AFib Treatment Guide
Click and find out more about each treatment:
Newest Class of
Oral Blood Thinners
The newest class of oral blood thinners helps reduce the risk of stroke without the restrictions of warfarin.
These anticoagulant blood thinners reduce stroke risk and offer an alternative to warfarin.
All of the newer anticoagulant blood thinners are as effective as warfarin in preventing strokes from AFib, not caused by a heart valve problem, but according to the updated treatment guidelines, they offer some important advantages.
- 1 Reduced risk of bleeding in the brain
- 2 No need for regular blood monitoring
- 3 Fewer drug-drug interactions
- 4 No known dietary restrictions
They are recommended for patients who have AFib not caused by a heart valve problem, and who have trouble keeping warfarin in the target range.
An anticoagulant blood thinner used to lower the risk of stroke in people who have AFib. It provides the recommended protection when patients are in the target range.
Warfarin, also known by the brand names Coumadin®, Jantoven®, and MarevanTM,* is an anticoagulant blood thinner that decreases the body's ability to form clots.
When taking warfarin, you must watch your diet because foods high in vitamin K, such as salad greens, can affect how well the medication works. You may also need to be careful about other medications you are taking due to the way that many drugs interact with warfarin. You must be monitored with regular blood tests to make sure the drug’s blood-thinning levels stay within the ideal range.
With warfarin, blood-thinning levels (e.g., international normalized ratio or INR) can vary, based on:
- Dietary changes
These are just a few of the reasons why regular blood monitoring—and frequent dose changes—are necessary with warfarin.
The latest American Heart Association, American College of Cardiology, and Heart Rhythm Society (AHA/ACC/HRS) treatment guidelines recommend that patients who have AFib not caused by a heart valve problem, and who have trouble keeping their warfarin in the target range, should consider taking one of the newest class of oral anticoagulant blood thinners instead. Research shows 25% of patients on warfarin treatment fail to reach a stable INR.
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Aspirin is no longer recommended to prevent AFib-related stroke in high-risk patients (CHA2DS2-VASc score of 2 or greater).
Aspirin is a different type of blood thinner, called an antiplatelet blood thinner. It reduces the formation of blood clots by keeping the smallest blood cells, or platelets, from clumping together to form a clot.
The 2014 American Heart Association, American College of Cardiology, and Heart Rhythm Society (AHA/ACC/HRS) Atrial Fibrillation Guidelines no longer recommend aspirin therapy for people with AFib who have a high risk of stroke (CHA2DS2-VASc score of 2 or greater):
The evidence for effective stroke prevention with aspirin in AF [AFib] is weak, with a potential for harm, as data indicate that the risk of major bleeding or intracranial haemorrhage (ICH) with aspirin is not significantly different to that of oral anticoagulation, especially in the elderly.- 2012 Focused Update of the European Society of Cardiology Guidelines for the Management of Atrial Fibrillation -
Those who do not use anticoagulants are largely unprotected from the high risk of life-altering strokes, even if they take aspirin.
- Ellis F. Unger, MD, Director, Office of Drug Evaluation I (ODE l), US FDA -
Other heart medications you may be taking
There are several medications—both prescription and over-the-counter—used to treat heart conditions. These medications work in different ways, but the only medications proven to reduce the risk of AFib-related stroke are anticoagulant blood thinners. Here is a general overview of different types of heart medications and how they work:
- Reduce AFib-related stroke risk
- Help prevent heart attacks
- Example: Aspirin
- Help prevent heart attacks
- Example: Clopidogrel
- Offer heart rate and rhythm control
- Examples: Atenolol, Carvedilol, Diltiazem, Digoxin
AFib puts you at a 5 times higher risk of stroke. Appropriate treatment with an anticoagulant blood thinner may help reduce that risk.
A person with AFib has a much higher risk of having a stroke. It's important to speak with your doctor to see if he or she recommends treatment with an anticoagulant blood thinner.
Treatment guidelines state: If you have an AFib risk assessment (CHA2DS2-VASc) score of 2 or greater, anticoagulation therapy is strongly recommended.
In 2014, medical experts from several organizations—the American Heart Association, the American College of Cardiology, and the Heart Rhythm Society (AHA/ACC/HRS) — joined forces to update the treatment guidelines for doctors managing patients with AFib. These updated guidelines reflect new data, improved risk-prediction tools, and the availability of new AFib treatment options.
One of the most important things to know is that ASPIRIN is no longer considered an effective treatment to reduce stroke risk in patients with a CHA2DS2-VASc score of 2 or greater.
Stroke risk can change over time. Calculate your risk.
See how having AFib increases your risk of a stroke.