Is There an Alternative to Warfarin?
There are different treatments available to reduce your stroke risk if you have AFib. The most common are blood thinners like warfarin. Learn about warfarin alternatives below.
Blood Thinner Medications and AFib Stroke Risk
Blood thinner medications, also called anticoagulant drugs, are an effective way to lower the risk of stroke in people with atrial fibrillation, or AFib, not caused by a heart valve problem.1
The blood thinner warfarin (also known as Coumadin®) has been around for more than 60 years. There are also several newer blood thinners available now, including Eliquis® (apixaban), Pradaxa® (dabigatran), Xarelto® (rivaroxaban), and Savaysa® (edoxaban).
For people who need an alternative, there are heart procedures that can effectively reduce the risk of stroke. WATCHMAN is a permanent implant that does just that.2
WATCHMAN or Blood Thinners?
Like warfarin, a common blood thinner, WATCHMAN can effectively reduce stroke risk.2 This permanent implant is for people with AFib not caused by a heart valve problem who need an alternative to warfarin, or a warfarin substitute.
Beyond Blood Thinners
Over a 1/3 of people with AFib feel trapped between the fear of having a stroke and fear of the risks associated with blood thinners. In fact, more than 4 in 5 people with AFib taking a blood thinner (83%) say they would be willing to try a different treatment to help reduce their risk of stroke.3
Warfarin vs Other Blood Thinner Medications
Warfarin is a common blood thinner prescribed to reduce stroke risk in people with atrial fibrillation. It’s been used for decades and is typically less expensive than the newer types of blood thinners—but it comes with certain requirements and restrictions.4,5
Regular blood tests: With warfarin, you have to get regular blood tests—from twice a week to once a month, depending on your doctor’s recommendation. These tests measure your INR, or International Normalized Ratio, a number that tells how long it takes for your blood to clot.
Dietary guidelines: Certain foods, like leafy greens, can affect your INR if you’re taking warfarin. Forgetting to take your medication can also put you out of range. If you’re outside the recommended INR, you may be at higher risk for stroke or higher risk for bleeding.
Newer blood thinners don’t come with the same dietary restrictions as warfarin, and they don’t require INR testing. If you have trouble with your warfarin treatment plan, your cardiologist may recommend that you take a different type of blood thinner. While these blood thinners offer additional options to warfarin, each medication comes with its own risks and benefits.1
Blood Thinner Medications and Bleeding Risks
Blood thinners, or anticoagulants, are very effective at reducing the risk of stroke in people with atrial fibrillation, and most people can take them for years without serious side effects. But because blood thinners help prevent clots by thinning the blood, they also increase the risk of bleeding.1
Minor bleeding: Most bleeding events are minor and easily treated, like a cut taking longer than normal to stop bleeding. Some people bruise more easily on blood thinners. You should discuss any of these symptoms with your doctor.
Major bleeding: In other cases, bleeding can be serious and require medical help or blood transfusions. Sometimes, the bleeding can be life-threatening, for example, when bleeding in the brain causes a stroke.
When considering your treatment options, your cardiologist will weigh your risk of a stroke against your risk of a serious bleeding problem. These risks depend on several factors—for some people the risk of bleeding is higher than for others.1
Blood Thinners Come with Challenges
Warfarin
- Bleeding Risk That Grows Over Time
- Daily Pills
- Continuing to Take Medication as Prescribed Long-Term
- Regular Blood (INR) Tests
- Food and Drug Interaction Issues
- Complicates Surgical Procedures
All Blood Thinners
- Bleeding Risk That Grows Over Time
- Daily or 2x/Daily Pills
- Continuing to Take Medication as Prescribed Long-Term
- Complicates Surgical Procedures
- High Cost
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If You Can’t Take a Blood Thinner Long Term
Some people with atrial fibrillation who should take warfarin or another anticoagulant to reduce their stroke risk can’t due to their lifestyle or health history. Other AFib patients choose not to take anticoagulants, or blood thinners, due to side effects or for other reasons.1
Left atrial appendage closure: A procedure called left atrial appendage closure provides an alternative to warfarin for people who need one. The left atrial appendage is a small pouch at the top of the heart. When a blood clot escapes from the left atrial appendage and travels to another part of the body, it can cut off the blood supply to the brain, causing a stroke.9 In people with AFib not caused by a heart valve problem, more than 90% of stroke-causing clots that come from the heart are formed in the left atrial appendage (LAA).9 Closing off the LAA is an effective way to reduce stroke risk in these people.
The WATCHMAN Implant is a left atrial appendage closure procedure. It is the only FDA-approved implant proven to reduce stroke risk in people with atrial fibrillation not caused by a heart valve problem (also referred to as non-valvular AFib).
Learn more about the WATCHMAN procedure ►
It’s important to understand that a stroke can be caused by factors other than a clot escaping from the left atrial appendage. These causes can include high blood pressure and the narrowing of blood vessels to the brain.8 Left atrial appendage closure will not prevent these other causes of stroke.
How Is WATCHMAN an Alternative to Warfarin?
WATCHMAN is a permanent heart implant that may replace the need for long-term blood thinners. WATCHMAN was compared to warfarin in clinical trials and was found to effectively reduce the risk of stroke.6
Learn more about WATCHMAN as an alternative to warfarin ►
In a clinical trial2:
This can mean a lower risk of bleeding from long-term warfarin use.7 After getting WATCHMAN and stopping warfarin, patients take aspirin and clopidogrel (Plavix®) for 6 months. After that, they take only aspirin on an ongoing basis.
WATCHMAN may be right for you if you have one of following:
- Major bleeding while taking blood thinners
- A lifestyle, occupation, or health concern that puts you at risk for bleeding
- Are taking warfarin and having trouble with your treatment plan, and you can't take a different type of blood thinner
It’s important to understand that, like blood thinners, WATCHMAN does not cure AFib. But it does offer people with AFib not caused by a heart valve problem a potentially life-changing alternative to taking daily blood thinners long term.
Questions to Ask Your Doctor
If you have atrial fibrillation not caused by a heart valve problem and need an alternative to warfarin, here are some questions to ask your cardiologist:
- What warfarin substitutes are available to me?
- What are the differences in cost between these options?
- What are the risks and benefits of the different blood thinners?
- Am I within the recommended blood clotting range on warfarin?
- Does my lifestyle or health history put me at risk for serious bleeding?
- Am I a candidate for left atrial appendage closure?
- What should I know about the WATCHMAN Implant?
If you think WATCHMAN could be right for you, answer a few questions and get a personalized guide for talking to your cardiologist.
WATCHMAN is for people with atrial fibrillation not caused by a heart valve problem who need an alternative to warfarin. This website is intended to provide patients and caregivers with some information about the WATCHMAN Implant. It may help prepare you for talking to your doctor about your options for reducing stroke risk.
The WATCHMAN Device is a permanent implant designed to close the left atrial appendage in the heart in an effort to reduce the risk of stroke.
With all medical procedures there are risks associated with the implant procedure and the use of the device. The risks include but are not limited to accidental heart puncture, air embolism, allergic reaction, anemia, anesthesia risks, arrhythmias, AV (Arteriovenous) fistula, bleeding or throat pain from the TEE (Trans Esophageal Echo) probe, blood clot or air bubbles in the lungs or other organs, bruising at the catheter insertion site, clot formation on the WATCHMAN™ Closure Device, cranial bleed, excessive bleeding, gastrointestinal bleeding, groin puncture bleed, hypotension, infection/pneumonia, pneumothorax, pulmonary edema, pulmonary vein obstruction, renal failure, stroke, thrombosis and transient ischemic attack. In rare cases death can occur.
Be sure to talk with your doctor so that you thoroughly understand all of the risks and benefits associated with the implantation of the WATCHMAN Device.
References:
- National Stroke Association. Making the Afib-Stroke Connection.https://www.stroke.org/sites/default/files/resources/Afib-Connection%20for%20hcp.pdf. Published 2012.Accessed September 1, 2016.
- Holmes DR Jr, Kar S, Price MJ, et al. Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial. J Am Coll Cardiol. 2014;64(1):1-12.
- WatchUsNow.com. The Harris Poll online survey. Boston Scientific. SH-574213-AA. https://www.watchusnow.com/?page=d75be9d4-ba36-456c-a72d-dc3df07892da. Accessed March 28, 2019.
- Agency for Healthcare Research and Quality (AHRQ). Blood Thinner Pills: Your Guide to Using Them Safely.http://www.ahrq.gov/sites/default/files/wysiwyg/patients-consumers/diagnosis-treatment/treatments/btpills/btpills.pdf. Published September 2015. Accessed September 8, 2016.
- American Heart Association website. http://www.heart.org/HEARTORG/. Published 2017.Accessed June 1, 2017.
- Holmes DR Jr, Doshi SK, Kar S, et al. Left atrial appendage closure as an alternative to warfarin for stroke prevention in atrial fibrillation: a patient-level meta-analysis. J Am Coll Cardiol.2015;65(24):2614-2623.
- Price MJ, Reddy VY, Valderrábano M, et al. Bleeding outcomes after left atrial appendage closure compared with long-term warfarin. JACC Cardiovasc Interv. 2015;8(15):1925-1932.
- American Stroke Association website. http://www.strokeassociation.org/STROKEORG/. American Heart Association. Published 2017. Accessed May 31, 2017.Cleveland Clinic. Atrial fibrillation (Afib). http://my.clevelandclinic.org/services/heart/disorders/arrhythmia/atrial-fibrillation-afib. Published May 2015. Accessed August 25, 2016.
- Blackshear JL, Odell JA. Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation. Ann Thorac Surg. 1996;61:755-759.