Warfarin for Stroke Prevention in AFib: More Benefits Or Risks?

Even though blood thinner can lead to a higher risk of bleeding, the benefit of anticoagulation usually outweighs any risk of bleeding for most patients.

Warfarin (Coumadin, generics), a vitamin K antagonist, has been the primary blood thinner in use for decades but carries a small increased risk of bleeding into the brain.

In addition, warfarin is hindered by many drug interactionsand diet restrictions, like green, leafy vegetables, due to vitamin K content. Increasing vitamin K levels in the body can promote clotting and reduce the effectiveness of warfarin. Patients who take warfarin will require regular blood tests (called an INR) to maintain a correct, therapeutic dose.

The novel oral anticoagulants may be an alternative for patients currently taking warfarin. These agents include:

  • Eliquis (apixaban)
  • Pradaxa (dabigatran)
  • Savaysa (edoxaban)
  • Xarelto (rivaroxaban)

Your doctor will determine which agent may be best for you.

Other Treatments for Stroke Prevention in AFib

Use of any blood thinner should be balanced with the risk of bleeding. Use should be balanced by looking at risk to benefit, including a risk score called the CHA2DS2-VASc score (a number that can help to predict stroke risk). Anticoagulation can reduce the risk of ischemic stroke by about two-thirds in patients with non-valvular atrial fibrillation.

The use of the novel agents:

  • Pradaxa (dabigatran)
  • Xarelto (rivaroxaban)
  • Savaysa (edoxaban)
  • Eliquis (apixaban)

are contraindicated (not to be used) in patients with prosthetic heart valves due to a higher risk for bleeding or stroke.

Instead, warfarin is the accepted standard of treatment for AFib stroke prevention in patients withprosthetic heart valves. The International Normalized Ratio (INR) should remain in the 2 to 3 range at least 70% of the time.

In patients with non-valvular AFib who are at risk for stroke, using an oral anticoagulant therapy, such as warfarin or one of the novel agents, is likely more effective than using aspirin plus clopidogrel(Plavix), but the bleeding risk may be slightly higher. The use of aspirin alone in this patient population is not usually recommended.