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Home Knowledge Center Wellness Library Atrial Fibrillation: Which Anticoagulant Should I Take to Prevent Stroke?

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 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 (Coumadin).
  • 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.
FAQs

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 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).

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 2footnote 3footnote 4footnote 5footnote 6

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 6footnote 3footnote 4footnote 5 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 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. footnote 7

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.

Stopping bleeding

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.

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?









Take warfarin to prevent stroke Take warfarin to prevent stroke
  • 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.
Take a direct oral anticoagulant (DOAC) to prevent stroke Take a direct oral anticoagulant (DOAC) to prevent 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.

More important
Equally important
More important

I'd rather take a familiar medicine with a long record of use, like warfarin.

I'm comfortable taking a newer medicine.

More important
Equally important
More important

I don't mind going to the doctor for regular blood tests.

I don't want to have to take regular blood tests.

More important
Equally important
More important

I prefer to take a less expensive medicine.

I'm not worried about the cost of my medicine.

More important
Equally important
More important

My other important reasons:

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.

Take warfarin

Take a direct oral anticoagulant (DOAC)

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

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?

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?

Not sure at all
Somewhat sure
Very sure
2, Check what you need to do before you make this 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

What matters to you

Print Summary

Credits and References

Credits
Author 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
References
Citations
  1. Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313):41.
  2. 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.
  3. Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12):1139-1151.
  4. Patel MR, et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrialfibrillation. New England Journal of Medicine, 365(10): 883-891.
  5. 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.
  6. Granger CB, et al. (2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11): 981-992.
  7. 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.
  8. Which oral anticoagulant for atrial fibrillation? (2016). Medical Letter on Drugs and Therapeutics, 58(1492):45-46. Accessed April 10, 2016.
Other Works Consulted
  • Ageno W, et al. (2012). Oral anticoagulant therapy: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinicalpractice guidelines. Chest, 141(2, Suppl): e44S-E88S.
  • Bruins Slot KMH, Berge E (2013). Factor Xa inhibitors versus vitamin Kantagonists for prevention cerebral or systemic embolism in patients with atrial fibrillation. Cochrane Database of Systematic Reviews (8). DOI: 10.1002/14651858.CD008980.pub2. Accessed April 4,2014.
  • Furie KL, et al.(2012). Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation:A science advisory for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 43(12): 3442-3453.
  • Hankey GJ, EikelboomJW (2011). Dabigatran etexilate: A new oral thrombin inhibitor. Circulation, 123(13):1436-1450.
  • Raval AN, et al.(2017). Management of patients on non-vitamin K antagonist oral anticoagulants in the acute and periprocedural setting: A scientific statement from the American Heart Association. Circulation,135(10): e604-e633. DOI: 10.1161/CIR.0000000000000477. Accessed March 9,2017.
  • 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.
  • Spinler SA, Willey VJ (2011). A patient's guide to taking dabigatranetexilate. Circulation, 124(8): e209-e211.
  • You JJ, et al.(2012). Antithrombotic therapy for atrial fibrillation: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl):e531S-e575S.
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?

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 your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. 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 (Coumadin).
  • 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.
FAQs

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.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).

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.23456

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.6345 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.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

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.

Stopping bleeding

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.

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?
  • 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.
  • 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.
What are the benefits?
  • Warfarin usually costs less than DOACs.
  • 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.
What are the risks and side effects?
  • 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.
  • 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

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.

More important
Equally important
More important

I'd rather take a familiar medicine with a long record of use, like warfarin.

I'm comfortable taking a newer medicine.

More important
Equally important
More important

I don't mind going to the doctor for regular blood tests.

I don't want to have to take regular blood tests.

More important
Equally important
More important

I prefer to take a less expensive medicine.

I'm not worried about the cost of my medicine.

More important
Equally important
More important

My other important reasons:

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.

Take warfarin

Take a direct oral anticoagulant (DOAC)

Leaning toward
Undecided
Leaning toward

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
That's right. All of the medicines can lower your risk of stroke if you have atrial fibrillation.

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
That's right. With DOACs, there are no regular blood tests to check the medicine dose. 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.

3. Do all of the medicines increase your risk of bleeding?

  • Yes
  • No
  • I'm not sure
That's right. All of the medicines increase your risk of bleeding, so it's important to take care to prevent falls and injuries.

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?

Not sure at all
Somewhat sure
Very sure

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.
Credits
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
References
Citations
  1. Prevention of stroke in patients with atrial fibrillation (2009). Medical Letter on Drugs and Therapeutics, 51(1313):41.
  2. 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.
  3. Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12):1139-1151.
  4. Patel MR, et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrialfibrillation. New England Journal of Medicine, 365(10): 883-891.
  5. 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.
  6. Granger CB, et al. (2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11): 981-992.
  7. 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.
  8. Which oral anticoagulant for atrial fibrillation? (2016). Medical Letter on Drugs and Therapeutics, 58(1492):45-46. Accessed April 10, 2016.
Other Works Consulted
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  • Bruins Slot KMH, Berge E (2013). Factor Xa inhibitors versus vitamin Kantagonists for prevention cerebral or systemic embolism in patients with atrial fibrillation. Cochrane Database of Systematic Reviews (8). DOI: 10.1002/14651858.CD008980.pub2. Accessed April 4,2014.
  • Furie KL, et al.(2012). Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation:A science advisory for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 43(12): 3442-3453.
  • Hankey GJ, EikelboomJW (2011). Dabigatran etexilate: A new oral thrombin inhibitor. Circulation, 123(13):1436-1450.
  • Raval AN, et al.(2017). Management of patients on non-vitamin K antagonist oral anticoagulants in the acute and periprocedural setting: A scientific statement from the American Heart Association. Circulation,135(10): e604-e633. DOI: 10.1161/CIR.0000000000000477. Accessed March 9,2017.
  • 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.
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  • You JJ, et al.(2012). Antithrombotic therapy for atrial fibrillation: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl):e531S-e575S.
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