Medications to prevent or treat blood clots and stroke include blood thinners, also called anticoagulants.
Blood thinners work by reducing the ability of the blood to clot. But as with all medications, blood thinners have side effects. In preventing blood clots from forming, there is also a higher chance for bleeding in some people. Usually, the bleeding is minor – for example, bruising more easily, or having a nosebleed or cut that takes longer to stop bleeding. However, some bleeding can be serious.
For many patients, the benefits of taking a blood thinner far outweigh the risk of bleeding, according to cardiologists. Even when bleeding does occur, it can usually be managed and is rarely life-threatening.
But research and clinical experience suggest that many patients – and even some clinicians – may worry more about the possibility of uncontrolled bleeding when taking a blood thinner than on the benefit of stroke prevention. It’s important to put these risks in context.
Risk is the chance, or likelihood, that something will happen.
For example, people over 80 years of age have a 10% risk of developing AFib. In other words, 10 out of 100 (or 1 in every 10) people in this age group will have AFib.
Using the CHA₂DS₂-VASc risk scoring (a tool used to predict the chances someone with AFib will have a stroke), if you are 75 years or older and have diabetes and high blood pressure, your score is 4. This means your risk of having a stroke in the next year is nearly 5%‐4.8% to be exact. In other words, among people who have these conditions, nearly 5 out of 100 will have a stroke.
A score of 6 ups the risk of stroke to 9.3% – meaning 9 out of 100 people will have a stroke this year.
“In general, most bleeding [related to anticoagulants] can be managed successfully and do not result in irreversible damage (with the exception of intracranial bleeding, which is very rare). In contrast, strokes are more likely to cause disability and can be life-altering, especially for young people,” said Mikhael F. El-Chami, MD, a heart specialist at Emory Healthcare.
While the likelihood of a major bleed from taking an anticoagulant is 2%-3% on average, the risk of stroke is higher. On average, the chance of having a stroke is 5% each year among people with AFib.
The trick is that two people with AFib may have very different risks of stroke and bleeding. That’s why reviewing your risks of both stroke and bleeding and making an informed decision with input from your care team is important.
The good news is there are many options nowadays for blood thinners.
“We have more options than ever,” said Dr. El-Chami. “Some of the newer anticoagulants have lower risks of bleeding compared with warfarin, and all of the newer drugs have a lower risk of bleeding in the brain (intracranial hemorrhage).”
It’s important to talk with your care team about your risk of stroke and bleeding, and your risk for either or both may change over time.
| Risk Factor||Points |
| Congestive Heart Failure||1|
| High Blood Pressure||1|
| A2: > 75 years old||2|
| Diabetes (type 2)||1|
| Stroke or Mini-Stroke||2|
| Vascular Disease (heart attack, peripheral artery disease)|| 1 |
| Age: 65-74 years old|| 1 |
| Sc: Female Sex|| 1 |