EMBARGOED FOR RELEASE UNTIL 4 PM ET, October 21, 2026
Study examines stroke prevention for people with AFib after brain bleeds
EMBARGOED FOR RELEASE UNTIL 4:00 P.M., ET, WEDNESDAY, OCTOBER 21, 2026
Highlights:
- In people with AFib who previously had a brain bleed, anticoagulant use was associated with a lower risk of ischemic stroke and death than taking no anticoagulants.
- Newer direct oral anticoagulants apixaban, rivaroxaban, edoxaban and dabigatran were not linked to an increased risk of another brain bleed.
- An older anticoagulant, warfarin, was tied to a lower risk of ischemic stroke and death but a higher risk of future brain bleeds.
- Researchers said the findings may help clinicians and patients make more individualized treatment decisions, though more research is needed.
- Because this was an observational study, the findings do not show that anticoagulants caused these differences in risk, only that they were associated with them.
MINNEAPOLIS — For people with atrial fibrillation
(AFib), an irregular heartbeat, and intracranial hemorrhage, a type of stroke also
known as a brain bleed, anticoagulant use was associated with a lower risk of an
ischemic stroke and death, according to a new study published October 21, 2026,
in Neurology®, the official medical journal of the American Academy of Neurology. The study also found no
increased risk of more brain bleeds when people took newer anticoagulants.
Anticoagulants are drugs that stop the blood from clotting
easily. Ischemic stroke is when blood flow is blocked, often by a blood clot,
to part of the brain.
While newer anticoagulants were not associated with an
increased risk of future brain bleeds, warfarin, an older anticoagulant, was.
Newer anticoagulants, called direct oral anticoagulants, include apixaban,
rivaroxaban, edoxaban and dabigatran.
Because this was an observational study, the findings do not
show that anticoagulants caused these differences in risk, only that they were
associated with them.
“Anticoagulants can help prevent ischemic stroke, but for
people with atrial fibrillation who have had a previous brain bleed, treatment
decisions can be complex due to concern about the possibility of another brain
bleed,” said Paula Tiili, MD, of the University of Helsinki in Finland. “For
our study, we wanted to better understand the risks of ischemic stroke and
brain bleeds in people using newer and older anticoagulants.”
The study included 1,502 people with an average age of 78 who
had AFib and brain bleeds that occurred at least four months prior to their
AFib diagnosis. They were followed up to two years. Of participants, 15% received
newer anticoagulants, 29% received warfarin and 56% received no anticoagulants.
During the study, 57 had an ischemic stroke, 45 people had
new brain bleeds and 257 died.
After adjusting for factors such as age, high cholesterol
and high blood pressure, researchers found that at one year after an AFib
diagnosis, fewer than 1% of people taking newer anticoagulants had an ischemic
stroke compared to 2% of those taking warfarin and 4% of those taking no
anticoagulants.
Researchers found that 1% of people taking newer
anticoagulants had a new brain bleed compared to 3% of people taking warfarin
and 2% of people taking no anticoagulants.
They also found that 5% of people taking newer
anticoagulants died of causes other than stroke within that first year,
compared to 9% of people taking warfarin and 15% taking no anticoagulants.
Compared with taking no medications, newer anticoagulant use
was associated with an 83% lower risk of ischemic stroke and an 80% lower risk
of death, without an increased risk of intracranial bleeding.
Warfarin use was associated with a 51% lower risk of
ischemic stroke and 40% lower risk of death, but an 85% higher risk of brain
bleeds.
“Our study found that anticoagulant use was linked to a
lower risk of ischemic stroke and death in this high-risk group,” said Tiili.
“Importantly, our study found newer anticoagulants were not associated with
another brain bleed, while warfarin was. Our findings may help clinicians make
more individualized treatment decisions when trying to prevent stroke in people
with AFib and prior brain bleeds. However, more research is needed to identify
who is most likely to benefit and who may still face a higher bleeding risk.”
A limitation of the study was that researchers included only
people who did not have a stroke or die within the first three months after an AFib
diagnosis, so the results may not apply to people in that earlier period of
time.
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