Aspirin is wrong drug for AF.

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In today's DAily Mail, more changes of mind from the medical profession  and NICE in particular.

They do though seem to forget that Warfarin is a massive culprit where life threatning bleeds are concerned:

"More than 200,000 people being prescribed aspirin for a heart condition that can trigger a stroke should be swapped to more effective drugs as it doesn’t work, say new NHS guidelines.

Aspirin has been recommended for almost a decade to combat strokes caused by an irregular heartbeat – but experts now say it is more likely to do harm than alternatives.

They want patients to use a new  generation of anti-clotting agents or an established drug called warfarin, based on rat poison.

Prescribing better drugs and treating more people at risk could save 7,000 strokes and 2,000 premature deaths a year, claims guidance from the watchdog Nice.

It is thought a million Britons have atrial fibrillation (AF) which causes around one in seven first-time strokes.

In AF the upper chambers of the heart are out of rhythm and  beat much faster than normal, which allows blood to pool and generate tiny blood clots which can trigger a stroke.

But around half of patients who could benefit from anticoagulant drugs are not getting them, while others are prescribed aspirin.

New guidelines from the National Institute for Health and Care Excellence (NICE) state that aspirin should no longer be prescribed to prevent AF-related strokes in  people at low or moderate risk – a reversal from its 2006 guidance.

The updated guidelines say the latest evidence shows aspirin is not as effective as anticoagulants – and not as safe because it may be more likely to cause bleeding in both the brain and stomach than other anti-clotting drugs.

Doctors will be advised to use  a new stroke risk assessment tool to determine whether patients need drugs.

Dr Campbell Cowan, chairman of NICE’s guideline development group, said ‘Aspirin has been a  little bit of a smokescreen to anticoagulation. We now know it is not safer and it’s questionable whether it has any effect at all.

‘Any stroke occurring in a patient with atrial fibrillation is a tragedy because it was preventable.’

He said patients did not need to stop taking aspirin immediately –  it might be prescribed for other medical reasons – but they should make a GP appointment to discuss their options.

In addition, those whose condition is poorly controlled with warfarin should be considered for newer drugs that do not need constant monitoring.

The drugs dabigatran, rivaroxaban and apixaban have been approved as cost-effective for the NHS even though they can cost £64 a month compared with £1 for warfarin, plus regular clinic visits.

But surveys show more than half of GPs feel under pressure not to prescribe them because of the expense. Many patients report tasking to be swapped because their warfarin treatment is  not working, but are ‘stonewalled’. Consultant cardiologist Dr Khalid Khan, who works at Wrexham Maelor Hospital, north Wales, said the guidelines were a ‘defining moment’.

He said ‘Currently there are many thousands of people with AF who unfortunately remain unprotected from the risk of stroke; whether they are on no treatment, on an ineffective treatment for AF such as aspirin, or on warfarin that is not being adequately controlled.

‘Today’s announcement gives doctors considerably more choice and clear guidance in this area.’

 

 

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7 Replies

  • Posted

    Hi Derek,

    Very very interesting your article. Just heard on the news about aspirin, I was advised many years ago to take aspirin when the government decided that all, I think it was 60 / 65 year olds should take one a day. The result with me was that i passed out twice as I found out that I was allergic to it. The Doc just said ok don't bother.

    in my opinion the whole business is a joke and that all our lives are being played with.

    I say to every one if your not happy or concerned about your drugs research them and request a change or find out if they are really necessary.

    Regards Ken.

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    • Posted

      When I first read in the 80's that doctors had started taking a daily aspirin I followed suit.

      Eventually when becoming hypertensive in 2000 I was prescribed it.

      After going into AF following a heart valve replacement in May 2012 it was replaced with warfarin and joint pain:-)

      The surgeon said that I could stop taking warfarin six months after cardioversion if I was still in sinus rhythm. The cardiologist asked me "If I wanted to die" I stopped warfarin after about 14 months and went back to aspirin. When I told my GP I was stopping warfarin he told me that I was the fourth patient that week who would not take it any longer.

      I stayed in sinus rhythm until another medical procedure put me back into AF last November. Since then back on warfarin that three months later started my joint pains again. I am again in sinus rhythm after a cardioversion in march.

      I am going to have to stop warfarin again as my weight bearing joints are so painful but now the great aspirin dilema. The new anti coagulants are contra-indicated for those who have had valve replacements. 

      It is difficult for GP's when all of their teachings are changed time and time again.

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  • Posted

    Thanks for uploading this article; most interesting.

    I'm becoming more inclined to think that AF is something that doctors and cardiologists struggle to treat.  It seems that a "suck it and see" approach is the best we can hope for.

    Some of the drugs, such as Bisoprolol (beta blocker) cause much worse side effects than AF.  I've been on Tildiem300, Digoxin, Bisoprolol, Ramipril (for BP) and I doubt if any of them do me any good.  I've had AF for over 7 years and am now reconciled to the fact that it will keep bothering me whatever drug is tried. Warfarin is the only medication that I trust to stop the chance of a blood clot and thus a stroke.  I do NOT like having to keep adjusting the dosage but will put up with that; the rest of the drugs is another matter.  I've recently stopped bothering with statins; this is something that only benefits the drug dealers, err ...pharmaceutical companies in my view.

    Oh well, we just have to accept that doctors are mere humans who know how to look up the drugs in their books or on the computer.  How wonderful, lol.

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    • Posted

      I'm quite new to AF having only experienced it for 10mths. It's been an interesting journey as I'm also a recently retired Registered Nurse and I must say I'm feeling increasingly disillusioned with the medical profession. I agree with you totally George, all they seem to offer are pills that may or may not work and may or may not give you worse symptoms that the actual AF! I'm also investigating supplements such as magnesium and Omega 3 oil, plus using meditation to at least give me a feeling of being more in control. All the best to you from New Zealand.
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    • Posted

      You are fortunate not to get warfarin side effects as many of us do. Warfarin scares me because of the chances of internal bleeding or getting an ICH.

      Many pharmacies deliver to the flats I live at. I usually ask any new young driver if his careers adviser suggested that he becpme a drug mule.

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  • Posted

    Hi Derek I too heard the discussion this morning. Presents a dilemma for me .... I was on warfarin for Afib - had a cardio version procedure which worked but 10 days later (still on warfarin) had a  bleed in the brain - immediate cessation of any anti-coagulants . I was fortunate in that it was fairly minor and am now back - with only slight spatial problems, but sold by the stroke consultant that I must not take any anti coagulants .  At present I have Afib around once every so often - four in 4 months. The cardiologist I should consider atrial appendage occlusion  which is offered to people who can't take coagulants . BUT in order to have the procedure I must take aspirin for 6 months before the procedure !!! Now it seems that aspirin  has a higher risk of bleed in the brain tha warfarin. Talk about catch 22 - I now don't know whre to go with this . Any ideas ?  
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    • Posted

      I hope that there is a solution for you.

      Have you looked at the website for the AF Association or Googled

      Left atrial appendage occlusion? There is a lot of information there and news of developments.

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