A-Fib Drug Therapy: Aspirin, Low-Dose or High Dose?Atrial Fibrillation: Resources for Patients

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FAQs A-Fib Drug Therapy: Aspirin

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

Palazzo, Mary O. Prevention of Blood Clot Formation. The Atrial Fibrillation Page. http://members.aol.com/mazern/afib101.htm 2014

O’Riordan, M. Acute Coronary Syndromes: More bleeding, no extra ischemic protection with high-dose aspirin in HORIZONS-AMI trial. Heartwire/theHeart.org. December 19, 2012. Last accessed Dec. 30, 2012.

Yu J. et al. “Safety and efficacy of high-versus low-dose aspirin after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction.” JACC Cardiovasc Interv, 2012; 5:1231-1238. Last Accessed March 23 2013. URL: http://tinyurl.com/bntttac.

Grosser, Tilo. “Coated-aspirin alert.” Bottom Line Health. Volume 27 Number 4, April, 2013, p. 1.

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

ESC Management of Atrial Fibrillation 2010 and Focused Update (2012): ESC Clinical Practice Guidelines. European Society of Cardiology URL: http://www.escardio.org/Guidelines-&-Education/Clinical-Practice-Guidelines/Atrial-Fibrillation-Management-of-2010-and-Focused-Update-2012

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