With A-Fib, What Can I Do to Make Sure I Never Have a Stroke?

Q & A: “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 reminds me of a close friend with A-Fib who suffered a major stroke even though at the time she was on Coumadin and her INR was in the correct range. I had 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.

Anticoagulants Reduces A-Fib Stroke Risk

Anticoagulants can significantly lower your overall stroke risk. When the blood thinner, warfarin (a vitamin K antagonist) was first approved in 1954, it was considered a ‘wonder drug’. It reduced the risk of an A-Fib stroke by as much as 70%―a huge reduction. Back then, for the first time, doctors (and patients) had something that would work to significantly lower the risk of an A-Fib stroke.

Today’s Direct Oral Anticoagulants (DOACs) have simplified oral anticoagulation therapy and replaced vitamin K antagonists for many indications. DOACs, like Xarelto and Eliquis, have revolutionized clinical practice as they can be used in fixed doses without routine laboratory monitoring.

DOACs act quickly, provide rapid anticoagulation, and have predictable responses, simplifying dosing. (It’s unnecessary to monitor blood clotting levels as with warfarin.) They are associated with lower risks of major bleeding, including intracranial hemorrhage. But DOACs may not be suitable for everyone, and can have risks such as kidney function impairment.

Caution: Anticoagulants are High Risk Drugs

Be aware that today’s 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, they are a welcome trade-off to having an A-Fib stroke.

An Medication Alternative: The Watchman Occlusion Device

Illustration: Watchman device positioned in LAA

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. 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.

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Last updated: Monday, September 28, 2026

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