Aspirin still overprescribed for stroke prevention in atrial fibrillation

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According to recently published research, aspirin is still overprescribed for stroke prevention in atrial fibrillation despite the potential for dangerous side effects.

Gregory YH Lip, lead author of the European Society of Cardiology’s ‘Real-world’ antithrombotic treatment in atrial fibrillation: the EURObservational Research Programme Atrial Fibrillation General Pilot study, says: “The perception that aspirin is a safe and effective drug for preventing strokes in atrial fibrillation needs to be dispelled. If anything, you could say that giving aspirin to patients with atrial fibrillation is harmful because it is minimally or not effective at stroke prevention, yet the risk of major bleeding or intracranial haemorrhage is not significantly different to well-managed oral anticoagulation.”

He adds: “All the contemporary guidelines say that aspirin should not be used for the prevention of stroke in patients with atrial fibrillation. And yet our study shows that aspirin is still overprescribed in these patients.”

According to a press release issued by the European Society of Cardiology, the study provides the most up-to-date picture of European cardiologists’ prescribing of antithrombotic treatment, which includes oral anticoagulation therapy (warfarin and the novel oral anticoagulants) and antiplatelet drugs (mainly aspirin). The data are from the EORP Atrial Fibrillation General Pilot Registry of more than 3,100 patients in nine countries.

Overall, the study found that the use of oral anticoagulants has improved over the last decade since the last Euro Heart Survey was performed. Where oral anticoagulation was used, most patients (72%) were prescribed warfarin and just 8% were prescribed a new oral anticoagulant.

Aspirin was commonly prescribed, either alone or in combination with an oral anticoagulant, when patients had myocardial infarction or coronary artery disease. The strongest reason to prescribe both drugs was coronary artery disease, which increased the use of combined therapy by more than eight-fold.

“Aspirin is still overused for stroke prevention in atrial fibrillation. European Society of Cardiology guidelines say concomitant aspirin should not be given to anticoagulated atrial fibrillation patients with stable vascular disease. The combination of drugs does not reduce cardiovascular events and stroke but does increase the risk of bleeding,” Lip says.

The press release reported that another worrying finding was that oral anticoagulants were under-prescribed in elderly patients, with aspirin alone more commonly prescribed. In addition, patients with paroxysmal atrial fibrillation were less likely to receive oral anticoagulation compared to patients with permanent atrial fibrillation.

“Our study of antithrombotic prescribing by cardiologists reveals a positive trend of increasing oral anticoagulant use. But worrying misconceptions and practices remain regarding aspirin, treatment of the elderly and paroxysmal atrial fibrillation,” Lip concluded.

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