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 FAQs A-Fib Ablations: Post-Ablation Aspirin

Catheter Ablation

Catheter Ablation

16. “I’ve had a successful ablation. For protection against potential stroke risk if my A-Fib re-occurs, which is better—81 mg baby aspirin or 325 mg?”

With respect, the question you should be asking is, “Why am I still on a blood thinner if I’ve had a successful ablation and have no signs of A-Fib?”

It’s normal after a successful Pulmonary Vein Ablation (Isolation), for doctors to keep you on warfarin (Coumadin) for three to six months while your heart heals. Re-growth or re-occurrence of your A-Fib is less likely to occur after six months.

Potential re-growth or recurrence doesn’t justify the associated risks of keeping a patient on warfarin.

Potential re-growth or recurrence doesn’t justify the associated risks of keeping a patient on warfarin.

Once you’ve had an ablation, your stroke risk drops down to that of a normal person. This doesn’t mean you will never have a stroke. People in normal sinus rhythm (NSR) do have strokes. But because you had A-Fib in the past doesn’t mean you have an increased risk of stroke now that you are A-Fib free. As Dr. John Mandrola says, “And if there is no A-Fib, there is no benefit from anticoagulation.”

In general you should know that aspirin is not very effective in preventing an A-Fib stroke (post-ablation or not).

A research study found high-dose aspirin was associated with a nearly threefold increased risk of major bleeding, particularly within the first two months, but also over the entire three-year follow-up period of the study.

Aspirin is not very effective in preventing an A-Fib stroke (post-ablation or not).

Aspirin also causes stomach ulcers in 13% of those using it. And these ulcers usually develop without any warning symptoms. Many of these ulcers will cause a serious stomach bleed at some point. Also, taking low-dose aspirin on a regular basis more than doubles your risk of developing wet macular degeneration. On the positive side, people regularly taking low-dose aspirin have a significantly lower chance of getting cancer.

What this means to you: You may want to talk to your doctors about your post-ablation risk of recurrence and why you are taking aspirin if you no longer have A-Fib. If you have other high-stroke risk conditions, and a blood thinner is called for, you should discuss the problems associated with aspirin.

For more, see our article, Anticoagulant Therapy after Successful A-Fib Catheter Ablation: Is it Right for Me?

 

Added 8/10/15. Aspirin is no longer recommended as first-line therapy:

Aspirin has been downgraded from class 1 in the 2006 guidelines to class 2B in the 2014 guidelines.

In a Danish registry study, aspirin didn’t show any benefit for stroke prevention.1 And in the European ESC guidelines, aspirin is not recommended as first-line therapy for patients with a CHA2DS2-VASc score of 1.2

Resources:
Palazzo, Mary O. Prevention of Blood Clot Formation. The Atrial Fibrillation Page. http://members.aol.com/mazern/afib101.htm
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation. Circulation. published online March 28, 2014, 4.2.1. Antiplatelet Agents, p 29.doi: 10.1161/CIR.0000000000000041 Last accessed Nov 23, 2014.URL: From http://content.onlinejacc.org/article.aspx?articleid=1854230
 Jacob, Elliot. MEDIFOCUS Atrial Fibrillation, Anticoagulants for Stroke Prevention in People with Atrial Fibrillation. 2009, p. 3

Shallenberger, Frank. Does This Exciting New Research mean I Have to Change My Advice About Taking Aspirin? Second Opinion. Vol. XXV, No. 9, September 2015.

Return to FAQ Drug Therapies

References    (↵ returns to text)

  1. Olesen, JB et al. Risks of thromboembolism and bleeding with thromboporphylaxis in patients with atrial fibrillation: a net clinical benefit analysis using a ‘real world’ nationwide cohort study. Thromb Haemost 2011;106:739-749
  2. Camm, AJ et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. EUR Heart J 2012;33:2719-47

 

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