Stroke prevention medications

Treatment options to reduce the risk of stroke for people with Atrial Fibrillation (AFib).

If you are diagnosed with AFib, you should be aware that it is a condition that will not just disappear over time. If you are experiencing few to no symptoms, it is still recommended that you speak with your doctor on a regular basis. Individuals with AFib have a significantly higher risk of stroke compared to those without AFib. Your doctor will decide which treatment option is most appropriate for your individual circumstances.

AFib stroke prevention medications

Medications specifically used to prevent clot formation and reduce stroke risk

The most common cause of stroke is a blood clot – which if you have Atrial Fibrillation (AFib), can form inside your heart and be pumped through your body. If this clot reaches your brain it has the ability to cause a stroke.

There are medications called anticoagulants or blood thinners available today that have been proven to help reduce the risk of stroke by preventing blood clots from forming.

These blood thinners prevent blood from ‘coagulating’ or clotting by blocking the activity of clotting factors in the blood. They are usually an important part of the long-term medical treatment for people who have AFib in whom anticoagulation medications are appropriate.

Below is a chart along with an overview of medications approved for use in Canada to help reduce the risk of stroke for patients living with AFib.

Treatments for stroke prevention in Atrial Fibrillation as recommended by the Canadian Cardiovascular Society

Click on the "+" to expand.

Coumadin®(Warfarin)Pradaxa®(Dabigatran Etexilate)Xarelto®(Rivaroxaban)Eliquis®(Apixaban)
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Does this medication need ongoing monitoring of blood clotting times?

Yes.

When first taking Coumadin® blood or PT/INR (prothrombin time/international normalized ratio) tests may need to be done every day for a few days, then may go to once every week.

To keep your blood coagulation/ Coumadin® in the best range, these blood tests need monitoring through regular visits to a health care provider.

PT/INR tests will be needed at periodic intervals throughout your course of therapy to keep your PT/INR in the best range for your medical condition.

No.

No.

No.

+-
How do I take it?

Coumadin® should be taken at the same time every day with or without food.

Pradaxa® should be taken twice a day with a full glass of water and can be taken with or without food.

Xarelto® should be taken once a day with food.

Eliquis® should be taken twice a day with or without food.

+-
Does this medication have any food interactions ?

Eat a normal balanced diet maintaining a consistent level of green, leafy vegetables. Do not make drastic changes in your diet, such as eating large amount of green, leafy vegetables. Avoid cranberry juice or any other cranberry products, as well as alcohol.

None.

None.

None.

+-
Is there a reversal agent to stop its blood thinning effect?

Beriplex® neutralizes the effects of vitamin K antagonists treatments (such as Coumadin®) by providing adequate amounts of the necessary missing or inhibited factors required for normal blood clotting.

Octaplex® can temporarily stop bleeding in patients with deficiency that is caused by Vitamin K antogonists (such as Coumadin®) of one or several of the coagulation factors II, VII, IX, and X, commonly called the Prothrombin Complex.

Vitamin K1 compounds, such as phytonadione, promote the activation of prothrombin in the liver, but do not directly reverse the effects of Coumadin®.

Praxbind™ (idarucizumab), binds to Pradaxa®, reversing its anti-clotting effect.

No product exists to reverse the effects of Xarelto®.

No product exists to reverse the effects of Eliquis®.

+-
When should treatment not be used?

Do not take Coumadin® if you:

  • Are pregnant or plan to become pregnant
  • Are allergic (hypersensitive) to warfarin, sodium or any of the components in Coumadin®

Do not take Pradaxa® if you:

  • Are already taking another blood thinner, including apixaban (Eliquis®), bivalirudin, dalteparin, enoxaparin, fondaparinux, rivaroxaban (Xarelto®), unfractionated heparin, warfarin (Coumadin®), unless your physician has decided to switch you to or from Pradaxa®
  • Have an artificial heart valve
  • Are breastfeeding. It is possible that Pradaxa® passes into breast milk
  • Are allergic to dabigatran etexilate, dabigatran, or any other ingredient in the formulation
  • Are taking oral ketoconazole, used to treat fungus infection
  • Have a disease that increases your chances of bleeding, bleeding in the brain (stroke) within the last 6 months of recent bleeding of a stomach ulcer
  • Have active bleeding or bleed excessively
  • Have severely reduced kidney function or your kidneys do not function
  • Have an epidural or spinal catheter in place

Do not take Xarelto® if you:

  • Are taking other anticoagulants (blood thinners) such as warfarin, apixaban, dabigatran, heparin or low molecular weight heparin (LMWH) including enoxaparin, dalteparin or heparin derivatives, such as fondaparinux
  • Have an artificial heart valve
  • If you are pregnant or breastfeeding
  • If you are allergic (hypersensitive) to rivaroxaban (active ingredient of Xarelto®) or any of the other ingredients of Xarelto®
  • Are taking certain oral medications to treat fungal infections or HIV/AIDS, such as Nizoral® (ketoconazole) or Norvir® (ritonavir)
  • Are aware of body wounds or injuries at risk of bleeding, including bleeding in the brain or bleeding in your stomach or gut
  • Have active bleeding, especially if you are bleeding excessively
  • Have severe liver disease which leads to an increased risk of bleeding

Do not take Eliquis® if you:

  • Are already taking medicines to prevent blood clots, e.g. warfarin (Coumadin®), heparin, rivaroxaban (Xarelto®), dabigatran (Pradaxa®), unless your physician has decided to switch you to Eliquis®
  • Have an artificial heart valve
  • Are pregnant
  • Are allergic (hypersensitive) to apixaban (active ingredient of Eliquis®) or any of the other ingredients of Eliquis®
  • Are taking oral ketoconazole (a drug used to treat fungus infection)
  • Have certain types of abnormal bleeding such as recent bleeding of a stomach ulcer
  • Are aware of body lesions at risk of bleeding, including bleeding in the brain (stroke)
  • Have active bleeding, especially if you are bleeding excessively
  • Have a severe liver disease which leads to increased risk of bleeding (hepatic coagulopathy)
  • Are also taking prasugrel (Effient) or ticagrelor (Brilinta)
  • Are younger than 18 years old
+-
What are some of the possible blood thinner side effects?

Coumadin® may cause bleeding, which may be serious and life-threatening.

Other side effects include:

  • Headache, dizziness or weakness
  • Fatigue, feeling tired, general feeling of illness
  • Bleeding from shaving or other cuts that does not stop
  • Bleeding from gums when brushing teeth
  • Nosebleeds
  • Coughing up blood
  • Vomiting blood or material that look like coffee grounds
  • Unusual bruising for unknown reasons
  • Pink or dark brown urine
  • Red or black color on your stool
  • More bleeding than usual when you get your menstrual period or unexpected bleeding from vagina
  • Unusual pain or swelling

As Pradaxa® acts on the blood clotting system, most side effects are related to signs of bruising or bleeding. Although rare, Pradaxa® can cause bleeding which may be serious and life-threatening.

Other side effect include:

  • Abdominal pain or diarrhea
  • Vomiting and nausea
  • Heartburn
  • Difficulty swallowing
  • Hives, itching, rash
  • Reflux of gastric juice
  • Upset stomach
  • Bruising

As Xarelto® acts on the blood clotting system, most side effects are related to signs of bruising or bleeding. Major or severe bleeding may occur and, regardless of location, may lead to disabling, life-threatening outcomes.

Other side effects include:

  • Stomach ache
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea
  • Indigestion
  • Decreased general strength and energy

As Eliquis® acts on the blood clotting system,  most side effects are related to signs of bruising or bleeding.  Major or severe bleeding may occur and, regardless of location, may lead to disabling, life-threatening outcomes.

Other side effects include:

  • Nausea
  • Anemia, which may cause loss of energy or weakness
+-
Are there any interactions with the medication to be aware of?

The following may interact with Coumadin®:

  • Aspirin and aspirin-containing ointments and skin creams
  • Natural medicines including garlic and ginkgo biloba
  • Some of your medicines may affect the way Coumadin® works, so tell your health provider about any prescription or non-prescription medication, vitamins, and herbal supplements
  • Other medication that contain warfarin
  • Cranberry juice and other cranberry products
  • Avoid alcohol consumption

Tell your health care provider about any prescription and non-prescription drugs that you are taking. Do not take any other medications that contain warfarin.

The following may interact with Pradaxa®:

  • Antifungal drugs, including orcal itraconazole and posaconazole
  • Blood thinners, including clopidgrel, prasugrel (Effient®) or ticagrelor (Brilinta®)
  • Antiviral drugs, used to treat HIV, including nelfinavir, ritonavir, saquinavir, and tipranavir
  • Antacids, used to treat heartburns. If you need to take an antacid, take it at least two hours after taking Pradaxa®
  • Antibiotics, including rifampicin and clarithromycin
  • Antidepressants, in particular selective serotonin re-uptake inhibitors (SSRIs) or selective serotonin norepinephrine re-uptake inhibitors (SNRIs)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), used to reduce pain and swelling
  • Drugs used to prevent organ rejection after transplantation, including cyclosporine and tacrolimus
  • Drugs used to treat epilepsy, including carbamazepine
  • Drugs used to treat irregular heartbeats, including amiodarone (Cordarone®), dronedarone (Multaq®) and quinidine
  • Proton pump inhibitors, used to treat heartburn
  • St. John’s wort (a herbal supplement used for depression)
  • Verapamil, used to lower blood pressure

The following may interact with Xarelto®:

  • Oral medications to treat fungal infections such as ketoconazole, itraconazole, posaconazole
  • Anticoagulants (blood thinners) such as warfarin (Coumadin®), heparin or low molecular weight heparin (LMWH) including enoxaparin, fondaparinux, bivalidrudin, apixaban, dabigatran, or anti-platelet agents, such as clopidogrel, ticlopidine, prasugrel, ticagrelor
  • Medications for HIV/AIDS such as ritonavir [Norvir®] and lopinavir/ritonavir [Kaletra®]
  • Anti-inflammatory and pain relieving medicines including non-steroidal anti-inflammatory drugs (NSAIDs) (eg, naproxen [Naprosyn®] or acetylsalicylic acid [Aspirin®])
  • Some antibiotics such as clarithromycin rifampicin
  • Anticonvulsants (to control seizures or fits) such as phenytoin, carbamazepine, phenobarbital
  • St John’s Wort (a herbal supplement used for depression)

The following may interact with Eliquis®:

  • Some medicines for fungal infections (e.g. ketoconazole, itraconazole, voriconazole and posaconazole)
  • Other medicines that are used to reduce blood clotting (e.g. enoxaparin, clopidogrel, prasugrel)
  • Some antiviral medicines for HIV / AIDS (e.g. ritonavir)
  • Anti-inflammatory or pain medicines (e.g. aspirin or naproxen)
  • Medicines for high blood pressure or heart problems (e.g. diltiazem)
  • Medicines to treat tuberculosis or other infections (e.g. rifampin, rifampicin)
  • Medicines to prevent epilepsy or seizures (e.g. phenytoin, carbamazepine, or phenobarbital)
  • St John’s Wort (a herbal supplement used for depression)
Coumadin(Warfarin)+-
Does this medication need ongoing monitoring of blood clotting times?

Yes.

When first taking Coumadin® blood or PT/INR (prothrombin time/international normalized ratio) tests may need to be done every day for a few days, then may go to once every week.

To keep your blood coagulation/ Coumadin® in the best range, these blood tests need monitoring through regular visits to a health care provider.

PT/INR tests will be needed at periodic intervals throughout your course of therapy to keep your PT/INR in the best range for your medical condition.

How do I take it?

Coumadin® should be taken at the same time every day with or without food.

Does this medication have any food interactions ?

Eat a normal balanced diet maintaining a consistent level of green, leafy vegetables. Do not make drastic changes in your diet, such as eating large amount of green, leafy vegetables. Avoid cranberry juice or any other cranberry products, as well as alcohol.

Is there a reversal agent to stop its blood thinning effect?

Beriplex® neutralizes the effects of vitamin K antagonists treatments (such as Coumadin®) by providing adequate amounts of the necessary missing or inhibited factors required for normal blood clotting.

Octaplex® can temporarily stop bleeding in patients with deficiency that is caused by Vitamin K antogonists (such as Coumadin®) of one or several of the coagulation factors II, VII, IX, and X, commonly called the Prothrombin Complex.

Vitamin K1 compounds, such as phytonadione, promote the activation of prothrombin in the liver, but do not directly reverse the effects of Coumadin®.

When should treatment not be used?

Do not take Coumadin® if you:

  • Are pregnant or plan to become pregnant
  • Are allergic (hypersensitive) to warfarin, sodium or any of the components in Coumadin®
What are some of the possible blood thinner side effects?

Coumadin® may cause bleeding, which may be serious and life-threatening.

Other side effects include:

  • Headache, dizziness or weakness
  • Fatigue, feeling tired, general feeling of illness
  • Bleeding from shaving or other cuts that does not stop
  • Bleeding from gums when brushing teeth
  • Nosebleeds
  • Coughing up blood
  • Vomiting blood or material that look like coffee grounds
  • Unusual bruising for unknown reasons
  • Pink or dark brown urine
  • Red or black color on your stool
  • More bleeding than usual when you get your menstrual period or unexpected bleeding from vagina
  • Unusual pain or swelling
Are there any interactions with the medication to be aware of?

The following may interact with Coumadin®:

  • Aspirin and aspirin-containing ointments and skin creams
  • Natural medicines including garlic and ginkgo biloba
  • Some of your medicines may affect the way Coumadin® works, so tell your health provider about any prescription or non-prescription medication, vitamins, and herbal supplements
  • Other medication that contain warfarin
  • Cranberry juice and other cranberry products
  • Avoid alcohol consumption

Tell your health care provider about any prescription and non-prescription drugs that you are taking. Do not take any other medications that contain warfarin.

Pradaxa(Dabigatran Etexilate)+-
Does this medication need ongoing monitoring of blood clotting times?

No.

How do I take it?

Pradaxa® should be taken twice a day with a full glass of water and can be taken with or without food.

Does this medication have any food interactions ?

None.

Is there a reversal agent to stop its blood thinning effect?

Praxbind™ (idarucizumab), binds to Pradaxa®, reversing its anti-clotting effect.

When should treatment not be used?

Do not take Pradaxa® if you:

  • Are already taking another blood thinner, including apixaban (Eliquis®), bivalirudin, dalteparin, enoxaparin, fondaparinux, rivaroxaban (Xarelto®), unfractionated heparin, warfarin (Coumadin®), unless your physician has decided to switch you to or from Pradaxa®
  • Have an artificial heart valve
  • Are breastfeeding. It is possible that Pradaxa® passes into breast milk
  • Are allergic to dabigatran etexilate, dabigatran, or any other ingredient in the formulation
  • Are taking oral ketoconazole, used to treat fungus infection
  • Have a disease that increases your chances of bleeding, bleeding in the brain (stroke) within the last 6 months of recent bleeding of a stomach ulcer
  • Have active bleeding or bleed excessively
  • Have severely reduced kidney function or your kidneys do not function
  • Have an epidural or spinal catheter in place
What are some of the possible blood thinner side effects?

As Pradaxa® acts on the blood clotting system, most side effects are related to signs of bruising or bleeding. Although rare, Pradaxa® can cause bleeding which may be serious and life-threatening.

Other side effect include:

  • Abdominal pain or diarrhea
  • Vomiting and nausea
  • Heartburn
  • Difficulty swallowing
  • Hives, itching, rash
  • Reflux of gastric juice
  • Upset stomach
  • Bruising
Are there any interactions with the medication to be aware of?

The following may interact with Pradaxa®:

  • Antifungal drugs, including orcal itraconazole and posaconazole
  • Blood thinners, including clopidgrel, prasugrel (Effient®) or ticagrelor (Brilinta®)
  • Antiviral drugs, used to treat HIV, including nelfinavir, ritonavir, saquinavir, and tipranavir
  • Antacids, used to treat heartburns. If you need to take an antacid, take it at least two hours after taking Pradaxa®
  • Antibiotics, including rifampicin and clarithromycin
  • Antidepressants, in particular selective serotonin re-uptake inhibitors (SSRIs) or selective serotonin norepinephrine re-uptake inhibitors (SNRIs)
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), used to reduce pain and swelling
  • Drugs used to prevent organ rejection after transplantation, including cyclosporine and tacrolimus
  • Drugs used to treat epilepsy, including carbamazepine
  • Drugs used to treat irregular heartbeats, including amiodarone (Cordarone®), dronedarone (Multaq®) and quinidine
  • Proton pump inhibitors, used to treat heartburn
  • St. John’s wort (a herbal supplement used for depression)
  • Verapamil, used to lower blood pressure
Xarelto(Rivaroxaban)+-
Does this medication need ongoing monitoring of blood clotting times?

No.

How do I take it?

Xarelto® should be taken once a day with food.

Does this medication have any food interactions ?

None.

Is there a reversal agent to stop its blood thinning effect?

No product exists to reverse the effects of Xarelto®.

When should treatment not be used?

Do not take Xarelto® if you:

  • Are taking other anticoagulants (blood thinners) such as warfarin, apixaban, dabigatran, heparin or low molecular weight heparin (LMWH) including enoxaparin, dalteparin or heparin derivatives, such as fondaparinux
  • Have an artificial heart valve
  • If you are pregnant or breastfeeding
  • If you are allergic (hypersensitive) to rivaroxaban (active ingredient of Xarelto®) or any of the other ingredients of Xarelto®
  • Are taking certain oral medications to treat fungal infections or HIV/AIDS, such as Nizoral® (ketoconazole) or Norvir® (ritonavir)
  • Are aware of body wounds or injuries at risk of bleeding, including bleeding in the brain or bleeding in your stomach or gut
  • Have active bleeding, especially if you are bleeding excessively
  • Have severe liver disease which leads to an increased risk of bleeding
What are some of the possible blood thinner side effects?

As Xarelto® acts on the blood clotting system, most side effects are related to signs of bruising or bleeding. Major or severe bleeding may occur and, regardless of location, may lead to disabling, life-threatening outcomes.

Other side effects include:

  • Stomach ache
  • Nausea
  • Vomiting
  • Constipation
  • Diarrhea
  • Indigestion
  • Decreased general strength and energy
Are there any interactions with the medication to be aware of?

The following may interact with Xarelto®:

  • Oral medications to treat fungal infections such as ketoconazole, itraconazole, posaconazole
  • Anticoagulants (blood thinners) such as warfarin (Coumadin®), heparin or low molecular weight heparin (LMWH) including enoxaparin, fondaparinux, bivalidrudin, apixaban, dabigatran, or anti-platelet agents, such as clopidogrel, ticlopidine, prasugrel, ticagrelor
  • Medications for HIV/AIDS such as ritonavir [Norvir®] and lopinavir/ritonavir [Kaletra®]
  • Anti-inflammatory and pain relieving medicines including non-steroidal anti-inflammatory drugs (NSAIDs) (eg, naproxen [Naprosyn®] or acetylsalicylic acid [Aspirin®])
  • Some antibiotics such as clarithromycin rifampicin
  • Anticonvulsants (to control seizures or fits) such as phenytoin, carbamazepine, phenobarbital
  • St John’s Wort (a herbal supplement used for depression)
Eliquis(Apixaban)+-
Does this medication need ongoing monitoring of blood clotting times?

No.

How do I take it?

Eliquis® should be taken twice a day with or without food.

Does this medication have any food interactions ?

None.

Is there a reversal agent to stop its blood thinning effect?

No product exists to reverse the effects of Eliquis®.

When should treatment not be used?

Do not take Eliquis® if you:

  • Are already taking medicines to prevent blood clots, e.g. warfarin (Coumadin®), heparin, rivaroxaban (Xarelto®), dabigatran (Pradaxa®), unless your physician has decided to switch you to Eliquis®
  • Have an artificial heart valve
  • Are pregnant
  • Are allergic (hypersensitive) to apixaban (active ingredient of Eliquis®) or any of the other ingredients of Eliquis®
  • Are taking oral ketoconazole (a drug used to treat fungus infection)
  • Have certain types of abnormal bleeding such as recent bleeding of a stomach ulcer
  • Are aware of body lesions at risk of bleeding, including bleeding in the brain (stroke)
  • Have active bleeding, especially if you are bleeding excessively
  • Have a severe liver disease which leads to increased risk of bleeding (hepatic coagulopathy)
  • Are also taking prasugrel (Effient) or ticagrelor (Brilinta)
  • Are younger than 18 years old
What are some of the possible blood thinner side effects?

As Eliquis® acts on the blood clotting system,  most side effects are related to signs of bruising or bleeding.  Major or severe bleeding may occur and, regardless of location, may lead to disabling, life-threatening outcomes.

Other side effects include:

  • Nausea
  • Anemia, which may cause loss of energy or weakness
Are there any interactions with the medication to be aware of?

The following may interact with Eliquis®:

  • Some medicines for fungal infections (e.g. ketoconazole, itraconazole, voriconazole and posaconazole)
  • Other medicines that are used to reduce blood clotting (e.g. enoxaparin, clopidogrel, prasugrel)
  • Some antiviral medicines for HIV / AIDS (e.g. ritonavir)
  • Anti-inflammatory or pain medicines (e.g. aspirin or naproxen)
  • Medicines for high blood pressure or heart problems (e.g. diltiazem)
  • Medicines to treat tuberculosis or other infections (e.g. rifampin, rifampicin)
  • Medicines to prevent epilepsy or seizures (e.g. phenytoin, carbamazepine, or phenobarbital)
  • St John’s Wort (a herbal supplement used for depression)

*For more information, visit the company’s website