Article Text

other Versions

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}


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

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.