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Antithrombotic therapy in atrial fibrillation: aspirin is rarely the right choice
  1. Ian N Sabir1,2,
  2. Gareth D K Matthews2,
  3. Christopher L-H Huang2
  1. 1Rayne Institute, St. Thomas’ Hospital, London, UK
  2. 2Physiological Laboratory, University of Cambridge, Cambridge, UK
  1. Correspondence to Dr Ian N Sabir, Physiological Laboratory, University of Cambridge, Downing Street, Cambridge CB2 3EG, UK; ins20{at}cam.ac.uk

Abstract

Atrial fibrillation, the commonest cardiac arrhythmia, predisposes to thrombus formation and consequently increases risk of ischaemic stroke. Recent years have seen approval of a number of novel oral anticoagulants. Nevertheless, warfarin and aspirin remain the mainstays of therapy. It is widely appreciated that both these agents increase the likelihood of bleeding: there is a popular conception that this risk is greater with warfarin. In fact, well-managed warfarin therapy (INR 2-3) has little effect on bleeding risk and is twice as effective as aspirin at preventing stroke. Patients with atrial fibrillation and a further risk factor for stroke (CHA2DS2-VASc >0) should therefore either receive warfarin or a novel oral agent. The remainder who are at the very lowest risk of stroke are better not prescribed antithrombotic therapy. For stroke prevention in atrial fibrillation; aspirin is rarely the right choice.

  • Atrial Fibrillation
  • Aspirin
  • Antithrombotic
  • Anticoagulant
  • Warfarin

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