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AFib Treatment Guide

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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.

Newest Class of Anticoagulant Blood Thinners
Represents Important Advances Over Warfarin
  • 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.

All Blood Thinners Have Benefits And Risks
All blood thinners carry the risk of bleeding.
Talk to your doctor about the best treatment option for you.

Warfarin 
(e.g., Coumadin®)

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.

The INR Scale. INR Ideal Range. INR less than 2: Greater risk of stroke. INR greater than 3: Greater risk of bleeding. Research shows only 56% of measured INRs were within the ideal INR range.

With warfarin, blood-thinning levels (e.g., international normalized ratio or INR) can vary, based on:

  • Age
  • Race
  • Weight
  • Gender
  • 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.

All Blood Thinners Have Benefits And Risks
All blood thinners carry the risk of bleeding.
Talk to your doctor about the best treatment option for you.

*All product names and brands are property of their respective owners. All company, product and service names used in this website are for identification purposes only. Use of these names and brands does not imply endorsement.

Aspirin and 
others

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-counterused 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:

Anticoagulant blood thinners (prescription)
  • Reduce AFib-related stroke risk
Antiplatelet blood thinners (over-the-counter)
  • Help prevent heart attacks
  • Example: Aspirin
Antiplatelet blood thinners (prescription)
  • Help prevent heart attacks
  • Example: Clopidogrel
Beta blocker, calcium channel blocker, cardiac glycosides
  • Offer heart rate and rhythm control
  • Examples: Atenolol, Carvedilol, Diltiazem, Digoxin

Not treating 
at all

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.

Key AFib management options for people at high risk of stroke
Newest class of oral 
blood thinners
Warfarin 
(e.g., 
Coumadin®)
Aspirin 
alone
Effective in reducing the risk of stroke
 
 
 
Lower risk of bleeding in the brain than Warfarin
 
N/A
 
Guideline recommended treatment for CHA2DS2-VASc ≥ 2
 
 
 

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.

Calculate Your Risk
Calculate Your Risk

Stroke risk can change over time. Calculate your risk.

Understand Your Stroke Risk With AFib
Understand Your Stroke Risk With AFib

See how having AFib increases your risk of a stroke.