Anticoagulants Other Than Warfarin for Atrial Fibrillation
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How It Works
Anticoagulants prevent blood clots and keep blood clots from getting bigger. They are also called blood thinners.
Apixaban and rivaroxaban block a blood clotting factor (Factor Xa) from working. Clotting factors are substances that make blood clot.
Dabigatran keeps thrombin from making a blood clot. Thrombin is a substance (enzyme) in the bloodstream that is needed for blood to clot.
Why It Is Used
Your doctor may recommend an anticoagulant based on your risk of having a stroke. If you are age 55 or older and have atrial fibrillation, you can find your risk of stroke using this Interactive Tool: What Is Your Risk for a Stroke if You Have Atrial Fibrillation?
Apixaban, dabigatran, and rivaroxaban are newer medicines than the anticoagulant medicine warfarin. Warfarin has been used for many years to help prevent stroke in people who have atrial fibrillation. If you are thinking about taking a newer anticoagulant instead of warfarin, talk with your doctor to see if it is right for you.
Reasons why you might take an anticoagulant other than warfarin include:
- You cannot take warfarin safely, such as not being able to keep a safe level of warfarin in your blood (INR).
- You have side effects from warfarin that are hard to live with.
- You do not want to have to get regular blood tests and watch how much vitamin K you eat. Both are needed if you take warfarin.
You cannot take apixaban, dabigatran, or rivaroxaban if you have heart valve disease, an artificial heart valve, or severe kidney or liver disease.
How Well It Works
How much your risk for a stroke will be lowered depends on how high your risk was to start with. Not everyone who has atrial fibrillation has the same risk of stroke. It's a good idea to talk with your doctor about your risk.
You will want to weigh the benefits of reducing your risk of stroke against the risks of taking an anticoagulant. Anticoagulants can help prevent stroke. But this medicine also raises the risk of bleeding. Your own risk of bleeding may be higher or lower than average, based on your own health.
All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.
Here are some important things to think about:
- Usually the benefits of the medicine are more important than any minor side effects.
- Side effects may go away after you take the medicine for a while.
- If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.
Call 911 or other emergency services right away if you have:
- Trouble breathing.
- Swelling of your face, lips, tongue, or throat.
Call your doctor if you have:
Call 911 or other emergency services right away if you have:
- You have a sudden, severe headache that is different from past headaches. (It may be a sign of bleeding in the brain.)
Call your doctor now or seek immediate medical care if you have:
- Any abnormal bleeding, such as:
- Vaginal bleeding that is different (heavier, more frequent, at a different time of the month) than what you are used to.
- Bloody or black stools, or rectal bleeding.
- Bloody or pink urine.
If you are injured, apply pressure to stop the bleeding. Realize that it will take longer than you are used to for the bleeding to stop. If you can't get the bleeding to stop, call your doctor.
Less serious side effects
Apixaban might cause a skin rash.
Dabigatran might cause stomach upset or stomach pain.
Rivaroxaban does not commonly cause other side effects, such as stomach problems.
Apixaban, dabigatran, and rivaroxaban are newer medicines. So doctors do not yet know if they have any other long-term side effects.
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
What To Think About
Dabigatran storage. Keep your medicine in its original container or blister pack. Do not use a pill organizer or pill box. This medicine is sensitive to moisture.5
Taking anticoagulants safely
Do not stop taking your medicine without talking with your doctor first.
Take extra steps to prevent bleeding problems such as:
- Prevent falls and injuries.
- Tell your doctors about all other medicines and vitamins that you take.
- Know what to do if you miss a dose of anticoagulant.
- Before any surgery or medical or dental procedure, talk with your doctor about whether you need to stop taking your anticoagulant for a short time beforehand.
Apixaban, dabigatran, and rivaroxaban work differently from warfarin to prevent blood clots. So some of the precautions and safety tips for these newer anticoagulants are different from those for warfarin. Just as with warfarin, you need to take extra steps to prevent bleeding. But with these newer medicines, you do not need regular blood tests to check the medicine dose. And you do not need to eat and drink the same amount of vitamin K (found in many vegetables) every day.
Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.
There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.
Advice for women
If you are pregnant, breast-feeding, or trying to get pregnant, talk with your doctor. Do not use any medicines unless your doctor tells you to.
If you are pregnant, tell your doctor right away. Doctors don't know how these anticoagulants will affect you if you take one while you are pregnant. But these medicines have a risk of pregnancy-related bleeding. Apixaban is not recommended for pregnant women. You and your doctor will decide what medicines are safe for you during pregnancy.
If you are not planning on getting pregnant, talk to your doctor about how you can prevent pregnancy.
Follow-up care is a key part of your treatment and safety. You might have regular tests to check how well your kidneys are working.
Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
- Fuster V, et al. (2011). 2011 ACCF/AHA/HRS focused update incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 123(10): e269–e367.
- Connolly SJ, et al (2009). Dabigatran versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 361(12): 1139–1151.
- Patel MR, et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 365(10): 883–891.
- Granger CB, et al. (2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11): 981–992.
- Spinler SA, Willey VJ (2011). A patient's guide to taking dabigatran etexilate. Circulation, 124(8): e209–e211.
Last Revised: August 9, 2013
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