Anticoagulation Myth Busters

MYTH

“Aspirin is a suitable alternative to OAC for stroke prevention, particularly for older patients at increased risk of a bleeding event”

REALITY

“There is a misconception that in older patients, particularly those aged >75 years, aspirin is a safe alternative to warfarin. This idea has been challenged in the BAFTA study, the findings of which demonstrate that aspirin does not confer the same benefits as warfarin in terms of stroke prevention in older adults and is associated with comparable bleeding risk.”1

NICE guidance CG180 (2014) states “Do not offer aspirin monotherapy solely for stroke prevention to people with AF”.2 This is reiterated in the European Society of Cardiology Atrial Fibrillation 2016 guidance “Antiplatelet monotherapy is not recommended for stroke prevention in AF patients, regardless of stroke risk”.3

REFERENCES
  1. Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370(9586):493-503.
  2. NICE CG 180. Atrial fibrillation: management. In: Excellence NIfHaC, editor. NICE: NICE; 2014.
  3. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. European heart journal. 2016;37(38):2893-962.
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