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Patients with atrial fibrillation ‘at risk’ from outdated aspirin prescribing practice

Aspirin is still being widely prescribed to patients with atrial fibrillation when it offers no benefit and may even be harmful, a leading UK expert on stroke prevention has warned.

Professor Gregory Lip, professor of cardiovascular medicine at the University of Birmingham, said his Europe-wide study showed cardiologists are too often continuing to prescribe aspirin in patients with atrial fibrillation, despite the fact it is no longer recommended in clinical guidelines and could lead to patients suffering serious bleeding events.

For the study, published in the American Journal of Medicine, Professor Lip’s team analysed thrombotic prescribing among 3,119 patients, across nine countries, who had recently been diagnosed with atrial fibrillation.

Of 902 patients admitted to hospital, who did not undergo cardioversion or catheter ablation, 41% were prescribed aspirin either alone or in combination with an anticoagulant.

Aspirin use was particularly common among patients with CHD, whereas the authors stressed that anticoagulation is the best option in patients with stable CHD.

Professor Lip commented: ‘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, yet the risk of major bleeding or intracranial haemorrhage is not significantly different to well-managed oral anticoagulation.’

He added that contemporary guidelines say that aspirin should not be used for the prevention of stroke in patients with atrial fibrillation.

NICE draft guidance on the management of atrial fibrillation recently brought its advice into line with European Society of Cardiology guidance that aspirin should no longer be prescribed for patients considered at risk of stroke, which should now be determined by their CHA2DS2-VASc score.

However the QOF still uses the CHADS2 score and rewards GPs for putting patients on either aspirin or an anticoagulant, for those with a score of 1.

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