Warfarin or Aspirin for Elderly People with Atrial Fibrillation?

atrial fibrillation

Atrial fibrillation is a condition of the heart that causes it to have an irregular heartbeat. Seniors suffering from atrial fibrillation and their caregivers and doctors must carefully weigh options for treatment. Atrial fibrillation means that someone’s blood does not pump through the body as it should.  Therefore, that person is at higher risk of blood clots, which, depending on the location and severity, can be life threatening. Atrial fibrillation increases the risk of stroke.


Millions of Americans suffer from this condition. That is why it is important to understand whether Warfarin or aspirin (the traditional blood thinner treatments for atrial fibrillation) is best to decrease risk of issues relating to atrial fibrillation.


Are Blood Thinners Necessary?

The first thing doctors look at when determining if a patient with atrial fibrillation requires blood thinners is how likely the person is to experience a blood clot. While no doctor can accurately predict the future, there is a formula they use to determine higher likelihood. The factors they consider include:


–    Is there a history of congestive heart failure?

–    Does the patient have high blood pressure?

–    The age of the patient

–    Does the patient have diabetes?

–    Has the patient ever had a stroke?

–    Does the patient have any type of blood vessel disease?

–    What is the gender of the patient?


After evaluating these factors, the doctor determines the likelihood of a blood clot and the necessity for Warfarin or aspirin.


Benefits of Warfarin

Warfarin is commonly thought to be more effective than aspirin as a blood thinner. However, it also carries a higher risk of hemorrhage, which causes concern for many people. Because of the risks that Warfarin carries, many people avoid the drug or take it at sub-therapeutic levels. This renders it ineffective, paving the way for these patients to risk experiencing a stroke.


Because of the greater effectiveness of Warfarin, doctors readily provide this medication at therapeutic doses and monitor the patients closely. This means blood tests on a regular basis (called INR, or International Normalized Ratio) to check on the blood’s ability to clot. The tests usually need to be performed frequently at first, until the doctor can perfect the dosage. Warfarin needs to mediate the person’s risk of stroke while managing the risk of bleeding in the brain or other parts of the body. Because Warfarin can interact with certain foods, alcohol, and other medications, constant contact with the doctor is important initially.  What’s more, whenever anything changes in the elderly person’s health or diet, the doctor should be notified.


Benefits of Aspirin

Aspirin has been shown time and again to be less effective than Warfarin in terms of stroke prevention. However, it does carry a much lower risk of bleeding. This is the reason why many patients, especially the very elderly, who are more prone to bleeding, choose this method. Studies show that aspirin only works on 19% of atrial fibrillation patients, as compared to a 64% effectiveness rate for Warfarin. Studies also show that a dosage of aspirin lower than 325 mg is ineffective in preventing stroke. This is especially true for people over the age of 75. Patients who have reason to worry about the risk of bleeding, however, find aspirin to be the better option.


Overall Health Matters

The ultimate decision between Warfarin and aspirin comes down to the person’s overall health. Even though Warfarin has a higher risk of causing internal bleeding, its safety depends on a person’s health. A very elderly person with additional health problems will likely be at higher risk for bleeding. He or she will need to be closely monitored or considered for a different medication. On the other hand, a person without too many other health problems could be the perfect candidate for Warfarin. The benefits of taking Warfarin typically greatly outweigh the risks. Many people worry about the risk of bleeding and how it is tied into the risk of elderly people injuring themselves through falls. However, studies show that the risk of bleeding as a result of falling, in combination with Warfarin, are almost nil.


If a patient takes Warfarin and has an adverse side effect of internal bleeding, doctors can react quickly with Vitamin K therapy. Of course, if a patient needs surgery or has other health issues, either Warfarin or aspirin might need to be discontinued or decreased for a period of time.


Only a doctor will be able to determine which medication is the best choice for a particular patient. The key is to talk to the doctor and discuss the pros and cons of each medication. Ignoring the need for anticoagulant treatment could be the worst decision. Therefore, making the best individual choice between Warfarin and aspirin is important to health.



Health in Aging. What Older Adults with Atrial Fibrillation Should Know About Taking Oral Blood Thinners. HealthinAging.Org. Retrieved from http://www.healthinaging.org/resources/resource:what-older-adults-with-atrial-fibrillation-should-know-about-taking-oral-blood-thinners/. Accessed on August 8, 2016.


Medscape. Aspirin in Stroke Prevention in Nonvalvular Atrial Fibrillation and Stable Vascular Disease. Retrieved from http://www.medscape.com/viewarticle/761516_4. Accessed on August 8, 2016.


Verheugt, F. W. A. (December 2007). Also the very elderly benefit from warfarin in atrial fibrillation. Netherlands Heart Journal, 15(12): 403-404. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2213448/. Accessed on August 12, 2016.


Zarraga, I. G. E., Kron, J. (January 2013). Oral Anticoagulation in Elderly Adults with Atrial Fibrillation,: Integrating new Options with Old Concepts. Abstract. Journal of the American Geriatrics Society, 61(1): 143-150. Wiley Online. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/jgs.12042/abstract. Accessed on August 12, 2016.