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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?
1Get the | 2Compare | 3Your | 4Your | 5Quiz | 6Your Summary |
Get the facts
Your options
- Take warfarin to prevent stroke.
- Take a direct oral anticoagulant (DOAC) 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 apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), and warfarin.
- 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.
- Newer anticoagulants, called direct oral anticoagulants (DOACs), 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 DOACs usually cost more than warfarin.
- A DOAC may be a good choice if you prefer these medicines. But you cannot take a DOAC if you have a mechanical heart valve or mitral valve stenosis.
- 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 a DOAC, 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.
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.footnote 5
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 apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), and warfarin.
How are these medicines the same?
Lowering the risk of stroke
All 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.
Direct oral anticoagulants (DOACs) 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 7footnote 2footnote 6footnote 3footnote 4
Raising the risk of bleeding
Anticoagulants 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 4footnote 2footnote 6footnote 3 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.
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 a mechanical heart valve or mitral valve stenosis, you can't take a direct oral anticoagulant (DOAC).
Risk of bleeding in the brain
All anticoagulants have a risk of causing bleeding in different parts of the body, including the brain. Bleeding in the brain is very serious. Warfarin has a higher risk of causing bleeding in the brain compared to DOACs.footnote 1
Research studies show that 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. About 6 out of 1000 people who take a DOAC may have bleeding in the brain. This means that 994 out of 1000 people may not have this bleeding problem. footnote 1
Blood tests and vitamin K monitoring
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.
When you take a DOAC, 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.
Cost
Warfarin usually costs less than DOACs. Warfarin is available as a generic medicine. Generic medicines cost less than brand-name medicines.
Why might your doctor recommend taking either warfarin or a direct oral anticoagulant (DOAC)?
Your doctor may recommend that you try a DOAC if:
- You prefer to take one of these anticoagulants.
- You are able to take the anticoagulant as directed. For example, you are willing to take dabigatran twice a day.
- 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.
Your doctor may recommend that you take or stay on warfarin if:
- You have a mechanical heart valve or mitral valve stenosis. You can't take a DOAC.
- You are already taking warfarin and aren't having any problems keeping a safe level of medicine in your blood.
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.
- You will try to eat and drink about the same amount of vitamin K each day.
- Warfarin usually costs less than DOACs.
- Warfarin increases your risk of bleeding problems. Warfarin has a higher risk of causing bleeding in the brain compared to DOACs.
- Side effects include skin rash.
- Warfarin lowers your risk of stroke, but you could still have a 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 a DOAC.
- DOACs lower the risk of stroke in people who have atrial fibrillation. They work as well as or slightly better than warfarin.
- 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.
- DOACs increase your risk of bleeding problems. Compared with warfarin, they have a lower risk of causing bleeding in the brain.
- DOACs may have side effects, such as a skin rash or stomach upset.
- DOACs usually cost more than warfarin.
- DOACs lower your risk for stroke, but you could still 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 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 a direct oral anticoagulant (DOAC).
Jane,59
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 a direct oral anticoagulant (DOAC)
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.
I don't mind going to the doctor for regular blood tests.
I don't want to have to take regular blood tests.
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 a direct oral anticoagulant (DOAC)
What else do you need to make your decision?
Check the facts
Decide what's next
Certainty
1. How sure do you feel right now about your decision?
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
| Author | Healthwise Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
- 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.
- Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12):1139-1151.
- 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.
- 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.
- Patel MR, et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrialfibrillation. New England Journal of Medicine, 365(10): 883-891.
- 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.
- Which oral anticoagulant for atrial fibrillation? (2016). Medical Letter on Drugs and Therapeutics, 58(1492):45-46. Accessed April 10, 2016.
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 a direct oral anticoagulant (DOAC) 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 apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), and warfarin.
- 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.
- Newer anticoagulants, called direct oral anticoagulants (DOACs), 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 DOACs usually cost more than warfarin.
- A DOAC may be a good choice if you prefer these medicines. But you cannot take a DOAC if you have a mechanical heart valve or mitral valve stenosis.
- 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 a DOAC, 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.
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.5
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 apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), and warfarin.
How are these medicines the same?
Lowering the risk of stroke
All 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.
Direct oral anticoagulants (DOACs) 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.72634
Raising the risk of bleeding
Anticoagulants 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.4263 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.
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 a mechanical heart valve or mitral valve stenosis, you can't take a direct oral anticoagulant (DOAC).
Risk of bleeding in the brain
All anticoagulants have a risk of causing bleeding in different parts of the body, including the brain. Bleeding in the brain is very serious. Warfarin has a higher risk of causing bleeding in the brain compared to DOACs.1
Research studies show that 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. About 6 out of 1000 people who take a DOAC may have bleeding in the brain. This means that 994 out of 1000 people may not have this bleeding problem. 1
Blood tests and vitamin K monitoring
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.
When you take a DOAC, 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.
Cost
Warfarin usually costs less than DOACs. Warfarin is available as a generic medicine. Generic medicines cost less than brand-name medicines.
Why might your doctor recommend taking either warfarin or a direct oral anticoagulant (DOAC)?
Your doctor may recommend that you try a DOAC if:
- You prefer to take one of these anticoagulants.
- You are able to take the anticoagulant as directed. For example, you are willing to take dabigatran twice a day.
- 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.
Your doctor may recommend that you take or stay on warfarin if:
- You have a mechanical heart valve or mitral valve stenosis. You can't take a DOAC.
- You are already taking warfarin and aren't having any problems keeping a safe level of medicine in your blood.
2. Compare your options
| Take warfarin to prevent stroke | Take a direct oral anticoagulant (DOAC) to prevent stroke | |
|---|---|---|
| What is usually involved? |
|
|
| What are the benefits? |
|
|
| What are the risks and side effects? |
|
|
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 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 a direct oral anticoagulant (DOAC)."
— Jane,59
"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 a direct oral anticoagulant (DOAC)
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.
I don't mind going to the doctor for regular blood tests.
I don't want to have to take regular blood tests.
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 a direct oral anticoagulant (DOAC)
5. What else do you need to make your decision?
Check the facts
1. Do all of the medicines lower your risk of stroke?
- Yes
- No
- I'm not sure
2. Do I need to have regular blood tests to check the medicine dose if I'm taking a direct oral anticoagulant (DOAC) (apixaban, dabigatran, edoxaban, or rivaroxaban)?
- Yes
- No
- I'm not sure
3. Do all of the 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.
| By | Healthwise Staff |
|---|---|
| Clinical Review Board | Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals. |
- 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.
- Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12):1139-1151.
- 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.
- 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.
- Patel MR, et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrialfibrillation. New England Journal of Medicine, 365(10): 883-891.
- 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.
- Which oral anticoagulant for atrial fibrillation? (2016). Medical Letter on Drugs and Therapeutics, 58(1492):45-46. Accessed April 10, 2016.
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: June 24, 2023
Author: Healthwise Staff
Clinical Review Board
All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.