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65 and Older: 99% Have Microbleeds—So Are Anticoagulants Risky?

Last updated: June 15, 2022

In a  recent study, 99% of subjects aged 65 or older had evidence of microbleeds; and closer examination of the cranial MRI images revealed an increased number of detectable microbleeds (i.e. the closer they looked, the more microbleeds they found).

Microbleeds in the brain are thought to be a precursor of hemorrhagic stroke.

Cerebral microbleeds (CMBs) are small chronic brain hemorrhages of the small vessels of the brain.

If Microbleeds Cause Hemorrhagic Stroke, Should I be on a Blood Thinner?

The fact that almost everyone 65 or older has microbleeds is astonishing and worrisome, particularly if you have A-Fib and have to take anticoagulants. Anticoagulants cause or increase bleeding. That’s how they work.

In plain language, this study indicates that cerebral microbleeds lead to or cause hemorrhagic stroke. It’s not surprising then that some doctors are reluctant to prescribe heavy-duty anticoagulants to older A-Fib patients.

Being older and already having microbleeds only makes taking anticoagulants all the more worrisome.

Risks of Taking Anticoagulants (Blood Thinners)

Taking almost any prescription medication has trade-offs. Older A-Fib patients find themselves between a rock and a hard place.

In the case of anticoagulants, on one hand you get protection from having an A-Fib stroke (which often leads to death or severe disability), but on the other hand you have an increased risk of bleeding.

For those over 65 who already have microbleeds, there’s a substantial downside to taking anticoagulants: an increased risk of hemorrhagic stroke, developing dementia, and other problems.

Added June 15, 2022: “About one-quarter of older adults (over 65) on an anticoagulant who develop a brain bleed will die as a result, versus 9% of elderly patients who are not on anticoagulant therapy.” (Bottom Line Personal, Volume 43, Number 11, June 1, 2022. p. 8.)

In an extensive examination of Aging Research Reviews, researchers from China were able to find ten studies involving 97,413 A-Fib patients with frailty. Frailty “conferred a 1.83-fold higher risk of major bleeding.” The researchers didn’t attempt to define, describe or measure the characteristics of “frailty”.

Since frailty often develops with increased age, older people who are frail have nearly twice as much at risk of having major bleeding problems.

Taking Blood Thinners is Not Like Taking Vitamins

Recent TV ads feature A-Fib patient and Saturday Night LIVE alumnus, Kevin Nealon, overjoyed to be taking anticoagulants. (Also in the Xarelto ad are NBA player, Chris Bosch, Arnold Palmer, and Bruce Vickers of NASCAR).

My pet peeve about these ads: Being on a blood thinner for stroke risk does nothing to treat your A-Fib. So what’s to be overjoyed about? You still have A-Fib!

But taking an anticoagulant is not like taking daily vitamins. (For example: If you take too much Vitamin C, your body expels the excess through your urine. No harm done.)

Contrary to these ads, you can’t just take an anticoagulant and live happily ever after with your A-Fib. That’s fantasyland!

In the case of the relatively young Kevin Nealon, he’s looking at 20-25+ years of life-long anticoagulation. Most Electrophysiologists (EPs) would have serious, second thoughts about leaving someone on anticoagulants for that long. See my article, All Anticoagulants Cause Bleeding.

Safer, Healthier Alternatives to Anticoagulants

Don’t worry, there are alternatives to taking anticoagulants that are better, more sane and healthier.

The #1 best way to avoid anticoagulants: No longer have A-Fib! No A-Fib, no increased risk of stroke (common sense, right?).

catheter ablation

Catheter ablating pulmonary vein

Request a catheter ablation procedure. Today, you can have an ablation immediately (called ‘first-line therapy’ by your doctor). You don’t have to waste a year on failed drug therapy.

An ablation is the least invasive treatment for A-Fib and has a 70%–85% cure rate (that rises to over 90% is a second ‘touch-up’ ablation is needed).

(There are surgical treatments, but they’re not recommended as a first option as they are more invasive, traumatic, risky and with longer recovery times.)

The #2 best way to avoid anticoagulants: Close off your Left Atrial Appendage (LAA). This is where 90%-95% of A-Fib clots originate.

Catheter positioning the Watchman occlusion device at the mouth of the Left Atrial Appendage

Catheter placing Watchman in LAA

Request a Watchman device. The Watchman device is inserted to close off your LAA to keep clots from entering your blood stream.

In fact, the Watchman device has proved a better option to being on the blood thinner, warfarin (Coumadin). See Watchman Better Than Lifetme on Warfarin.

You Won’t Hear it from the Media

Of course, you won’t hear about these alternatives in those TV ads for anticoagulants.

Why? Being cured of A-Fib or no longer needing anticoagulants means big Pharma will lose a life-long drug customer (like Kevin Nealon who’s looking at 20-25+ years on Xarelto).

Most media outlets won’t tell you about these alternatives either. Today’s media companies are either owned, operated, supported or influenced by drug companies. For example, and are controlled and operated by, among others, the drug company Eli Lilly.

What this Means to Patients Over 65

CT brain with Ischemic stroke at

CT of brain with Ischemic stroke

Start a dialog with your doctor about microbleeds and the associated risks of taking anticoagulants at your age. Ask questions such as:

• “I probably have microbleeds, so will taking anticoagulants increase the microbleeds (and lead to other health problems, increased risk of dementia, etc.)?”
• “As I get older and keep taking anticoagulants, how much more am I at risk of developing microbleeds and a hemorrhagic stroke?”

Consider non-prescription blood thinners. Ask about your CHADS2 or CHA2DS2-VASc score (stroke risk assessors). If your CHADS2 score is a 1 or 2, ask if you could take a non-prescription approach to stroke prevention.

Perhaps you can benefit from an increase in natural blood thinners such as turmeric, ginger and vitamin E or especially the supplement Nattokinase. But be advised that this web site in no way recommends or encourages the use of natural blood thinners. There isn’t enough research to say that they work as well as anticoagulant drugs.

Consider Catheter Ablation or the Watchman. To eliminate the need to take blood thinners, consider a catheter ablation to stop your A-Fib. Or consider having a Watchman device installed to reduce or eliminate the need for blood thinners.

For more about anticoagulation therapy, see my article: Risks of Life-Long Anticoagulation. For more about stroke risk assessors, see my article: The CHADS2 & CHA2DS-VASc Stroke-Risk Grading Systems. Read more about ‘natural blood thinners‘ in my FAQ answer.
References for this article
Best, Ben. The 2015 International Stroke Conference, September 2015. Life Extension Magazine.

He, L. et al. Impact of frailty on all-cause mortality and major bleeding in patients with atrial fibrillation: A meta-analysis. Science Direct, Aging Research Reviews, Volum3 73, January 2022, 101257.

Janaway BM, et al. Brain haemosiderin in older people: pathological evidence for an ischaemic origin of magnetic resonance imaging (MRI) microbleeds. Neuropathol Appl Neurobiol.2014 Apr;40(3):258-69.

Song TJ, et al. Association of cerebral microbleeds with mortality in stroke patients having atrial fibrillation. Neurology. 2014;83:1308-1315.

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