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Pierre Jaïs, M.D. Professor of Cardiology, Haut-Lévêque Hospital, Bordeaux, France

"Dear Steve, I saw a patient this morning with your book [in hand] and highlights throughout. She loves it and finds it very useful to help her in dealing with atrial fibrillation."

Dr. Wilber Su Cavanaugh Heart Center, Phoenix, AZ

"Your book [Beat Your A-Fib] is the quintessential most important guide not only for the individual experiencing atrial fibrillation and his family, but also for primary physicians, and cardiologists."

Jane-Alexandra Krehbiel, nurse, blogger and author "Rational Preparedness: A Primer to Preparedness"



ABOUT A-FIB.COM...


"Steve Ryan's summaries of the Boston A-Fib Symposium are terrific. Steve has the ability to synthesize and communicate accurately in clear and simple terms the essence of complex subjects. This is an exceptional skill and a great service to patients with atrial fibrillation."

Dr. Jeremy Ruskin of Mass. General Hospital and Harvard Medical School

"I love your [A-fib.com] website, Patti and Steve! An excellent resource for anybody seeking credible science on atrial fibrillation plus compelling real-life stories from others living with A-Fib. Congratulations…"

Carolyn Thomas, blogger and heart attack survivor; MyHeartSisters.org

"Steve, your website was so helpful. Thank you! After two ablations I am now A-fib free. You are a great help to a lot of people, keep up the good work."

Terry Traver, former A-Fib patient

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Aspirin

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

 

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.

FAQs A-Fib Ablations: Why Use Aspirin After Successful Ablation?

 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

 

Return to FAQ Catheter Ablations

FAQs A-Fib Treatments: Catheter Ablation Procedures

Catheter ablation illustration at A-Fib.com

Catheter ablation

Atrial Fibrillation patients seeking a cure and relief from their symptoms often have many questions about catheter ablation procedures. Here 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 defective Mitral Valve? Is it causing my A-Fib? Should I have my Mitral Valve fixed first before I have a PVA?

2. “With the recent improvements in Pulmonary Vein ablation techniques, should I wait for a better technique? I’m getting by with my Atrial Fibrillation.”

3. “Are there different types of “Pulmonary Vein Ablation”? Are they different from “Pulmonary Vein Isolation?

4. I’’ve heard of Cryo (freezing) catheters for PVA(I) ablations. Are they good or better than the RF (Radio Frequency) catheters for ablations?

5. “How dangerous is a Pulmonary Vein Ablation procedure? What are my risks?

6. “During the ablation procedure A-Fib doctors actually burn within the heart with RF energy. How does this burning and scarring affect how the heart functions? Should athletes, for example, be concerned that their heart won’t function as well after an ablation?

7. “How dangerous is the fluoroscopy radiation during an ablation? I know I need a Pulmonary Vein Ablation (Isolation) procedure to stop my A-Fib—A-Fib destroys my life. I can’t work or exercise, and live in fear of the next attack. Antiarrhythmic meds cause me bad side effects. But I’m worried about being exposed to radiation during the ablation.

8. “I have serious heart problems and chronic heart disease along with Atrial Fibrillation. Would a Pulmonary Vein Ablation help me? Should I get one?

9. “What is an enlarged heart? Does it cause A-Fib?. I was told I can’t have a Pulmonary Vein Ablation (Isolation) procedure because I have an enlarged heart. Why is that?”

10. “I am 82 years old. Am I too old to have a successful Pulmonary Vein Ablation? What doctors or medical centers perform PVAs on patients my age?

11. “Since my PVI, I have been A-Fib free with no symptoms for 32 months. What do you think my chances of staying A-Fib free are?”

12. “How long before you know a Pulmonary Vein Ablation procedure is a success? I just had a PVA(I). I’ve got bruising on my leg, my chest hurts, and I have a fever at night. I still don’t feel quite right. Is this normal?”

13. I want to read exactly what was done during my Pulmonary Vein Ablation. Where can I get the specifics? What records are kept?

14. “What is the typical length of a catheter ablation today versus when you had your catheter ablation in 1998 in Bordeaux, France? What makes it possible?

15. “After my successful Pulmonary Vein Ablation, do I still need to be on blood thinners like Coumadin or aspirin?

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

17. Since my ablation, my A-Fib feels worse and is more frequent than before, though I do seem to be improving each week. My doctor said I shouldn’t worry, that this is normal. Is my ablation a failure?

18. “I love to exercise and I’m having a PVA. Everything I read says ‘You can resume normal activity in a few days.’ Can I return to what’s ‘normal’ exercise for me?

19. I have Chronic Atrial Fibrillation (the heart remains in A-Fib all the time). Am I a candidate for a Pulmonary Vein Ablation? Will it cure me? What are my chances of being cured compared to someone with Paroxysmal (occasional) A-Fib?

20. “I’m 80 and have been in Chronic (persistent/permanent) A-Fib for 3 years. I actually feel somewhat better now than when I had occasional (Paroxysmal) A-Fib. Is it worth trying to get an ablation?

21.“Will an ablation take care of both A-Fib and Flutter? Does one cause the other? Which comes first A-Fib or Flutter?

22. Are there other areas besides the pulmonary veins with the potential to turn into A-Fib hot spots? I had a successful catheter ablation and feel great. Could they eventually be turned on and put me back into A-Fib

23. “During an ablation, how much danger is there of developing a clot? What are the odds? How can these clots be prevented?

24. “I was told that I will have to take an anticoagulant for about 2-3 months after my ablation. After all, if fibrillation episodes are reduced or eliminated after an ablation, shouldn’t there be even less need for a prescription anticoagulant rather than more?

25. “I’m six months post CryoBalloon ablation and very pleased. But my resting heart rate remains higher in the low 80s. Why? I’ve been told it’s not a problem. I’m 64 and exercise okay, but I’ve had to drop interval training.”

26. “I’ve heard good things about the French Bordeaux group. Didn’t Prof. Michel Häissaguerre invent catheter ablation for A-Fib? Where can I get more info about them? How much does it cost to go there?

27. “I’m a life-long runner. I recently got intermittent A-Fib. Does ablation (whether RF or Cryo) affect the heart’s blood pumping output potential because of the destruction of cardiac tissue? And if so, how much? One doc said it does.

Last updated: Thursday, September 8, 2016

Return to FAQs

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: Wednesday, May 25, 2016

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

FAQs A-Fib Drug Therapy: Aspirin or Warfarin

 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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