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 FAQs A-Fib Drug Therapy: Aspirin and Warfarin 

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

6. “Which is the better anticoagulant to prevent stroke in atrial fibrillation patients—aspirin or warfarin (Coumadin)?”

See August 2015 update below.

People with less risk factors for stroke are sometimes put on aspirin. People more at risk for stroke such as those over 65 years old with frequent A-Fib episodes are often on warfarin (Coumadin) (baring other risk factors such as peptic ulcer, etc.).

Aspirin and warfarin work differently.

Aspirin is an antiplatelet drug that decreases the stickiness of circulating platelets (small blood cells that start the normal clotting process), so that they adhere to each other less and are less likely to form blood clots.

Whereas warfarin (brand name Coumadin) is an anticoagulant that works by slowing the production of blood clotting proteins made in the liver.

Current research indicates that aspirin is not as effective in preventing blood clots (and therefore, strokes) as Coumadin.

Current research indicates that aspirin is not as effective in preventing blood clots (and therefore, strokes) as Coumadin. “Warfarin is highly effective, reducing the annual risk of stroke by approximately two thirds; Aspirin has a more modest 20% effectiveness rate.” But aspirin is less likely to cause abnormal bleeding than warfarin.

Younger people with a low risk of an A-Fib stroke “appear to derive little benefit from warfarin. And, indeed, warfarin may do more harm (intracranial hemorrhage) than good (prevention of ischemic A-Fib stroke).”

Bottom line: Weighing the various risk/benefit ratios is a decision for you and your doctor and may change as you grow older.

August 2015 Update: Aspirin is No Longer Recommended as First-Line Therapy for A-Fib

Aspirin is no longer recommended as first-line therapy for Atrial Fibrillation patients according to the 2014 AHA/ACC/HRS Treatment Guidelines for Atrial Fibrillation. Though not a new finding, it should be noted that aspirin has been downgraded to a class 2B drug.

A similar directive is included in the 2012 European ESC guidelines for the Management of Atrial Fibrillation: aspirin is not recommended as first-line therapy for patients with a CHA2DS2-VASc score of 1.

Aspirin is not appropriate for people who are at low risk of cardiovascular disease and stroke. For these people, the risks of gastrointestinal bleeding and hemorrhagic strokes outweigh any potential benefit. “Among the more than 16,000 deaths each year linked to bleeding…,about one-third of those deaths occur in those who take low-dose (81-mg) aspirin.” The FDA in 2014 warned against widespread use of aspirin in people of average risk.

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. But according to Dr. Randall S. Stafford of Stanford, “no one should take daily, low-dose aspirin solely for the purpose of preventing cancer.”

When is aspirin appropriate? Aspirin is recommended for “secondary” prevention of cardiovascular disease such as to prevent reoccurrence of a stroke or heart attack. Aspirin significantly reduces the risk for a second heart attack or stroke.

References for this article

Return to FAQ Drug Therapies

Last updated: Thursday, September 24, 2015

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