A new study has found that prescribing blood thinners to adults under 65 with atrial fibrillation (AFib) but no other health risks does not help prevent stroke, mini-stroke (TIA), or memory problems. The study, called BRAIN-AF, was presented on November 16 at a major heart conference in the United States.
Understanding Atrial Fibrillation and Stroke Risk
Atrial fibrillation is a common heart condition that causes an irregular and often rapid heartbeat. When the heart does not beat properly, blood can pool inside the heart and form clots. If a clot travels to the brain, it can block blood flow and cause a stroke.
Doctors usually prescribe blood thinners to people with AFib who are over 65 or have other stroke risks, such as high blood pressure, diabetes, heart failure, or a previous stroke. These medications help prevent clots from forming.
However, some younger adults with AFib but no additional health risks are still given blood thinners, even though it is unclear whether they actually need them.
The Study and What It Found
The BRAIN-AF study was designed to see if blood thinners could reduce stroke risk and cognitive decline in younger adults with AFib who had no other health problems. Researchers followed 1,235 adults in Canada, with an average age of 53. None of them had conditions that would normally require blood thinners.
Half of the participants were randomly chosen to take a blood thinner called rivaroxaban (15 mg daily), while the other half received a placebo (a pill with no active medication). The study was meant to last five years, but it was stopped early—after 3.7 years—because it became clear that the medication was not helping.
The key findings were:
- About 1 in 5 participants showed signs of cognitive decline, stroke, or TIA (a temporary stroke-like episode).
- Memory problems accounted for 91% of these cases.
- The risk of major bleeding was very low, with only 1 in 200 experiencing serious bleeding.
- The stroke rate was less than 1 in 100 per year (0.8%).
- There was no difference between those taking rivaroxaban and those taking a placebo.
This means that blood thinners did not prevent strokes or memory problems in younger adults with AFib who had no other risk factors.
What This Means for Patients
Dr. Lena Rivard, the study’s lead researcher, believes that many younger adults with AFib are being overtreated with blood thinners, while some older patients who actually need them are not getting them.
She emphasized that younger AFib patients without other risk factors already have a very low risk of stroke, so taking blood thinners does not add any extra protection.
Instead of relying on medication, Dr. Rivard advises patients to focus on healthy lifestyle choices to protect their memory and brain health. This includes regular exercise, a balanced diet, and activities that keep the brain active, such as reading or solving puzzles.
Unanswered Questions and Future Research
While the study showed that rivaroxaban does not prevent cognitive decline, researchers are still investigating why some younger AFib patients experience memory problems over time. They collected over 5,700 memory tests during the study and plan to analyze them further using blood and genetic tests.
One big question is whether other treatments, such as a heart procedure called ablation, might help protect brain health in AFib patients. The study also used a low dose of rivaroxaban, so it remains unknown whether a higher dose or a different type of blood thinner would have made a difference.
Final Thoughts
The BRAIN-AF study confirms that younger adults with AFib but no additional health risks do not need blood thinners to prevent strokes or cognitive decline. Instead, they should focus on healthy habits to maintain brain function.
Doctors should be cautious about prescribing blood thinners to patients who may not benefit from them, while ensuring that older patients with real stroke risks receive proper treatment.
If you care about brain health, please read studies about vitamin D deficiency linked to Alzheimer’s and vascular dementia, and higher magnesium intake could help benefit brain health.
For more information about brain health, please see recent studies about antioxidants that could help reduce dementia risk, and coconut oil could help improve cognitive function in Alzheimer’s.
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