If you have atrial fibrillation, it is likely that your healthcare team will prescribe medications to help stabilize your heart rate and rhythm (pharmacologic conversion) as well as medications to help prevent stroke. These medications are known as blood-thinners or anticoagulants. There are different types of anticoagulants available for people with Afib. In some cases, these drugs do not precisely make your blood thinner. Instead, they work by making it take longer than normal for your blood to clot. In fact, this is the purpose of these medications:  to keep blood clots from forming and causing a stroke.

Blood clots can form almost anywhere in the heart or blood vessels. For people with atrial fibrillation, the risk of blood clots is higher than normal because the irregular heartbeat may allow blood to collect in the heart, particularly in the heart’s left atrial appendage (LAA). When blood pools for too long, it tends to clot. A blood clot that travels out of the heart and to the brain may prevent blood reaching the brain and providing the oxygen the brain needs. This is called an ischemic stroke, and it is a medical emergency that can lead to permanent disability or even death. Everyone should know the symptoms of a stroke so they know when to call 9-1-1 either for themselves or the people they love. Click here to learn the F-A-S-T method for spotting a stroke. 

People with Afib are approximately five times more likely to have a stroke than people without Afib. This is why doctors prescribe anticoagulants to most people with Afib. Like all medications, anticoagulants have benefits and risks. One limitation of anticoagulant medications is that the blood can become too thin, which can lead to internal bleeding. Some of the common anticoagulants (warfarin/Coumadin and dabigatran/Pradaxa) have antidotes that can be used to reverse their blood-thinning effects. You can learn more about anticoagulant antidotes here.  

For most people, the risks associated with taking blood-thinner medications are less serious than the risks of having a stroke. The most commonly prescribed anticoagulants are:

• Warfarin (Coumadin) is perhaps the best-known of all the anticoagulant drugs because it has been in use for stroke prevention since the 1950s. While warfarin is effective at preventing blood clots, it does have drawbacks. Read more about warfarin here.
• Dabigatran (Pradaxa) is one of the newer anticoagulants. It is a short-acting medication that does not stay in the bloodstream as long as warfarin. Learn more about dabigatran here.
• Rivaroxaban (Xarelto) is an anticoagulant that is taken once daily. Click here to read about rivaroxaban.
• Apixaban (Eliquis) is an anticoagulant that has proven to be effective at reducing the risk of stroke. You can read about apixaban here.

The information about anticoagulants on SecondsCount is a general overview. It should not replace talking with your doctor about your specific situation, the treatments that are best for you as well as the benefits and risks of each option. Working with you, your medical team will find the medication that works best for you.

Your Health History & Anticoagulant Therapy

Your doctor will perform an assessment to decide whether anticoagulant therapy is suitable for you, or whether another form of treatment will work better. He or she will ask you a number of questions about your health history as well as about your lifestyle, including your activity level, your eating and drinking habits, and more. It is absolutely critical that you answer your doctor’s questions honestly. Just like you, your doctor wants the best possible outcome, and having a complete picture of your overall health will help him or her find the best treatment method possible for you.

If You Have Atrial Fibrillation: Questions to Ask Your Doctor About Anticoagulant Medications for Stroke Prevention

To help you prepare to talk with your doctor about anticoagulant medications, the SecondsCount editors have compiled a short list of questions you may want to ask your doctor. We invite you to print this list and take it with you to your next appointment. It’s always a good idea to take a family member or friend with you to appointments. They can help you take notes and remember what you learned.

If you have been recently diagnosed with atrial fibrillation, it is likely you have a number of questions to ask your doctor. If you and your doctor are considering anticoagulant therapy for stroke prevention, you may want to ask specific questions about how these medications will affect you. Some sample questions might include:

• How often will I have to take this medication?
• What time of day should I take it?
• What would happen if I missed a dose?
• What side effects can I expect?
• Will I need to have regular tests to check how my blood is clotting? How often? What would happen if I missed a test?
• If I cut myself will I bleed too much? Would cutting myself doing routine chores or activities (such as shaving) become a medical emergency?
• Can I drink alcohol while I’m on this medication?
• Are there foods I should avoid?
• What other medications can I take or not take?
• Should I wear a medical bracelet if I am taking this medication? What should it say?

Print this list, Questions to Ask Your Doctor About Anticoagulant Medications for Stroke Prevention, here.