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How to Avoid the Bleeding Risk of Anticoagulants

Taking almost any prescription medication has trade-offs.

In the case of anticoagulants, on the 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. That’s how they work. Bleeding events are common complications of taking anticoagulants. Therefore anticoagulants are inherently dangerous. “Oral anticoagulants are high-risk medications” as stated by Drs. Witt and Hanseen of the University of Utah College of Pharmacy.

As an A-Fib patient, whether or not to be on anticoagulant or not, and which one, is one of the most difficult decisions you and your doctor must make.

Your Risk of Life-Long Anticoagulation Therapy

With the 2014 Guidelines for Management of Patients with Atrial Fibrillation, came significant changes to the rating scale doctors use to assess your risk of stroke. The guidelines call for many more people to be on a lifetime of anticoagulant therapy.

An anticoagulant should not be prescribed as a precaution, but only when a significant risk of stroke exists.

But taking an anticoagulant isn’t like taking a daily vitamin. An anticoagulant should not be prescribed as a precaution, but only when a significant risk of stroke exists.

Long term, we know the anticoagulant warfarin (Coumadin) is associated with microbleeds, hemorrhagic stroke, and developing early dementia. What about the newer NOACs? There’s little long-term risk data, but we expect similar long-term risks.

Was 10 years of Anticoagulant Use the Cause of this Patient’s Dementia?

Dr. John Day, in an editorial in The Journal of Innovations in Cardiac Rhythm Management, described his patient, Bob, who had been on anticoagulation therapy for 10 years (even though he had had a successful catheter ablation and was A-Fib free).

“Could the drug therapy be the cause of this case of dementia? – Dr. John Day”

Bob was suffering from early dementia. A cranial MRI revealed many cerebral microbleeds (probably from taking anticoagulants for years). Both antiplatelet and anticoagulant therapy significantly increase the risk of cerebral microbleeds which are associated with dementia. These microbleeds are usually permanent and irreversible.

Dr. Day asked, “Could it be that this was an iatrogenic [caused by a doctor’s activity or therapy] case of dementia? Was his 10 years of anticoagulant use for atrial fibrillation the cause of his dementia?”

Safer, Healthier Alternatives to Anticoagulants

If you are facing a lifetime of anticoagulant therapy―you should be very concerned about the associated risks. But don’t worry. You do have alternatives.

#1 Alternative: Consider non-prescription blood thinners

Ask 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.10 Red Vert - Become yoour own best patient advocate 600 x 1100 pix at 300 res

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

#2 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.

#3 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.

What Patients on Anticoagulants Need to Know

Most EPs are well aware of the risks of life-long anticoagulation. Never-the-less, you can expect your EP to insist adamantly that you be on life-long anticoagulation.

What you can do: Start a dialog with your doctor about the associated risks of taking anticoagulants: cerebral microbleeds, the greater risk of hemorrhagic stroke, and developing early dementia.

Talk about alternatives to anticoagulants:

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

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

Further reading: see my articles: Risks of Life-Long Anticoagulation., Catheter Ablation Reduces Stroke Risk Even for Higher Risk Patients, and Watchman Better Than Lifetime on Warfarin

References for this article
AHA/ACC/HRS. 2014 Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014; 130: e199-e267 DOI: 10.1161/CIR.0000000000000041.

Day, John. Letter from the Editor in Chief. The Journal of Innovations in Cardiac Rhythm Management, 5 (2014), A6-A7. Last accessed May 15, 2014, URL: Dr. John Day is Director of Heart Rhythm Services, Intermountain Medical Center, Salt Lake City, UT.

CHA2DS2-VASc Score: Stroke Risk Assessment in Non-valvular Atrial Fibrillation (Risk factor-based scoring system). GlobalRPh: The Clinician’s Ultimate Reference URL:

Mandrola, John. Atrial Flutter–15 facts you may want to know. August 5, 2013. Dr John Mandrola is a cardiac electrophysiologist in Louisville, KY; and regular contributor to Medscape Cardiology at

Witt, Daniel W. and Hansen, Alisyn L. editorial in New Oral Anticoagulants Can Require Careful Dosing Too. by Scott Baltic. Medscape/Reuters Health Information, December 29, 2016.

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