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Aspirin unsafe and ineffective for stroke prevention in AF

Aspirin increases the risk of bleeding without decreasing the risk of stroke/thromboembolism sufficiently in patients with atrial fibrillation (AF), according to a study1 published recently in Thrombosis and Haemostasis.

Researchers led by Dr Jonas B Olesen (Copenhagen University Hospital Gentofte, Department of Cardiology) investigated more than 130,000 subjects with AF, determining the optimal stroke prevention strategy by balancing stroke risk against major bleeding risk.

Findings showed that aspirin should not be used for stroke prevention in any patient with AF, as the net clinical benefit does not support its use.  The authors also found that patients with AF at very low risk of stroke (defined using the CHA2DS2-VASc risk score) should not receive antithrombotic therapy, as the net clinical benefit of warfarin was actually negative.

The net clinical benefit was found to be higher in patients with a HAS-BLED score of 3 and above, the authors recommending warfarin use in the elderly and patients perceived to be at a higher bleeding risk.  Dr Olesen said: “Medical professionals must acknowledge that, even though the current available drug of choice, warfarin, is inconvenient with regard to monitoring, the treatment saves lives”.

Referring to new oral anticoagulants, Dr Olesen added: “These new drugs would be a major advance, allowing effective therapy, i.e. anticoagulation, for patients with AF and stroke risk factors. Indeed, aspirin is an inferior choice and is not any safer”.


1 Olesen JB, Lip GYH, Lindhardsen J, et al. Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: A net clinical benefit analysis using a ‘real world’ nationwide cohort study. Thromb Haemost 2011;106:739–51.

Published on: November 3, 2011

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