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 FAQs A-Fib Drug Therapy: Alternatives to Xarelto

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

24. “I have A-Fib, and my heart doctor wants me to take Xarelto 15 mg. I am concerned about the side effects which can involve death. What else can I do?”

You are right to be concerned about the side effects of Xarelto, one of the new Novel Oral Anticoagulants (NOACs).

All anticoagulants are inherently dangerous. You bruise easily, cuts take a long time to stop bleeding, you can’t participate in any contact sports; there is an increased risk of developing a hemorrhagic stroke and gastrointestinal bleeding. (Most EPs are well aware of the risks of life-long anticoagulation.)

Primary risk: Uncontrolled bleeding is the primary risk (patients have bled to death in the ER.) Anticoagulants cause or increase bleeding. That’s how they work. To decrease your risk of blood clots and stroke, they hinder the clotting ability of your blood. But, they also increase your risk of bleeding.

Normally, clotting is a good thing like when you have a scrape or cut.

Other risks: Do the NOACs have the same long-term problems as warfarin (Coumadin), i.e., microbleeds in the brain, hemorrhagic stroke, early dementia, etc.?

We don’t know yet. The NOACs haven’t been around long enough to determine their side effects. But intuitively one would expect so. (The recent spate of ads from lawyers seeking clients who have been harmed by NOACs would seem to lead to this conclusion.)

Anticoagulants Protect You and Give Peace of Mind

But in spite of the possible negative effects of anticoagulants, if you have A-Fib and a real risk of stroke, anticoagulants do work. You’re no longer 4–5 times more likely to have an A-Fib (ischemic) stroke. Taking an anticoagulant to prevent an A-Fib stroke also may give you peace of mind.

What Else Can You Do? Remove the Reason for an Anticoagulant—Three Options

Be advised: No anticoagulant will absolutely guarantee you will never have a stroke.

Be advised that no anticoagulant or blood thinner will absolutely guarantee you will never have a stroke. Even warfarin [Coumadin] only reduces the risk of stroke by 55% to 65% in A-Fib patients. See Risks of Life-Long Anticoagulation.

The best way to deal with the increased risk of stroke and side effects of anticoagulants is to no longer need them. Here are three options:

#1 Alternative: Get rid of your A-Fib.

As EP and prolific blogger Dr. John Mandrola wrote: “…if there is no A-Fib, there is no benefit from anticoagulation.”

Action: Request a catheter ablation procedure. Today, you can have an ablation immediately (called ‘first-line therapy’). You don’t have to waste a year on failed drug therapies. See Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients

#2 Alternative: Close off your Left Atrial Appendage (LAA).

The Left Atrial Appendage is where 90%-95% of A-Fib clots originate.

Action: Request a Watchman device. The Watchman device is inserted to close off your LAA and keep clots from entering your blood stream. See Watchman Better Than Lifetime on Warfarin

#3 Alternative: Consider non-prescription blood thinners

Ask your doctor about your CHA2DS2-VASc score (a stroke risk assessor). If your score is a 1 or 2 (out of 10), ask if you could take a non-prescription approach to a blood thinner.

Perhaps you can benefit from an increase in natural blood thinners such as turmeric, ginger and vitamin E or, especially, the supplement Nattokinase. See FAQ: “Are natural blood thinners as good as prescription blood thinners?” 

Bottom Line

Whether or not to take anticoagulants (and which one) is one of the most difficult decisions you and your doctor must make. Talk to your doctor about alternatives to anticoagulants: 

Taking an anticoagulant isn’t like taking a daily vitamin. Only take one if you are at a real risk of stroke.

• Catheter ablation
• LAA closure (Watchman device)
• Non-prescription blood thinners

If you decide to stay on a NOAC, ask your doctor about taking Eliquis instead of Xarelto. Eliquis tested better than the other NOACs and is considered safer. See Warfarin vs. Pradaxa and the Other New Anticoagulants and the FAQ: Is Eliquis Safer.

Thanks to Jim Lewis for this question.

Remember:
You must be your own best patient advocate.
Don’t settle for a lifetime on anticoagulants or blood thinners.

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Last updated: Thursday, May 19, 2016 Return to FAQ Drug Therapies

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