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Aspirin too risky for stroke patients, NICE says

10 July 2015

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Adults with atrial fibrillation (AF) should no longer be prescribed aspirin to prevent stroke, NICE guidance released today said.

Aspirin has been used for years to protect patients from strokes, but the risks of taking aspirin – which can cause stomach bleeds – now outweigh any benefits and anticoagulants should be used instead.

AF is a condition that affects the heart, causing it to beat irregularly and too fast. When this happens, blood does not flow properly through the heart and the rest of the body, so people with AF may be at an increased risk of blood clots. A stroke can occur if a blood vessel in the brain is blocked by a clot.

Dr Matthew Fay, a GP and specialist member of the committee that developed the standard, said: “The ineffectiveness of aspirin and the need to remove it from the AF patient pathway receives a much needed, and rare, negative statement. This should provide the impetus to those who still speculate on the value of aspirin from historic practice to have the discussion with their patients about the benefits of anticoagulation hopefully before, and not after a devastating stroke event.”

Instead NICE’s latest quality standard, recommends that people with AF who have a CHA2DS2-VASC stroke risk score of 2 or above are offered newer anticoagulants, such as apixaban, dabigatran etexilate, rivaroxaban or a vitamin K antagonist like warfarin.

However, it is important to note that many adults with AF may already be taking aspirin for other conditions. If so, this may result in the patient taking aspirin as well as anticoagulants.