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Atrial Fibrillation: Should I Take an Anticoagulant 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: 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
Options

3
Your
Feelings

4
Your
Decision

5
Quiz
Yourself

6
Your
Summary

Get the facts

Your options

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

An implanted device, which closes the left atrial appendage, 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. The risk of stroke isn't the same for everyone. Your doctor can help you know your risk.
Taking an anticoagulantanticoagulant lowers the risk of stroke. But how much your risk will be lowered depends on how high your risk was to start with.
Taking an anticoagulant raises your risk of bleeding problems. This risk isn't the same for everyone. Your doctor can help you understand your risk of bleeding.
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.
There are different types of anticoagulants. You and your doctor can choose the medicine that is right for you.

FAQs

What are anticoagulants?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 direct oral anticoagulants (DOACs) and warfarin. DOACs include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).

You and your doctor can decide which medicine is right for you. This decision may depend on the cost, your health, and your preferences about taking medicine. Talk with your doctor about any concerns you have about the cost of your medicine. Your doctor can let you know if certain anticoagulants are safer than others based on your health.

Doctors usually recommend DOACs first. They work as well as or slightly better than warfarin. They are less likely to cause bleeding in the brain.^{footnote 2footnote 2}

How can medicine help if you have atrial fibrillation?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 1footnote 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:

Being older than 65.

Being female.

Heart failure.

High blood pressure.

A previous stroke or transient ischemic attack (TIA).

Heart attack, peripheral artery disease, or other blood vessel disease.

Diabetes.

What are the risks of taking an anticoagulant?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.

The risk of bleeding isn't the same for everyone. Your doctor can help you understand your risk. Your doctor can check things that can raise your risk of serious bleeding. Examples of these things are having very high blood pressure, kidney disease, or liver disease or having had a stroke. Serious bleeding includes any bleeding that requires a blood transfusion or being in the hospital.

Over 2 to 3 years, about 6 people out of 100 will have a problem with serious bleeding. This means that about 94 out of 100 will not.^{footnote 3footnote 3} But these are average risks. Your own risk may be higher or lower.

You will want to weigh the benefits of reducing your risk of stroke against your risk of bleeding.

Some people can't take anticoagulants, because they have a higher risk of having a serious problem if bleeding occurs.

When you take an anticoagulant, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also need to have regular blood tests and watch how much vitamin K you eat or drink.

How well do anticoagulants work?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. Your doctor can help you know your risk based on your age, sex, and health.

What can you do instead of taking an anticoagulant?What can you do instead of taking an anticoagulant?

No medicine

You can choose to not take an anticoagulant. For example, some people who have a low risk of stroke may decide that the possible stroke prevention does not outweigh the risk of bleeding.

Left atrial appendage closure

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?Why might your doctor recommend taking an anticoagulant?

Compare your options

	Take an anticoagulant to reduce the risk of stroke	Don't take an anticoagulant
What is usually involved?	You take a pill once or twice a day. You try to avoid injuries and falls that could cause bleeding. You'll need to let your doctor know of any new medicines you start taking while you are taking an anticoagulant. If you take warfarin, you will have regular blood tests and you will try to eat and drink about the same amount of vitamin K each day.	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.

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.
You try to avoid injuries and falls that could cause bleeding.
You'll need to let your doctor know of any new medicines you start taking while you are taking an anticoagulant.
If you take warfarin, you will have regular blood tests and you will try to eat and drink about the same amount of vitamin K each day.

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.

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

My doctor says I have a very high risk of bleeding. So I can't take an anticoagulant.

Geraldo, age 52

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

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

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.

I don't worry much about my risk of stroke.

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:

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

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 decisionYour decision

Your knowledge of the factsYour knowledge of the facts

Getting ready to actGetting ready to act

What matters to youWhat matters to you

Print SummaryPrint Summary

Credits and ReferencesCredits and References

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.

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

An implanted device, which closes the left atrial appendage, 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. The risk of stroke isn't the same for everyone. Your doctor can help you know your risk.
Taking an anticoagulantanticoagulant lowers the risk of stroke. But how much your risk will be lowered depends on how high your risk was to start with.
Taking an anticoagulant raises your risk of bleeding problems. This risk isn't the same for everyone. Your doctor can help you understand your risk of bleeding.
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.
There are different types of anticoagulants. You and your doctor can choose the medicine that is right for you.

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 direct oral anticoagulants (DOACs) and warfarin. DOACs include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).

You and your doctor can decide which medicine is right for you. This decision may depend on the cost, your health, and your preferences about taking medicine. Talk with your doctor about any concerns you have about the cost of your medicine. Your doctor can let you know if certain anticoagulants are safer than others based on your health.

Doctors usually recommend DOACs first. They work as well as or slightly better than warfarin. They are less likely to cause bleeding in the brain.²²

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.¹¹ 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:

Being older than 65.
Being female.
Heart failure.
High blood pressure.
A previous stroke or transient ischemic attack (TIA).
Heart attack, peripheral artery 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.

The risk of bleeding isn't the same for everyone. Your doctor can help you understand your risk. Your doctor can check things that can raise your risk of serious bleeding. Examples of these things are having very high blood pressure, kidney disease, or liver disease or having had a stroke. Serious bleeding includes any bleeding that requires a blood transfusion or being in the hospital.

Over 2 to 3 years, about 6 people out of 100 will have a problem with serious bleeding. This means that about 94 out of 100 will not.³³ But these are average risks. Your own risk may be higher or lower.

You will want to weigh the benefits of reducing your risk of stroke against your risk of bleeding.

Some people can't take anticoagulants, because they have a higher risk of having a serious problem if bleeding occurs.

When you take an anticoagulant, you need to take extra steps to avoid bleeding problems, such as preventing falls and injuries. If you take warfarin, you also need to have regular blood tests and watch how much vitamin K you eat or drink.

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. Your doctor can help you know your risk based on your age, sex, and health.

What can you do instead of taking an anticoagulant?

No medicine

You can choose to not take an anticoagulant. For example, some people who have a low risk of stroke may decide that the possible stroke prevention does not outweigh the risk of bleeding.

Left atrial appendage closure

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.

2. Compare your options

	Take an anticoagulant to reduce the risk of stroke	Don't take an anticoagulant
What is usually involved?	You take a pill once or twice a day. You try to avoid injuries and falls that could cause bleeding. You'll need to let your doctor know of any new medicines you start taking while you are taking an anticoagulant. If you take warfarin, you will have regular blood tests and you will try to eat and drink about the same amount of vitamin K each day.	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

"My doctor says I have a very high risk of bleeding. 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.

I don't worry much about my risk of stroke.

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:

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

Credits

By	Ignite Healthwise, LLC StaffIgnite Healthwise, LLC Staff
Clinical Review Board	Clinical Review BoardClinical Review Board All Ignite Healthwise, LLC education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

References

Citations

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.
January CT, et al. (2019). 2019 AHA/ACC/HRS Focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Circulation, published online January 28, 2019. DOI: 10.1161/CIR.0000000000000665. Accessed January 31, 2019.
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.

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: July 31, 2024

Author: Ignite Healthwise, LLC StaffIgnite Healthwise, LLC Staff

Clinical Review BoardClinical Review Board
All Ignite Healthwise, LLC education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

This information does not replace the advice of a doctor. Ignite Healthwise, LLC, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of UseTerms of Use. Learn how we develop our contenthow we develop our content.

To learn more about Ignite Healthwise, LLC, visit webmdignite.comwebmdignite.com.

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Individual and family medical and dental insurance plans are insured by Cigna Health and Life Insurance Company (CHLIC), Cigna HealthCare of Arizona, Inc., Cigna HealthCare of Illinois, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of South Carolina, Inc., and Cigna HealthCare of Texas, Inc. Group health insurance and health benefit plans are insured or administered by CHLIC, Connecticut General Life Insurance Company (CGLIC), or their affiliates (see a listing of the legal entities a listing of the legal entities that insure or administer group HMO, dental HMO, and other products or services in your state). Accidental Injury, Critical Illness, and Hospital Care plans or insurance policies are distributed exclusively by or through operating subsidiaries of Cigna Corporation, are administered by Cigna Health and Life Insurance Company, and are insured by either (i) Cigna Health and Life Insurance Company (Bloomfield, CT); (ii) Life Insurance Company of North America (“LINA”) (Philadelphia, PA); or (iii) New York Life Group Insurance Company of NY (“NYLGICNY”) (New York, NY), formerly known as Cigna Life Insurance Company of New York. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc. LINA and NYLGICNY are not affiliates of Cigna.

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Author	Ignite Healthwise, LLC StaffIgnite Healthwise, LLC Staff
Clinical Review Board	Clinical Review BoardClinical Review Board All Ignite Healthwise, LLC education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.

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

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

1Get theFacts

2CompareOptions

3YourFeelings

4YourDecision

5QuizYourself

6YourSummary

Get the facts

Your options

Key points to remember

What are anticoagulants?What are [link-slot] sup {font-size: 0.75em; line-height: normal !important; top: 0 !important;}anticoagulants?

How can medicine help if you have atrial fibrillation?How can medicine help if you have atrial [link-slot] sup {font-size: 0.75em; line-height: normal !important; top: 0 !important;}fibrillation?

What are the risks of taking an anticoagulant?What are the risks of taking an [link-slot] sup {font-size: 0.75em; line-height: normal !important; top: 0 !important;}anticoagulant?

How well do anticoagulants work?How well do anticoagulants [link-slot] sup {font-size: 0.75em; line-height: normal !important; top: 0 !important;}work?

What can you do instead of taking an anticoagulant?What can you do instead of taking an [link-slot] sup {font-size: 0.75em; line-height: normal !important; top: 0 !important;}anticoagulant?

Why might your doctor recommend taking an anticoagulant?Why might your doctor recommend taking an [link-slot] sup {font-size: 0.75em; line-height: normal !important; top: 0 !important;}anticoagulant?

Credits and ReferencesCredits and [link-slot] sup {font-size: 0.75em; line-height: normal !important; top: 0 !important;}References

Page Footer

I want to...

Audiences

Secure Member Sites

The Cigna Group Information

Disclaimer

1
Get the
Facts

2
Compare
Options

3
Your
Feelings

4
Your
Decision

5
Quiz
Yourself

6
Your
Summary

What are anticoagulants?What are anticoagulants?

How can medicine help if you have atrial fibrillation?How can medicine help if you have atrial fibrillation?

What are the risks of taking an anticoagulant?What are the risks of taking an anticoagulant?

How well do anticoagulants work?How well do anticoagulants work?

What can you do instead of taking an anticoagulant?What can you do instead of taking an anticoagulant?

Why might your doctor recommend taking an anticoagulant?Why might your doctor recommend taking an anticoagulant?

Credits and ReferencesCredits and References