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.
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 apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), rivaroxaban (Xarelto), and warfarin (Coumadin).
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. 2 3 4 56
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. 6 3 45 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.
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).
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.7
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. 7
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.
Warfarin usually costs less than DOACs. Warfarin is available as a generic medicine. Generic medicines cost less than brand-name medicines.
If you have a bleeding problem or need surgery right away, your doctor may need to quickly reverse the effects of an anticoagulant.
Apixaban, dabigatran, rivaroxaban, and warfarin. Doctors can use medicines to quickly reverse the effects of these anticoagulants and stop bleeding.
Edoxaban. Doctors do not have a medicine that has been approved to quickly reverse the effects of this anticoagulant.
Your doctor may recommend that you try a DOAC if:
Your doctor may recommend that you take or stay on warfarin if:
| Take warfarin to prevent stroke | Take a direct oral anticoagulant (DOAC) to prevent stroke | |
|---|---|---|
What is usually involved?
| What is usually involved?
| |
What are the benefits?
| What are the benefits?
| |
What are the risks and side effects?
| What are the risks and side effects?
|
Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.
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
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:
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)
1. Do all of the medicines lower your risk of stroke?
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)?
3. Do all of the medicines increase your risk of bleeding?
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?
1. How sure do you feel right now about your decision?
2. Check what you need to do before you make this decision.
| 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 |
| Primary Medical Reviewer | Adam Husney MD - Family Medicine |
| Primary Medical Reviewer | John M. Miller MD, FACC - Cardiology, Electrophysiology |
| Primary Medical Reviewer | Heather Quinn MD - Family Medicine |