Don't add aspirin for associated stable vascular disease in a patient with atrial fibrillation receiving anticoagulation

doi:10.1136/bmj.39351.706586.AD

BMJ 2008;336:614-615 (15 March), doi:10.1136/bmj.39351.706586.AD

Practice

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Don’t add aspirin for associated stable vascular disease in a patient with atrial fibrillation receiving anticoagulation

Gregory Y H Lip, professor of cardiovascular medicine

¹ University Department of Medicine, City Hospital, Birmingham B18 7QH

g.y.h.lip@bham.ac.uk

The first 150 words of the full text of this article appear below.

Key points

Adding aspirin to warfarin does not seem to preventstroke and vascular events in patients with atrial fibrillationand stable vascular disease
Bleeding risks are much higherin patients prescribed both warfarin and aspirin
We shouldstop prescribing aspirin plus warfarin to prevent stroke andvascular events in stable patients with atrial fibrillationwho are receiving anticoagulation treatment

The clinical problem

Atrial fibrillation is the commonest cardiac arrhythmia, withincreasing prevalence and incidence.¹ Adjusted dose oral anticoagulation(such as with warfarin) is the most effective treatment forstroke prevention in high risk patients with atrial fibrillation.²

However, common practice is to add aspirin (or other antiplatelettreatment) to warfarin in atrial fibrillation if there is associatedchronic stable coronary or peripheral artery disease.² Thisis despite relatively little evidence that adding aspirin towarfarin reduces stroke or other vascular events in patientswith atrial fibrillation.

I propose here that we should not add . . . [Full text of this article]