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aspirin-pill-bigJuly 15 2015

Adults with atrial fibrillation should be prescribed anticoagulants instead of aspirin to reduce the risk of stroke, NICE has announced.

“Aspirin has been used for years to help protect patients from strokes, but the risks of taking aspirin – which can cause stomach bleeds – now outweigh any benefits of taking the drug,” it said launching its latest quality standard, QS93 dealing with atrial fibrillation.

Patients with AF should also discuss their anticoagulation therapy at least annually with their doctor in order to improve adherence. In addition, patients should have their anticoagulation therapy reassessed if they are taking a vitamin K antagonist and have poor anticoagulation control. A referral to specialist management within four weeks should be made for those symptoms have not been controlled by anticoagulation.

QS93 recommends that “people with AF who have a CHA2DS2-VASC stroke risk score of 2 or above are offered newer anticoagulants, such as apixaban, dabigatran etexilate, rivaroxaban or a vitamin K antagonist like warfarin.

“However, it is important to note that many adults with AF may already be taking aspirin for other conditions. If so, this may result in the patient taking aspirin as well as anticoagulants. If a patient chooses not to take anticoagulants, this decision and the reason for it should be documented by their doctor.”

Dr Matthew Fay, a GP and specialist member of the committee that developed the standard, said: “The ineffectiveness of aspirin and the need to remove it from the AF patient pathway receives a much needed, and rare, negative statement. This should provide the impetus to those who still speculate on the value of aspirin from historic practice to have the discussion with their patients about the benefits of anticoagulation hopefully before, and not after a devastating stroke event.”

Professor Beverley Hunt, Medical Director of Thrombosis UK and specialist member of the committee that developed the standard, added: “The NICE AF quality standard provides a minimum standard of care expected within NHS England. It demands that patients at high risk of stroke without a bleeding risk are offered blood thinners - either warfarin or the newer oral anticoagulants - but not aspirin.

“Every patient needs to decide with their health care professional which is most suitable for them and they should be reviewed annually. Those who self-monitor their warfarin with a home coagulometer should be supported. Lastly if treatment fails to control symptoms, then patients should be referred for specialist management within four weeks.”

The quality standard contains a number of quality statements covering identification, treatment and management of atrial fibrillation (including paroxysmal, persistent and permanent atrial fibrillation, and atrial flutter) in adults. It includes the following:

  • Adults with non-valvular atrial fibrillation and a CHA2DS2-VASC stroke risk score of 2 or above are offered anticoagulation.
  • Adults with atrial fibrillation are not prescribed aspirin as monotherapy for stroke prevention.
  • Adults with atrial fibrillation who are prescribed anticoagulation discuss the options with their healthcare professional at least once a year.
  • Adults with atrial fibrillation taking a vitamin K antagonist who have poor anticoagulation control have their anticoagulation reassessed.
  • Adults with atrial fibrillation whose treatment fails to control their symptoms are referred for specialised management within four weeks.
  • Adults with atrial fibrillation on long‑term vitamin K antagonist therapy are supported to self‑manage with a coagulometer.

Links:

NICE announcement    

NICE QS 93 ‘Atrial fibrillation: treatment and management’    

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