Atrial Fibrillation: Get the Right Drug

Health Writer
Medically Reviewed

Q. I have atrial fibrillation. What medications do I need to prevent a stroke?

A. Atrial fibrillation (also called AFib) raises the odds of blood clots forming in the heart’s upper chambers—and potentially dislodging and causing a stroke. So stroke prevention is a major goal of AFib treatment.

The precise treatment plan depends on your overall risk of suffering a stroke. Some people with AFib are at relatively low risk and can stick with a daily aspirin and healthy lifestyle measures. But if you have a moderate to high risk of stroke, you and your doctor should consider an anticoagulant—powerful, clot-preventing drugs like warfarin, dabigatran, apixaban, or rivaroxaban.

To determine AFib patients’ stroke risk, doctors use standard scoring systems. Your score is based on whether you have risk factors like diabetes, high blood pressure, heart failure, or a history of stroke or heart attack.

Unfortunately, there’s evidence that many AFib patients who should be on anticoagulants are not. A study published in the June 28, 2016, Journal of the American College of Cardiology examined nearly 295,000 AFib patients who were candidates for anticoagulants based on their stroke risk scores. Only about 60 percent were on the medications, while 40 percent were using aspirin instead.

If you are not taking an anticoagulant, ask your doctor why. The drugs are clearly superior to aspirin for cutting AFib patients’ stroke risk. And while they do carry the risk of internal bleeding, so does aspirin, but without the same benefits in terms of reducing strokes.