We are going to talk about blood thinners for Afib. What they are and which one is best for you?
Blood thinners are commonly recommended for people with Afib. The reason is that Afib can increase your risk for stroke, and blood thinners can decrease that risk.
If you aren’t sure if you need a blood thinner for your Afib, please watch our video, Blood Thinners for Afib — Do I Really Need Them?
People who have Afib can have risk of stroke that is up to 12 times more than those who do not have Afib. However, the appropriate blood thinner medication can lower that risk by over 70%.
There are several blood thinners that are used in Afib, but which ones are the most effective?
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The oldest effective blood thinner, and previous mainstay of stroke prevention in Afib is warfarin, or sometimes called Coumadin®.
Warfarin has been around since the 1950s. It works by blocking vitamin K, which is used by your body to create some of the blood clotting factors. It did start as rat poison, but when it was discovered that it could be useful in humans who were at risk of blood clots, it became one of the most useful and prescribed medications we had.
Warfarin is inexpensive but not easy to take for several reasons. For one, it is slow to take effect and slow to get out of your system. But the biggest disadvantage of warfarin is how variable its effect is from person to person and also over time. Because of that variability, we need to frequently monitor the blood of someone taking warfarin to know if it’s in the right range. Too much warfarin, and you are at higher risk of bleeding. Too little warfarin and you’re at risk of blood clots.
Direct Oral Anti-Coagulants (DOACs)
For decades, our only option to thin the blood was warfarin. However, now we have several newer medications that are easier to use, although they are more expensive. These medications are called DOACs which stands for Direct Oral Anti-Coagulant.
I will point out that while the DOACs may be better choices for many people with Afib to prevent stroke, there are still some people where warfarin is better, such as those with mechanical heart valves, other severe heart valve disease, advanced liver disease and possibly advanced kidney disease.
There are 4 DOACs that are commonly used:
- Dabigatran (Pradaxa®)
- Rivaroxaban (Xarelto®)
- Apixaban (Eliquis®)
- Endoxaban (Savaysa®)
The advantages of the DOACs is that they have a more consistent effect than warfarin and don’t need to be monitored. They also may be safer with evidence of less bleeding risk and in particular, less risk of bleeding in the brain.
Other advantages of the DOACs are less drug and food interaction than warfarin and more rapid onset and offset.
The disadvantages are that they are more expensive than warfarin, cannot be safely used in some patients as noted earlier. The DOACs also are less easy to reliably monitor as warfarin and the methods to reverse the blood thinning, for example in the setting of a traumatic injury, is less well-established than with warfarin.
The last thing I will mention is about aspirin in the prevention of stroke in Afib. Although there is some debate on whether aspirin plays any role in preventing stroke in Afib, what is known is that if aspirin helps at all, it’s a very small benefit. Many cardiologists do not recommend aspirin for stroke prevention in Afib.
I will emphasize, the only way to determine the best treatment options for you is with your doctor. This is not medical advice, but information to help you know what questions to ask when working with your doctor to decide what is best for you.
- When you have Afib, the most important decision you and your physician will make is whether you should be on blood thinners. Talk to your physician to better understand the benefits and risks of blood thinners for you.
- Blood thinners are recommended based on the risk for blood clots and NOT on what type of Afib or Atrial flutter you have.
- Whether your Afib is all the time (called permanent Afib) or off and on (called paroxysmal Afib), both types should be treated with blood thinners if the blood clot risk is high enough.
- If a blood thinner is recommended, and you are eligible for a DOAC, that is generally preferred over warfarin because of their higher safety.
- There is some debate on whether aspirin plays any role in preventing stroke in Afib, what is known is that if aspirin helps at all, it’s a very small benefit.
- The only way to determine the best treatment options for you is with your doctor.