A-Fib Requires More Than Aspirin Alone

Swedish researchers tracked 182,678 atrial fibrillation patients, 1/3 of whom took only Aspirin, and 2/3 of whom took other oral anticoagulants with or without Aspirin. At the time the study was conducted, European Union guidelines permitted doctors to prescribe Aspirin for the prevention of strokes in people who have atrial fibrillation, although since 2012 Aspirin monotherapy has only been permitted for people who cannot tolerate a combination of clopidogrel (Plavix) and Aspirin or who refuse to take any other oral anticoagulants because of their experiences with increased bruising and bleeding.

If Aspirin actually makes the risk of stroke worse, why had doctors been prescribing it for so long? The use of Aspirin in atrial fibrillation had been based on seven studies conducted in the 1970's and 1980's. Only one of the seven studies found a net positive benefit of Aspirin in preventing blood clotting events in people who have this kind of arrhythmia. There was a 22% reduction in the risk of stroke, but to get the 22% figure in that study, the researchers had to count transient ischemic attacks (TIA's) and "small strokes" as strokes. The benefits of taking Aspirin as the sole medication for A-fib seem to have been limited to minor cerebrovascular events, not the kinds of strokes that can cause permanent disability.

Dutch researchers followed 8,423 people, average age 69 at the beginning of the study, for an average of 13 years. Of this group, 857 developed atrial fibrillation.

When the researchers accounted for smoking, cholesterol, blood pressure, and other cardiovascular risk factors, they found that people who use non-steroidal anti-inflammatory drugs such as Aspirin, Ibuprofen, and Tylenol on a regular basis are 80% more likely to develop atrial fibrillation if they do not already have it.

The lead researcher in the study, Dr. Bruno H. Stricker, a professor of pharmaco-epidemiology at Erasmus University Medical Center in Rotterdam, said these drugs have also been associated with the risk for coronary artery disease and heart attack.

See Also: Supraventricular Tachycardia: Diagnosis & Therapy

“I would really strongly advise that older people be very careful with using these drugs,” he said. “They don’t do anything except relieve pain. Pain is a nuisance, but dying is a nuisance, too.”

You should always rely on your doctor's advice, but it seems like a good idea for everyone to avoid using Aspirin for preventing blood clots unless it is combined with another drug such as Plavix. (Aspirin must not be used with some of the newer anticoagulants, such as Brilinta.) Taking Aspirin to relieve pain on an occasional basis is probably OK, but if you have A-fib, or you are at risk for A-fib, you should not use it as your only anticoagulant medication.