Anticoagulation Choice

Decision Aid



To begin, let’s review your medical situation

Over the next 5 years
people will have no stroke
people will have a fatal or disabling stroke
people will have a non-disabling stroke

Current
Risk of Stroke

Without Anticoagulation

In 100 people like you who are not taking an anticoagulant, at 5 years...

Future
Risk of Stroke

With Anticoagulation

In 100 people like you who are taking an anticoagulant, at 5 years...

Over the next 5 years
people will have no stroke
people will have a fatal or disabling stroke
people will have a non-disabling stroke
people will avoid a stroke by taking anticoagulation

Fitting anticoagulation in your life:

Which issue would you like to discuss first?

  • Bleeding

  • Anticoagulation Routine

  • Reversing Anticoagulation

  • Cost

  • Diet & Medication Interaction

Anticoagulation Choices

There are choices for anticoagulation medicines

Warfarin or Direct Anticoagulant

  • Apixaban Eliquis
  • Dabigatran Pradaxa
  • Edoxaban Savaysa
  • Rivaroxaban Xarelto

To choose between anticoagulaton approaches, let’s think about how the options would fit in your life

Continue

Bleeding

When taking an anticoagulant
you may...

  • bruise more easily
  • bleed more easily
  • require emergency treatment

Bleeding

For Average Risk

In 100 people, over the next 5 years...

86 people will not need emergency treatment for bleeding

5 will need emergency treatment whether they take an anticoagulant or not

9 more people will need emergency treatment because they take an anticoagulant

Some bleeds are fatal

Bleeding

In your day-to-day life...

Are there activities at work,
home, or during recreation where you might fall or hurt yourself?

Bleeding

In your medical situation...

Medical factors associated with bleeding may put you at

  • Lower than Average Risk
  • Average Risk
  • Higher than Average Risk

Lower than Average Average Risk Higher than Average Risk

Over 5 years

more people will need emergency treatment because they take an anticoagulant

serious bleed without anticoagulation

additional serious bleed with anticoagulation

Anticoagulation Routine

Warfarin Coumadin
Once daily
Regular
blood tests
at a clinic or
possibly at
home

Direct Anticoagulants

Apixaban Eliquis AMPM
Dabigatran Pradaxa AMPM
Edoxaban Savaysa Once daily
Rivaroxaban Xarelto Once daily

Reversing Anticoagulation

Warfarin Coumadin

Medications to reverse the effects of Warfarin are:

commonly available

Direct Anticoagulants

Medications to reverse the effects of Direct Anticoagulants are:

not commonly available

Cost

Warfarin Coumadin

$545 per year

including cost of blood tests

Direct Anticoagulants

$2,930 per year

Apixaban Eliquis
Dabigatran Pradaxa
Edoxaban Savaysa
Rivaroxaban Xarelto

Diet & Medication Interaction

Warfarin Coumadin

Requires a consistent diet

Interacts with common foods, medications, and supplements

Direct Anticoagulants

Few interactions with food or medications

We have discussed that this patient has a 5-year risk of stroke associated with atrial fibrillation of X% and that this risk can be reduced with anticoagulation by Y% to K%.

We have discussed the pros and cons of the available options, including their impact on the risk of bleeding, cost, and practical considerations in using them regularly. After thorough discussion, we have decided to use ENTER INTERVENTION.
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