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FAQs A-Fib Drug Therapy: Stroke Prevention
“For A-Fib patients, which is the better to prevent A-Fib-related stroke—warfarin (Coumadin), a NOAC or aspirin?”
Updated: June 2018. For decades, patients more at risk for A-Fib-related stroke have been on warfarin (Coumadin). In the last few years, many of these patients have switched to the newer NOACs. A-Fib patients with low or no risk factors for stroke are often put on aspirin, or nothing at all.
Differences with the Same Goal
Aspirin is an antiplatelet drug that decreases the stickiness of circulating platelets (small blood cells that start the normal clotting process), so that they adhere to each other less and are less likely to form blood clots. (Cost: dirt cheap.)
Warfarin (brand name Coumadin) is an anticoagulant that works by slowing the production of blood clotting proteins made in the liver. Warfarin is highly effective, reducing the annual risk of stroke by approximately two thirds, but does require periodic lab tests to maintain the proper therapeutic level. (Cost: dirt cheap + lab tests.)
NOACs stands for Novel Oral AntiCoagulants. NOACs are alternatives for vitamin K antagonists (e.g., Warfarin). NOACs don’t require periodic blood testing as with warfarin. The clinical trials indicate NOACs work as well as warfarin. (Cost: Very expensive.)
Takeaways
The FDA approved the NOACs without any recognized method of determining their clot preventing effectiveness (as with warfarin, i.e. INR).
Warfarin has been successfully used for stroke prevention in A-Fib patients at high or intermediate risk for stroke. It’s readily available and inexpensive.
Aspirin is no longer recommended as first-line therapy for Atrial Fibrillation patients according to the 2014 AHA/ACC/HRS Treatment Guidelines for Atrial Fibrillation. And has been downgraded to a class 2B drug.
Microbleeds: We obviously don’t have any data on the long-term effects of taking NOACs for years. Some people on long-term warfarin have been known to develop micro bleeds and dementia. Will this happen with the NOACs? We simply don’t know. But intuitively one would expect the same thing to happen, though probably not to the extent of warfarin.
Weighing the various risk/benefit ratios is a decision for you and your doctor. And should be re-evaluated as you grow older.
Return to FAQ Drug Therapies
Last updated: Monday, June 18, 2018
