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Anticoagulant medications (warfarin, dabigatran, rivaroxaban, apixaban, edoxaban among others) are strong blood thinners that can help prevent ischemic (blockage type) strokes in patients with atrial fibrillation (an irregular heart rhythm) and stabilize/resolve blood clots in conditions such as deep venous thrombosis (DVT, clot in the legs), pulmonary embolism (PE, clot in lung vessels) or after an acute myocardial infarction (MI, heart attack). Their down-side is that they increase the risk of bleeding including brain bleeds and the brain bleeds that happen while on anticoagulants tend to have even poorer outcomes than in patients not using these blood thinners.

The need for anticoagulation poses an added risk in patients who have higher brain bleeding risk discussed under Types of Brain Bleeds of this website. It should nevertheless be remembered that anticoagulants have established benefits in preventing clotting in appropriate patients. Like any other medical or surgical treatment, it is helpful to weigh the risks and benefits of different treatment approaches.

Patients with higher brain bleeding risk who are on anticoagulants should discuss the need for and the duration of anticoagulant use with an expert physician. There are particular situations where there might be an established alternative to life-long use of anticoagulant medications such as left atrial appendage closure procedure that might spare long-term anticoagulation in patients with non-valvular atrial fibrillation. An open discussion using shared-decision making approaches between the patient and appropriate experts would result in better-informed management plans. 

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