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Drug Therapies for Atrial Fibrillation, A-Fib, Afib

FAQs A-Fib Drug Therapy: Guarantee Against Stroke?

“I’ve heard of people with A-Fib on anticoagulants who still had a stroke. What can I do to make sure I never have a stroke?”

This question is very timely as a close friend of mine just suffered a major stroke, even though she was on Coumadin and her INR was in the correct range. I can’t tell you how discouraging this is, not just for her but for me, too. I worked with her to get the best treatment possible and by one of the best EPs in our area. But she still had a stroke.

There’s No Absolute Guarantee

There is currently no way to absolutely guarantee you will never experience a stroke. “Even when A-Fib patients are effectively anticoagulated, 14% are still found with clots,” stated Dr. John Camm of St. George’s Medical School, London, England, at the 2008 Boston AF Symposium.

Anticoagulants Reduces A-Fib Stroke Risk

Anticoagulants can significantly lower your overall stroke risk. When warfarin was first approved (in 1954 with brand names: Coumadin and Jantoven), it was considered a ‘wonder drug’. It reduced the risk of an A-Fib stroke by as much as 70%―a huge reduction. For the first time, doctors (and patients) had something that would work to significantly lower the risk of an A-Fib stroke.

Caution: Anticoagulants are High Risk Drugs

Be aware that anticoagulants in general are considered high risk medications. They work by causing or increasing bleeding. They aren’t like taking vitamins.

As Thomas J. Moore of the Institute for Safe Medical Practices points out, “Anticoagulant treatment for people with A-Fib ranks as one of the highest risk treatments in older Americans…more than 15% of older patients treated with blood thinners for 1 year have bleeding.”

Nevertheless, for most people, even though anticoagulants are considered high risk meds, they are a welcome trade-off to having an A-Fib stroke.

An Medication Alternative: The Watchman Occlusion Device

The Left Atrial appendage (LAA) is where 90%–95% of A-Fib clots originate. Closing off the LAA is an alternative strategy for people who can’t or don’t want to take anticoagulants. The Watchman Device (Boston Scientific), an occlusion device, is an ingenious method of closing off the LAA. (Other occlusion devices include the Lariat II and AtriClip surgical device.)

Inserting the Watchman is a very low risk procedure which takes as little as 20 minutes. Usually afterwards, the patient doesn’t need to be on an anticoagulant.

Combine the Watchman with an Anticoagulant?

One may wonder: Could combining a Watchman Device with an anticoagulant (to prevent strokes from other parts of your heart) come close to guaranteeing you will never have a stroke?

This treatment strategy is very speculative. I don’t know of any clinical studies on this subject.

However, if you have a Watchman Device installed, you could discuss with your doctor continuing on an anticoagulant as added protection.

Reference for this Article
Doheney, Kathleen. Blood-Thinner Pradaxa: What You Should Know. WebMD Health News July 25, 2014.

Moore, TJ. ISMP Quarter Watch. Monitoring FDA MedWatch Reports.  Institute for Safe Medication Practices. May 7, 2014 Page 2.

Return to FAQ Drug Therapies
Last updated: Monday, June 18, 2018


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