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New guidelines recommend blood thinners for women, people over 65, with AFib

March 03, 2015

If you are a woman, or over 65, and have been diagnosed with atrial fibrillation, new guidelines suggest blood-thinning drugs may reduce your risk for stroke. The new guidelines could affect nearly one million people with irregular heartbeats known as atrial fibrillation (AFib).

Why blood thinners for a fib?

Nearly three million people in the U.S. are diagnosed with atrial fibrillation (AFib), an irregular heartbeat that can lead to blood clots, stroke, heart failure and other heart-related complications. Blood thinners, also called anticoagulants, help prevent blood from clotting and potentially causing stroke.

Increasing the number of women with atrial fibrillation recommended for treatment with blood thinners is a revision to 2014 guidelines issued by the American Heart Association, American College of Cardiology and Heart Rhythm Society. The guidelines also lower the age at which all people are considered at risk for stroke from 75 to 65.

“The guideline change is significant because it could potentially reclassify almost one million people with atrial fibrillation who are recommended for anticoagulation therapy,” said Emily O’Brien, PhD, who led the Duke research that resulted in the guideline recommendation. This means more people could be treated with blood thinners than ever before.

O’Brien’s group analyzed data from a large population of men and women for stroke risk and the use of anticoagulants. Their findings were published in JAMA-Internal Medicine.

Read the Duke Health press release.

Being female is a risk factor for stroke

While it’s not clear exactly what it is about the female sex that increases stroke risk, studies continue to show a strong link between being female and a significantly higher risk of stroke in people with atrial fibrillation, she said. As a result, nearly 98 percent of women with AFib could now be recommended for treatment with blood thinners.

Talk to your doctor

Because the guidelines are so new, it’s not yet clear how many doctors will incorporate the new treatment recommendations into their practice. O’Brien said it’s also unclear how this will impact the long-term outcomes of people who could benefit from this therapy. “That will be the next step for our study,” she said.

In the meantime, people with atrial fibrillation should talk to their doctors about whether blood thinners are right for them. 

“Optimal treatment decisions incorporate the doctor’s clinical judgment and the patient’s priorities. People with AFib should talk to their doctors about their personal risk and how they might benefit,” O’Brien advised. “Risk estimation from clinical guidelines is just one of several factors that need to be considered when making decisions about anticoagulant therapy.”

Blood thinners can protect patients against a blood clot or stroke, but might also increase risk for bleeding. For most people, however, the benefits outweigh the bleeding risk, O'Brien said.

Learn more about atrial fibrillation treatment at Duke

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