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Aspirin

FAQs A-Fib Treatments: Medicines and Drug Therapies

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

Drug Therapies for Atrial Fibrillation

Atrial Fibrillation patients often search for unbiased information and guidance about medicines and drug therapy treatments. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)

1. “ I have a heart condition. Which medications are best to control my Atrial Fibrillation?” What medications work best for me?“

2. HRT: “Do you have information about Hormone Replacement Therapy (HRT) and if it might help or hinder my atrial fibrillation?”

3. Rate Control Drug: “I take atenolol, a beta-blocker. Will it stop my A-Fib.”

Antiarrhythmic Drugs

1. “Is the “Pill-In-The-Pocket” treatment a cure for A-Fib? When should it be used?” (“Pill-In-The-Pocket” makes use of an antiarrhythmic drug such as flecainide)

2. I’ve been on amiodarone for over a year. It works for me and keeps me out of A-Fib. But I’m worried about the toxic side effects. What should I do?”

3. “Is the antiarrhythmic drug Multaq [dronedarone] safer than taking amiodarone? How does it compare to other antiarrhythmic drugs?”

4. “My doctor told me about the Tikosyn drug option that I want to consider in getting rid of my 5-month-old persistent A-Fib. That seems like something that should be discussed on your web site.”

Blood Thinners/Anticoagulants

Note: August 2015 Update: Aspirin is no longer recommended as first-line therapy to prevent A-Fib stroke.

1. “Are anticoagulants and blood thinners the same thing? How do they thin the blood?

2. Should everyone who has A-Fib be on a blood thinner like warfarin (brand name: Coumadin)?”

3. Which is the better to prevent stroke—warfarin (Coumadin), an NOAC or aspirin?

4. “I am on Coumadin (warfarin). Do I now need to avoid foods with Vitamin K which would interfere with its blood thinning effects?”

5. Are natural blood thinners for blood clot treatment as good as prescription blood thinners like warfarin?”

6. “I’m worried about having to take the blood thinner warfarin. If I cut myself, do I risk bleeding to death?

Related question: My new cardiologist wants me to switch from Pradaxa to Eliquis. if bleeding occurs, is Eliquis easier to deal with?

Related question: My heart doctor wants me to take Xarelto. I am concerned about the side effects which can involve death. What else can I do?”

7. “I”ve read about a new anticoagulant, edoxaban (brand names: Lixiana, Savaysa) as an alternative to warfarin (Coumadin). For A-Fib patients, how does it compare to warfarin? Should I consider edoxaban instead of the other NOACs?”

Post-Procedure

1. I’ve had a successful catheter ablation and am no longer in A-Fib. But my doctor says I need to be on a blood thinner. I’ve been told that, even after a successful catheter ablation, I could still have “silent” A-Fib—A-Fib episodes that I’m not aware of. Is there anything I can do to get off of blood thinners?“

2. “I just had an Electrical Cardioversion. My doctor wants me to stay on Coumadin for at least one month. Why is that required? They mentioned something about a “stunned atrium.” What is that?“

A-Fib Stroke Risk

1. “What are my chances of getting an A-Fib stroke?

2. “The A-Fib.com web site claims that an A-Fib stroke is often worse than other causes of stroke. Why is that? If a clot causes a stroke, what difference does it make if it comes from A-Fib or other causes? Isn’t the damage the same?“

3. “How long do I have to be in A-Fib before I develop a clot and have a stroke?

4. “Is there a way to get off blood thinners all together? I hate taking Coumadin. I know I’m at risk of an A-Fib stroke.”

If you find any errors on this page, email us. Y Last updated: Tuesday, February 14, 2017
Return to Frequently Asked Questions

Beware: Women More Likely on Aspirin Inappropriately

Aspirin-rod-povray". Licensed under CC BY-SA 3.0 via Wikimedia Commons

Aspirin 3D model

I recently wrote about how aspirin is no longer recommended as first-line therapy to prevent A-Fib stroke. (See my posts: New A-Fib Guidelines: Ditch the Aspirin for Stroke Prevention; and More Than 1 in 10 Take Aspirin When They Shouldn’t)

In doing my research, I came across aspirin therapy studies that should be of interest to women.

Another Example of Gender Bias

One research study found that women were more likely than men to receive inappropriate aspirin therapy.

Another study spanning 15 years followed nearly 28,000 women taking aspirin for primary prevention of cardiovascular disease (CVD). The findings? For most women the benefits of aspirin did not outweigh the risks of bleeding complications.

The researchers concluded that aspirin “is ineffective or harmful in the majority of women with regard to the combined risk of cardiovascular disease, cancer, and major gastrointestinal bleeding.”

Like Other Blood Thinners, Aspirin is a Pharmaceutical Drug

It’s all too easy to take an aspirin―we don’t need a prescription to get it. But taking an aspirin isn’t like taking a vitamin. Aspirin is a pharmaceutical drug.

Discuss aspirin therapy with your doctor just as you’d do for any ‘by prescription’ blood thinner. (Take along a copy of my posts cited above.)

References for this article

Warn Family & Friends: 1 in 10 Take Aspirin When They Shouldn’t

I recently wrote about how aspirin is no longer recommended as first-line therapy to prevent A-Fib stroke. (See my AF Symposium report, AHA/ACC/HRS Treatment Guideline Changes.).

But it’s not just A-Fib patients who shouldn’t be on aspirin therapy for stroke prevention.

Data indicates more than 1 in 10 patients take aspirin when they shouldn’t.

Warn your family and friends who are taking daily aspirin for stroke risk: Maybe they shouldn’t be.
Aspirin-rod-povray". Licensed under CC BY-SA 3.0 via Wikimedia Commons

Aspirin 3D model

50 Million in the US Take Aspirin for Prevention of Cardiovascular Disease

The problem with routinely taking aspirin is an increased risk of bleeding complications. More than one-third of all adults in the U.S. are now taking aspirin for primary and secondary prevention of cardiovascular disease (CVD).

“Primary” means preventing a first event like a heart attack. “Secondary” means preventing a reoccurrence of an event, like a second stroke.

When is Aspirin Therapy Appropriate?

As a “primary” prevention, only patients with a moderate to high 10-year risk of cardiovascular disease and stroke should be on aspirin therapy (estimated using the ACC/AHA risk-prediction calculator or similar calculator).

Aspirin is recommended for “secondary” prevention.

Try the ACC/AHA Risk-Prediction Calculator for yourself but beware: 
Critics claim it overestimates CVD risk by 75-150% and could land you on lifelong statin therapy.

When is Aspirin Therapy Not Appropriate?

Aspirin is not appropriate for people who are at low risk—defined by their 10-year risk score. 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 these deaths occur in those who take low-dose (81-mg) aspirin.” The FDA in 2014 released a statement that warned against widespread use (of aspirin) in people of average risk.

Like Other Blood Thinners, Aspirin is a Pharmaceutical Drug

It’s all too easy to take an aspirin―we don’t need a prescription to get it. But taking an aspirin isn’t like taking a vitamin. Aspirin is a pharmaceutical drug.

Instead of routinely taking aspirin, you should discuss aspirin therapy with our doctor just as you’d do for any ‘by prescription’ blood thinner. (Take along a copy of this post.)

Note: Suddenly stopping daily aspirin therapy could have a rebound effect that may trigger a blood clot. If you have been taking daily aspirin therapy and want to stop, it’s important to talk to your doctor before making any changes.

References for this article

 

Update: Aspirin No Longer Recommended as First-Line Therapy for Stroke Prevention

Aspirin: No longer recommended for stroke risk

Aspirin: No longer recommended for stroke risk

by Steve Ryan, Update August 2015

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.

Antiplatelet Aspirin

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: Saturday, February 11, 2017

New A-Fib Guidelines: Ditch the Aspirin for Stroke Prevention

“Many patients with atrial fibrillation may be taking aspirin because they think it is ‘good for their health,’ said Dr T Jared Bunch of Intermountain Medical Center, Murray, UT. “But if they are not taking it for a prescribed reason (because they have CAD or a stent), they should stop taking aspirin because it adds risk over time.”

As I reported in my 2015 AF Symposium report:

Aspirin is no longer recommended as first-line therapy to prevent A-Fib stroke.

It’s amazing how many of us have been convinced to take a baby aspirin daily to improve heart health and to prevent a stroke (myself included).

Taking an aspirin isn’t like taking a vitamin. Aspirin is a pharmaceutical drug.

We now know we are risking tearing up our stomach with GI bleeds and developing a hemorrhagic stroke.

It’s all too easy to take an aspirin―we don’t need a prescription to get it. But taking an aspirin isn’t like taking a vitamin. Aspirin is a pharmaceutical drug.

Tablets - photo by  holohololand

photo by holohololand

Discuss Aspirin Therapy With Your Doctor: You should discuss aspirin therapy with your doctor just as you do for any other (by prescription) blood thinner. You might want to take along a copy my AF Symposium report, AHA/ACC/HRS Treatment Guideline Changes.

Note: Suddenly stopping daily aspirin therapy could have a rebound effect that may trigger a blood clot. If you have been taking daily aspirin therapy and want to stop, it’s important to talk to your doctor before making any changes.

Archive: FAQs A-Fib Treatments: Medicines and Drug Therapies

FAQs A-Fib Treatments: Medicines and Drug Therapies

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

Drug Therapies for Atrial Fibrillation

Atrial Fibrillation patients often search for unbiased information and guidance about medicines and drug therapy treatments. These are answers to the most frequently asked questions by patients and their families. (Click on the question to jump to the answer.)

1. Which medications are best to control my Atrial Fibrillation?” “I have a heart condition. What medications work best for me?

2. “Is the “Pill-In-The-Pocket” treatment a cure for A-Fib? When should it be used?”

3. “I take atenolol, a beta-blocker. Will it stop my A-Fib.”

4. I’ve been on amiodarone for over a year. It works for me and keeps me out of A-Fib. But I’m worried about the toxic side effects. What should I do?”

5. Should everyone who has A-Fib be on a blood thinner like warfarin (Coumadin)?”

6. Which is the better anticoagulant to prevent stroke—warfarin (Coumadin) or aspirin?

7. What’s the difference between warfarin and Coumadin?

8. I’m on warfarin. Can I also take aspirin, since it works differently than warfarin? Wouldn’t that give me more protection from an A-Fib (ischemic) stroke?

9. “What are my chances of getting an A-Fib stroke?

10. “I’m worried about having to take the blood thinner warfarin (brand name Coumadin). If I cut myself, do I risk bleeding to death?

11. “I am on Coumadin (warfarin) to thin my blood and prevent A-Fib blood clots. Do I now need to avoid foods with Vitamin K which would interfere with the blood thinning effects of Coumadin?” UPDATED

12. “The A-Fib.com web site claims that an A-Fib stroke is often worse than other causes of stroke. Why is that? If a clot causes a stroke, what difference does it make if it comes from A-Fib or other causes? Isn’t the damage the same?

13. “I just had an Electrical Cardioversion. My doctor wants me to stay on Coumadin for at least one month. Why is that required? They mentioned something about a “stunned atrium.” What is that?

14. Are natural blood thinners for blood clot treatment as good as prescription blood thinners like warfarin?”

15. “How long do I have to be in A-Fib before I develop a clot and have a stroke?

16. I have to be on aspirin for stroke prevention. Which is better—the low-dose baby aspirin (81 mg) or a high dose (325 mg)? Should I take the immediate-release (uncoated) or the enteric-coated aspirin?

17. I don’t want to be on blood thinners for the rest of my life. I’ve had a successful catheter ablation and am no longer in A-Fib. But my doctor says I need to be on a blood thinner. I’ve been told that, even after a successful catheter ablation, I could still have “silent” A-Fib—A-Fib episodes that I’m not aware of.  Is there anything I can do to get off of blood thinners?

18. “My last cardiologist had me on Pradaxa. My new cardiologist wants me to switch to Eliquis. Is Eliquis easier to deal with if bleeding occurs?

19. “My doctor told me about the Tikosyn drug option that I want to consider in getting rid of my 5-month-old persistent A-Fib. That seems like something that should be discussed on your web site.

20. “I hate taking Coumadin. Is there a way to get off blood thinners all together? I know I’m at risk of an A-Fib stroke.”

21. “I”ve read about a new anticoagulant, edoxaban, as an alternative to warfarin (Coumadin) for reducing risk of stroke. For A-Fib patients, how does it compare to warfarin? Should I consider edoxaban instead of the other NOACs?

22. “Do you have information about Hormone Replacement Therapy (HRT) and if it might help or hinder my atrial fibrillation?

23. Are Anticoagulants and blood thinners the same thing? How do they thin the blood?

24. I have A-Fib, and my heart doctor wants me to take Xarelto 15 mg. I am concerned about the side effects which can involve death. What else can I do?

25. “Is the antiarrhythmic drug Multaq [dronedarone] safer than taking amiodarone? How does it compare to other antiarrhythmic drugs?”

Last updated: Saturday, February 11, 2017

Back to FAQs by Patients with Atrial Fibrillation

FAQs A-Fib Drug Therapy: Aspirin, Low-Dose or High Dose?

 FAQs A-Fib Drug Therapy: Aspirin

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

16. “My doctor has me on aspirin for stroke prevention. Which is better—the low-dose baby aspirin (82 mg) or a high dose (325 mg)? Also, should I take the immediate-release (uncoated) or the enteric-coated aspirin?”

See August 2015 update below.

The HORIZONS-AMI study found that patients on high-dose aspirin had higher rates of major bleeding than those on low-dose aspirin. And the high-dose aspirin didn’t provide any additional protection against ischemic stroke.

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.

Realize that aspirin is not very effective in preventing an A-Fib stroke.

If you have to take aspirin, this study indicates a baby aspirin is preferable over high-dose aspirin.

Also, uncoated aspirin is generally better. In a study measuring aspirin absorption, half the subjects didn’t fully absorb the coated aspirin within eight hours, but all absorbed the uncoated aspirin. And “coated aspirin has never been shown to reduce bleeding in the stomach.” (Since almost all baby aspirin is coated, chew it before swallowing to remove the enteric coating.)

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

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 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.

When is aspirin appropriate? Aspirin is recommended for “secondary” prevention of cardiovascular disease such as reoccurrence of a stroke or heart attack.

References for this article

Return to FAQ Drug Therapies

Last updated: Wednesday, September 2, 2015

FAQs A-Fib Drug Therapy: Warfarin + Aspirin Combo?

 FAQs A-Fib Drug Therapy: Warfarin + Aspirin?  

Drug Therapies for Atrial Fibrillation, A-Fib, Afib

8. I’m on warfarin. Can I also take aspirin, since it works differently than warfarin? Wouldn’t that give me more protection from an A-Fib (ischemic) stroke?”

No, combining is dangerous.

Preliminary research indicates that combining anticoagulants (warfarin) and antiplatelets (aspirin) in the same patient is associated with a substantially higher risk of fatal or non-fatal internal bleeding.

There’s no indication that combining warfarin with an antiplatelet (aspirin, clopidogrel, or both) reduces the risk of ischemic stroke.

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

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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