Aspirin is wrong drug for AF.

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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