Aspirin does very little
ASPIRIN GOES in and out of fashion so often it’s hard even for a doctor to keep up. The latest news is not good for aspirin: we’ve been using it for years to prevent strokes in a group of patients where it turns out to do very little.
Stroke is the third leading cause of death in England. We all know about smoking and high blood pressure but actually the major risk factor is an irregular heart beat known as atrial fibrillation or AF. Strokes caused by AF are often the severe, devastating ones that leading to disability and sadly death. It is estimated that each year 12,500 strokes are the direct result of AF and over 7,000 strokes could be prevented if AF is managed properly.
AF is the most common type of heart rhythm disturbance where the pulse does not beat regularly but rather in a more haphazard fashion causing turbulence and blood clots. When blood clots break off and travel to the brain, a stroke occurs.
For years we have been treating AF in order to prevent strokes but new guidance by the National Institute for Health and Care Excellence out this month, is going to highlight that shockingly for years we have been treating it wrongly. Treatment aims to thin the blood so the stroke-causing clots cannot form. As a result, a large number of patients take warfarin, the blood thinner of choice for the past 50 years. In reality, a good number of patients are unable to tolerate warfarin and are put onto aspirin as a substitute: however, it is no substitute as there is little evidence that aspirin can prevent stroke. The new NICE guidance for AF treatment this month will concur with European guidelines that aspirin is not a good enough prevention for strokes and should not be offered. Either warfarin or the newer anti-coagulant drugs known as NOACs should be prescribed: it is predicted that this new direction will prevent over 2,000 AF-related deaths a year.
AF is thought to affect over a million people in England and Wales. If you are on aspirin as a treatment for AF discuss starting a newer tablet. GPs will have to get used to this: it is thought 300,000 patients will need proper treatment once the new guidance is published.
‘Aspirin is not a good enough prevention for strokes’
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