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Is It Safe To Use Anticoagulants And Have Bleeding Or To Have Greater Stroke Risk?

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Posted on Mon, 24 Mar 2014
Question: I have taken Pradaxa for almost three years due to AFib. Recently, I acquired a family physician (a cardiologist had prescribed the Pradaxa), and had a CBC and other blood tests done. The results showed extremely anemic (I had been feeling quite fatigued for some time and chosen to ignore this symptom and ignored the presence of blood occasionally in the stool off and on for the three years that I took Pradaxa), and I immediately received five units of blood in a transfusion. Now I feel much better, and the family physician has changed me from Pradaxa to Xarelto. I am going to do a better job (!) at not ignoring important symptoms and markers, but from some things that I read, it becomes an either/or choice: take an anticoagulant and have some internal bleeding or don't take it and run greater stroke risk. Is there a solution to this seeming Catch-22? Will the Xarelto likely not cause as much bleeding as the Pradaxa did? Any other options?
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Answered by Dr. Dr. Prasad J (5 hours later)
Brief Answer: I would choose to use anticoagulants... Detailed Answer: Hi, I read through your post with diligence. I understand you have a tricky situation here. Though anticoagulants are saviors and prevent strokes/venous thrombosis it comes packed with risk of bleeding. In this setting, if I were to choose between the risk of having minor internal bleeding or exposing to risk of strokes, I would choose to accept anticoagulants. Off course that was my opinion. You have an option now which is to discuss about your CHADS2 score. Your treating doctor will know about it (I would be able to calculate it if I would be able to review your echocardiogram and past medical history data). If the score is low (below1), you can skip using anticoagulants and use antiplatelets. It's better to be on anticoagulants if score is higher. As far as Xarelto is concerned, risks of intestinal bleeding is much lower than pradaxa. Stats indicate the risk to be 10-15% lower. Apixaban has even lower risks of intestinal bleeding. You can discuss about this with your treating physician. Hope this helped. Let me know if you need clarifications. Regards
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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Dr. Prasad J

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Practicing since :2005

Answered : 3701 Questions

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Is It Safe To Use Anticoagulants And Have Bleeding Or To Have Greater Stroke Risk?

Brief Answer: I would choose to use anticoagulants... Detailed Answer: Hi, I read through your post with diligence. I understand you have a tricky situation here. Though anticoagulants are saviors and prevent strokes/venous thrombosis it comes packed with risk of bleeding. In this setting, if I were to choose between the risk of having minor internal bleeding or exposing to risk of strokes, I would choose to accept anticoagulants. Off course that was my opinion. You have an option now which is to discuss about your CHADS2 score. Your treating doctor will know about it (I would be able to calculate it if I would be able to review your echocardiogram and past medical history data). If the score is low (below1), you can skip using anticoagulants and use antiplatelets. It's better to be on anticoagulants if score is higher. As far as Xarelto is concerned, risks of intestinal bleeding is much lower than pradaxa. Stats indicate the risk to be 10-15% lower. Apixaban has even lower risks of intestinal bleeding. You can discuss about this with your treating physician. Hope this helped. Let me know if you need clarifications. Regards