatran, because they have a higher risk of having a serious problem if bleeding occurs. You shouldn't take these drugs if:
- You have blood in your stool for no clear reason.
- You can't control your blood pressure.
- You drink large amounts of alcohol.
Let your doctor know if you are scheduled for any procedure that raises your risk of bleeding. Your medicine may need to be adjusted.
How are these medicines different?
Taking warfarin
Warfarin 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. How much your risk will be reduced when you take warfarin depends on how high your risk was to start with.
When 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.
Warfarin may cause birth defects and problems if you take it while you are pregnant.
Taking dabigatran
Dabigatran is a newer anticoagulant. Its long-term effects aren't known. It works slightly better than warfarin at preventing stroke.2 But like warfarin, how much your risk will be reduced depends on how high your risk was to start with. You don't need to have regular blood tests or watch your vitamin K intake with dabigatran.
You can't take dabigatran if you have heart valve disease, an artificial heart valve, or severe kidney or liver disease.4 Doctors don't know how dabigatran will affect you if you take it while you are pregnant.
Cost
Dabigatran costs about $3000 for a 1-year supply. Warfarin costs about $48 for a 1-year supply. If you have health insurance, some or all of this cost may be covered.5
Surgery
Doctors know how to monitor warfarin and how to reverse its effects if you need surgery. Since dabigatran is newer, doctors still don't know about long-term side effects. If you are taking dabigatran and need surgery, it may take longer to reverse the blood-thinning effects.
Why might your doctor recommend taking either warfarin or dabigatran?
Your doctor may recommend that you take or stay on warfarin if:
- You have heart valve disease, an artificial heart valve, or severe kidney or liver disease. You can't take dabigatran if you have these health problems.
- 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 dabigatran 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 dabigatran twice a day as directed.
Compare your options
Compare
What is usually involved? | ||
What are the benefits? | ||
What are the risks and side effects? |
- 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.
- 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 $48.5
- If you need surgery or if you have serious bleeding, the blood-thinning effects of warfarin can be reversed.
- Warfarin increases your risk of bleeding problems.
- Side effects include skin rash.
- You need to be careful about how much vitamin K you eat and drink.
- Warfarin may cause birth defects if you take it while you are pregnant.
- Warfarin lowers your risk of stroke, but you could still have a stroke.
- You take a pill twice 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 dabigatran.
- Dabigatran lowers the risk of stroke in people who have atrial fibrillation. It works slightly better than warfarin.2
- You don't need regular blood tests from your doctor.
- You don't need to watch how much vitamin K you eat.
- Dabigatran increases your risk of bleeding problems, especially stomach bleeding.
- Side effects include stomach upset and stomach pain.
- It can be expensive. A 1-year supply of dabigatran costs $3000.5
- The long-term side effects of dabigatran are not known. Doctors don't know if dabigatran will affect you if you are pregnant.
- If you need surgery or have a serious bleed, the blood-thinning effects of dabigatran can be hard to reverse.
- Dabigatran lowers your risk for stroke, but you could still have a stroke.
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about taking warfarin and dabigatran
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.
Chuck, age 48
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.
Maria, 70
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 dabigatran.
Jane, 59
I'm already taking a lot of different medicines. I don't know if I could remember to take two pills at different times of the day on top of all that. Also, I like knowing that my doctor is checking my blood regularly. I think I'll try warfarin first and see how it works.
Javier, 66
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 dabigatran
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.
I'd rather take a familiar medicine with a long record of use, like warfarin.
I'm comfortable taking a newer medicine, like dabigatran.
I don't mind going to the doctor for regular blood tests.
I don't want to have to take regular blood tests.
I can only keep track of taking one pill a day.
I can remember to take a pill twice a day.
I prefer to take a less expensive medicine.
I'm not worried about the cost of my medicine.
My other important reasons:
My other important reasons:
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 dabigatran
What else do you need to make your decision?
Check the facts
Do both kinds of medicine lower your risk of stroke?
- YesThat's right. Both medicines can lower your risk of stroke if you have atrial fibrillation.
- NoSorry, that's not right. Both medicines can lower your risk of stroke if you have atrial fibrillation.
- I'm not sureIt may help to go back and read "Get the Facts." Both medicines can lower your risk of stroke if you have atrial fibrillation.
Do I need to have regular blood tests if I'm taking dabigatran?
- YesSorry, that's not right. With dabigatran, there are no regular blood tests. If you take warfarin, it's important to have regular blood tests to make sure that your medicine is working the way it should.
- NoThat's right. With dabigatran, there are no regular blood tests. 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.
- I'm not sureIt may help to go back and read "Get the Facts." With dabigatran, there are no regular blood tests. 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.
Do both medicines increase your risk of bleeding?
- YesThat's right. Both medicines increase your risk of bleeding, so it's important to take care to prevent falls and injuries.
- NoSorry, that's not right. Both medicines increase your risk of bleeding, so it's important to take care to prevent falls and injuries.
- I'm not sureIt may help to go back and read "Get the Facts." Both medicines increase your risk of bleeding, so it's important to take care to prevent falls and injuries.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
Certainty
How sure do you feel right now about your decision?
Check what you need to do before you make this decision.
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
Credits and References
| Credits | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Specialist Medical Reviewer | Theresa O'Young, PharmD - Clinical Pharmacy |
- Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313): 41.
- Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12): 1139–1151.
- Antiplatelet and anticoagulant drugs (2008). Treatment Guidelines From The Medical Letter, 6(69): 29–36.
- Wann LS, et al. (2011). 2011 ACCF/AHA/HRS focused updated on the management of patients with atrial fibrillation (update on dabigatran): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(10): 1144–1150.
- Avorn J (2011). The relative cost-effectiveness of anticoagulants: Obvious, except for the cost and the effectiveness. Circulation. Published online May 23, 2011 (doi:10.1161/circulationaha.111.030148).
Atrial Fibrillation: Which Anticoagulant Should I Take To Prevent Stroke?
- 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 warfarin to prevent stroke.
- Take dabigatran 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 either warfarin (Coumadin) or dabigatran (Pradaxa) lowers that risk.
- 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.
- Dabigatran is a newer medicine that also lowers the risk of stroke. It works as well as warfarin, but it costs more. It may be a good choice if you cannot take warfarin safely.
- 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 dabigatran, there are no regular blood tests and you don't have to watch your vitamin K intake.
- Both medicines work by increasing the time it takes for a blood clot to form, so they increase your risk of problems from bleeding. Whether you take warfarin or dabigatran, you need to be careful to avoid serious bleeding by preventing falls and injuries.
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 people who have atrial fibrillation are 5 times more likely to have a stroke than are people who don't have atrial fibrillation.1
Taking an anticoagulant such as warfarin (Coumadin) or dabigatran (Pradaxa) 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.
How are these medicines the same?
Lowering risk of stroke
Warfarin and dabigatran work about the same to lower your risk of stroke if you have atrial fibrillation.2
Raising risk of bleeding
Anticoagulants make your blood clot slower than normal. Both warfarin and dabigatran increase 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 either medicine, you need to take extra care to prevent bleeding, such as preventing falls and injuries.
The risks of bleeding are about the same for warfarin and dabigatran. Each year about 2 out of 100 people who take warfarin will have a problem with severe bleeding, and 98 will not.3 And each year about 3 out of 100 people who take dabigatran have a problem with severe bleeding, while 97 do not.2 Your own risk of bleeding may be higher or lower than average, based on your own health. Ask your doctor to help you understand your risk.
Some people can't take warfarin or dabigatran, because they have a higher risk of having a serious problem if bleeding occurs. You shouldn't take these drugs if:
- You have blood in your stool for no clear reason.
- You can't control your blood pressure.
- You drink large amounts of alcohol.
Let your doctor know if you are scheduled for any procedure that raises your risk of bleeding. Your medicine may need to be adjusted.
How are these medicines different?
Taking warfarin
Warfarin 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. How much your risk will be reduced when you take warfarin depends on how high your risk was to start with.
When 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.
Warfarin may cause birth defects and problems if you take it while you are pregnant.
Taking dabigatran
Dabigatran is a newer anticoagulant. Its long-term effects aren't known. It works slightly better than warfarin at preventing stroke.2 But like warfarin, how much your risk will be reduced depends on how high your risk was to start with. You don't need to have regular blood tests or watch your vitamin K intake with dabigatran.
You can't take dabigatran if you have heart valve disease, an artificial heart valve, or severe kidney or liver disease.4 Doctors don't know how dabigatran will affect you if you take it while you are pregnant.
Cost
Dabigatran costs about $3000 for a 1-year supply. Warfarin costs about $48 for a 1-year supply. If you have health insurance, some or all of this cost may be covered.5
Surgery
Doctors know how to monitor warfarin and how to reverse its effects if you need surgery. Since dabigatran is newer, doctors still don't know about long-term side effects. If you are taking dabigatran and need surgery, it may take longer to reverse the blood-thinning effects.
Why might your doctor recommend taking either warfarin or dabigatran?
Your doctor may recommend that you take or stay on warfarin if:
- You have heart valve disease, an artificial heart valve, or severe kidney or liver disease. You can't take dabigatran if you have these health problems.
- 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 dabigatran 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 dabigatran twice a day as directed.
2. Compare your options
| Take warfarin to prevent stroke | Take dabigatran to prevent stroke | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
Personal stories
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
Personal stories about taking warfarin and dabigatran
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."
— Chuck, age 48
"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."
— Maria, 70
"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 dabigatran."
— Jane, 59
"I'm already taking a lot of different medicines. I don't know if I could remember to take two pills at different times of the day on top of all that. Also, I like knowing that my doctor is checking my blood regularly. I think I'll try warfarin first and see how it works."
— Javier, 66
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 dabigatran
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.
I'd rather take a familiar medicine with a long record of use, like warfarin.
I'm comfortable taking a newer medicine, like dabigatran.
I don't mind going to the doctor for regular blood tests.
I don't want to have to take regular blood tests.
I can only keep track of taking one pill a day.
I can remember to take a pill twice a day.
I prefer to take a less expensive medicine.
I'm not worried about the cost of my medicine.
My other important reasons:
My other important reasons:
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 dabigatran
5. What else do you need to make your decision?
Check the facts
1. Do both kinds of medicine lower your risk of stroke?
- Yes
- No
- I'm not sure
2. Do I need to have regular blood tests if I'm taking dabigatran?
- Yes
- No
- I'm not sure
3. Do both medicines increase your risk of bleeding?
- Yes
- No
- I'm not sure
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?
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.
| By | Healthwise Staff |
|---|---|
| Primary Medical Reviewer | Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology |
| Primary Medical Reviewer | Adam Husney, MD - Family Medicine |
| Specialist Medical Reviewer | Theresa O'Young, PharmD - Clinical Pharmacy |
- Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313): 41.
- Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12): 1139–1151.
- Antiplatelet and anticoagulant drugs (2008). Treatment Guidelines From The Medical Letter, 6(69): 29–36.
- Wann LS, et al. (2011). 2011 ACCF/AHA/HRS focused updated on the management of patients with atrial fibrillation (update on dabigatran): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(10): 1144–1150.
- Avorn J (2011). The relative cost-effectiveness of anticoagulants: Obvious, except for the cost and the effectiveness. Circulation. Published online May 23, 2011 (doi:10.1161/circulationaha.111.030148).
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.
Last Revised: August 19, 2011
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