Can Afib Patients Take Aspirin To Reduce The Risk Of Stroke
Atrial fibrillation or AFib is a specific type of arrhythmia that occurs in the top chambers of the heart. Symptoms may include heart palpitations, shortness of breath, fatigue, light headedness, dizziness, and sometimes passing out. AFib on its own is not generally life threatening, but patients with AFib do have a higher risk of stroke than the average population.
When assessing a patients risk of stroke, physicians at the Oklahoma Heart Hospital use the CHADS VASC scoring system. This system assigns risk factors based on age, gender, other health conditions such as diabetes, and existing heart conditions, including congestive heart failure, prior stroke, hypertension, or other vascular disease. Most patients diagnosed with AFib will score a 1 or higher on the CHADS VASC scoring system, at which point blood thinners are prescribed to reduce the stroke risk.
Patients frequently ask if aspirin is an effective blood thinner for reducing the stroke risk associated with atrial fibrillation. Currently in the American Academy of Cardiology guidelines, aspirin is listed as an option for patients with a CHADS VASC score of 1. In contrast, the European guidelines have completely eliminated aspirin as a treatment option to reduce stroke risk associated with AFib. Why? In multiple randomized trials, only one trial showed aspirin to be more effective than placebo, and only slightly so in that trial.
Atrial Fibrillation Care: Changes To Expect
Four atrial fibrillation assessment and treatment changes patients can expect are:
Factors Known To Increase Risk Of Bleeding
While the TGA stated that routine plasma monotoring is not required to manage bleeding in patients on one of these medicines,8 it is important to note that there are certaincircumstances that may increase risk of bleeding.
- are aged 75 years or over
- have special haemorrhagic risks from diseases orrecent medical procedures
- have moderate renal impairment
- are concurrently taking NSAIDs and/or antiplatelets.
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Blood Thinners For Afib: Which One Is Right For You
Anticoagulants or blood thinners are medications that help to reduce the bodys natural clotting processes. They can decrease the risk of unwanted clots caused by atrial fibrillation that can cause strokes.
If youve been diagnosed with AFib, your cardiologist may want to start you on a blood thinner as part of your treatment.
There are five blood thinners currently on the market that are approved to help prevent stroke in patients with AFib. Your doctor will help you choose which medication is right for you.
In this article, well compare the available blood thinners for AFib.
Eliquis Vs Xarelto What Do I Choose For My Patients
There has overall been no direct head to head comparison of any of the newer blood thinning medications. However, the largest comparison is the 2018 ARISTOPHANES Study. This was a retrospective study of pooled data from Medicare patient data from 2013-2015. In this very large study, over 434,000 patients were included. Here is a summary of the principle findings:
In general, in almost every study, newer blood thinners have consistently performed better then warfarin when it comes to stroke risk reduction, with a lower rate of major bleeding, which includes intracranial bleeding.
Which blood thinner I pick for my patients depends on a variety of factors. For patients with a signfiicant concern for bleeding risk, I will likely choose Eliquis, as multiple studies have indicated a lower risk of major bleeding. However, there are some indications, such as patients with diabetes or severely obese patients where Xarelto has some favorable data. Also factors such as age, weight, or the presence of underlying kidney disease may also affect the medication or the doseage of a particular blood thinner I choose for my patient.
Of course, another factor to consider is cost. All of these medications make contracts with insurance companies which lead to a wide range of out of pocket costs for these medications. Whichever of these medications is a preferred status and a lower cost to the patient will also likely factor into my decision.
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What Is The Dosage Of Aspirin Vs Eliquis
Aspirin should be taken with food. Doses range from 50 mg to 6000 mg daily depending on the use.
- Usual doses for mild to moderate pain are 350 or 650 mg every 4 hours or 500 mg every 6 hours.
- Doses for rheumatoid arthritis include 500 mg every 4-6 hours 650 mg every 4 hours 1000 mg every 4-6 hours 1950 mg twice daily.
- Heart attacks are prevented with 75, 81, 162 or 325 mg daily.
- 160 to 325 mg of non-enteric coated aspirin should be chewed immediately when experiencing symptoms of a heart attack.
- The dose for preventing another stroke is 75 to 100 mg daily.
- The usual dose in nonvalvular atrial fibrillation is 5 mg by mouth twice daily. For individuals 80 years or older, weighing less than or equal to 60 kg, or with reduced kidney function, the usual dose is 2.5 mg twice daily.
- The recommended dose for treating DVT or pulmonary embolism is 10 mg twice daily for the first 7 days and then 5 mg twice daily. After six months of treatment, the dose may be reduced to 2.5 mg daily for prevention of DVT or pulmonary embolism.
- When apixaban is used to prevent the risk of DVT after hip or knee replacement surgery, the suggested dose is 2.5 mg daily beginning 12 to 24 hours after the surgery is completed.
Practice Points To Avoid The Risk Of Bleeding
- Advise patients to tell their doctor, dentist orpharmacist that they are taking an anticoagulant before starting or stoppingany other medicine, herbal or over-the-counter products, particularly aspirin.
- Assess the need of aspirin in the patients managementplan. Advise patients to avoid low-dose aspirin and other NSAIDs while taking anoral anticoagulant.
- Encourage patients to see a health professionalif they have any unexplained bruising or bleeding, or pink, red or dark-brownurine.
- Recognise that there are treatment cessationprotocols if they undergo any surgical procedures.
- If switching patients from warfarin to apixaban,dabigatran or rivaroxaban, warfarin should be stopped, INR measured daily andthe new medicine started when the patients INR is < 2.5.3
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Why Are Patients With Atrial Fibrillation Prescribed Blood Thinners
In atrial fibrillation, the hearts upper chambers beat irregularly. This can cause sudden symptoms such as heart palpitations, feeling short of breath, or fainting.
One of the biggest risks of AFib is that the irregular rhythm of the heart can cause stagnant blood to pool in the uppers chambers of the heart long enough to start to clot.
This clot can then travel through your bloodstream and become stuck in one of the smaller blood vessels of the body. Depending on where the blood clot becomes stuck, it may cause a stroke. Unfortunately, a stroke due to AFib can be more disabling when compared to other types of strokes.
Your doctor will likely prescribe an anticoagulant to reduce your bodys ability to form blood clots. This will reduce the chance of your body making an unwanted blood clot that causes a stroke or other problems.
For This Reader Aspirin Did Not Mix Well With Eliquis
Q: After being diagnosed with bradycardia , I had a pacemaker implanted. My blood pressure rose, and I was put on an increased dose of lisinopril. The doctor also prescribed furosemide, amlodipine and Eliquis.
I was already taking levothyroxine and using aspirin regularly for aches and pain.
No one warned me about a possible interaction of Eliquis and aspirin. I developed anemia, fluid in the lungs, shortness of breath and misery. The doctors reduced my dose of Eliquis and started talking about heart surgery.
None of the GI tests showed bleeding anywhere. But before the tests, I stopped taking aspirin, as per instructions. Soon everything was back to normal, and I resumed the regular dose of Eliquis without any harmful effects. I think patients on blood thinners like Eliquis ought to be warned about aspirin.
A: Agreed! No one should take aspirin together with an oral anticoagulant like apixaban unless a doctor has prescribed it. Aspirin alone can increase the risk of bleeding. Together with an anticoagulant, the danger is even greater.
Q: I was on metformin for years with no problem. Then my dose was increased, and I started to have colon spasms and extreme bathroom urgency.
The doctor prescribed meds to manage that, but this wasnt perfect. I started to stay home and skip a lot of activities.
My physician took me off metformin and the GI drugs, and now Im fine. Its much better not to worry about bathroom emergencies.
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Other Strategies To Reduce Bleeding Risk
Although reducing the total number of antithrombotic medications is highly effective at reducing bleeding risk, this is not always feasible and does not completely eliminate bleeding risk for patients. Other strategies may be recommended .
First, the use of clopidogrel is recommended over other P2Y12 inhibitors for patients taking concurrent oral anticoagulants. In fact, most patients in the randomized trials detailed earlier used clopidogrel rather than prasugrel or ticagrelor. This recommendation is also supported by a class IIa recommendation from the 2019 American Heart Association/American College of Cardiology guideline on AF management and the 2018 European Consensus guidelines.
Second, use of a DOAC is preferred to warfarin when combined with either single antiplatelet or DAPT therapy. Although only the AUGUSTUS trial was designed for a head-to-head comparison of warfarin and a DOAC independent of antiplatelet therapy, data from randomized trials in AF, VTE, and other indications have generally demonstrated safety with the entire class of DOAC medications, especially with regard to intracranial hemorrhage. This finding has been reinforced in a number of guidelines and expert consensus documents favoring DOAC use over warfarin, both in general and when combined with antiplatelet therapy.
What Drugs Interact With Aspirin Vs Eliquis
- Aspirin is associated with several suspected or probable interactions that affect the action of other drugs. The following examples are the most common of the suspected interactions.
- NSAIDs may increase the blood levels of lithium by reducing the excretion of lithium by the kidneys. Increased levels of lithium may lead to lithium toxicity.
- Aspirin may reduce the blood pressure lowering effects of blood pressure medications. This may occur because prostaglandins have a role in the regulation of blood pressure.
- When aspirin is used in combination with methotrexate or aminoglycoside antibiotics the blood levels of the methotrexate or aminoglycoside may increase, presumably because their elimination from the body is reduced. This may lead to more methotrexate or aminoglycoside-related side effects.
- Individuals taking oral blood thinners or anticoagulants, for example, warfarin, should avoid aspirin because aspirin also thins the blood, and excessive blood thinning may lead to serious bleeding.
- Apixaban is a substrate of both CYP3A4 and P-gp. Inhibitors of CYP3A4 and P-gp increase exposure to apixaban and increase the risk of bleeding. Inducers of CYP3A4 and P-gp decrease exposure to apixaban and increase the risk of stroke and other thromboembolic events.
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Averroes Results Can Be Extrapolated To All Older Patients With Af
Participation in AVERROES was restricted to AF patients deemed unsuitable to receive VKAs. However, the patient features in AVERROES were very similar to those of other recent randomised trials testing antithrombotic therapy in AF patients and to clinical cohorts . Consequently, we believe that the results are applicable to most elderly AF patients. An important advantage of the AVERROES trial design is the comparison with aspirin rather than to warfarin, allowing the effect on clinical events of apixaban to be more fully delineated against mono antiplatelet therapy.
Whilst the number of patients 85 years in this subgroup analysis was limited, the findings were consistent with the larger analysis comparing patients 75 years with their younger counterparts. The results in both analyses provide support for the efficacy and safety of apixaban in an underrepresented group of patients.
Benefits Risks Of Daily Aspirin
Aspirin is a nonsteroidal anti-inflammatory drug . You can get it without a prescription, but that doesnt mean it cant cause problems.
Taking aspirin to help reduce inflammation, pain, and fever is one thing. Taking it every day is another. Aspirin is also a blood thinner, so it reduces the bloods ability to clot.
For some people, thats a good thing.
Low-dose aspirin is currently recommended to prevent new cardiovascular events in patients with known atherosclerotic vascular disease, Chan said.
This includes people with recent or prior heart attacks, history of acute occlusive strokes, peripheral artery disease, or chronic ischemic heart disease, such as those with prior coronary stents or coronary artery bypass surgery, he added.
Doctors may recommend low-dose aspirin in addition to a blood thinner if theres sufficient benefit to do so, Chan noted.
The typical reasons that may occur is in patients with known coronary artery disease, such as those with a history of heart attacks, coronary stents, or coronary artery bypass surgery, Chan said.
In appropriately selected patients, low-dose aspirin reduces the risk for heart attack or stroke. In patients with recent coronary artery stents, it reduces the risk of the stent abruptly clotting and is widely recommended in this setting, he continued.
For other people, taking two blood thinners is not a good idea.
He advises people to follow their doctors recommendations.
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Aspirin And Anticoagulant Treatment Linked To Bleeding Risks In Afib Vte Patients
A new study finds patients with atrial fibrillation or venous thromboembolism were at higher risk of increased bleeding and hospitalization when treated with combination DOAC and aspirin.
Investigators found in a recent study that one-third of patients with atrial fibrillation and/or venous thromboembolism who were treated with a direct oral anticoagulant also received acetylsalicylic acid without a clear prescribing indication.
The team, led by Jordan K. Schaefer, MD, of the Department of Internal Medicine at the University of Michigan, the concurrent use of DOAC and aspirin had associations with increased bleeding and hospitalizations in comparison to DOAC monotherapy. A similar observed thrombosis rate occurred in comparison as well.
The combination of aspirin and oral anticoagulation may be indicated for patients with certain heart devices, nonvalvular atrial fibrillation and/or VTE who experience acute coronary syndrome , or undergo percutaneous coronary intervention .
The team hypothesized that compared with the dual therapy of aspirin and warfarin, a lower rate of bleeding in aspirin plus DOAC would be observed. However, they noted that other studies have shown higher rates of gastrointestinal bleeding with DOAC compared to warfarin.
Aspirin Fish Oil And Atrial Fibrillation
The American College of Cardiology completed their 2021 scientific sessions, where many research teams presented trial results. Dr. Steve Nissen, cardiologist and Chief Academic Officer, Heart, Vascular & Thoracic Institute, presents the summaries of three trials answering the following questions:
Left Atrial Appendage Occlusion Study : If you have atrial fibrillation and undergoing heart surgery should you have your left atrial appendage closed during surgery?
ADAPTABLE : What is the best dose of aspirin to prevent future cardiac events?
Secondary Analysis of STRENGTH Trial: Is fish oil beneficial to reduce cardiovascular risk?
Aspirin, Fish Oil, and Atrial Fibrillation – 3 New Studies Answer Questions
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Should A Patient Be Taking Aspirin And Eliquis
Question posted by cocoa0223 on 14 Nov 2016
Last updated on 26 October 2017 by suzanne66
Eliquis is an oral anticoagulant approved by the Food and Drug Administration for the reduction in the risk of stroke in patients with atrial fibrillation.
If Eliquis and aspirin are taken together there is an increased risk of bleeding because aspirin is also an anticoagulant.
Some patients are prescribed both medicines together but not always.
Your specialist will be able to advise you of the safe taking of aspirin.
Better Atrial Fibrillation Risk Assessment
The newer afib risk calculator is more complex than the older one, says Day. Previously, the health risks that counted were congestive heart failure, high blood pressure, age, diabetes, and stroke. In contrast, the new risk calculator uses all of these and other factors to more accurately predict patients’ risks.
What the new afib risk calculator uses to help determine the best treatment options:
- Congestive heart failure: 1 point
- High blood pressure: 1 point
- Age 75 or higher: 1 point
- Diabetes: 1 point
- Age 65 or higher: 1 point
- Being female: 1 point
If your score is two or higher, you need a potent blood thinner. As you can see, if you are a woman and are 65 or older, then you automatically require a potent blood thinner, says Day.
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Combined Anticoagulantantiplatelet Use By Patients With Multiple Indications
Numerous trials have explored reducing the number of antithrombotic medications used by patients taking chronic oral anticoagulants, usually for AF, who then undergo PCI or experience an ACS that necessitates antiplatelet therapy. The first of these was the WOEST trial, an open-label trial comparing oral anticoagulation plus clopidogrel alone to oral anticoagulation plus DAPT . As might be expected, any bleeding was less common among patients in the double therapy group . However, patients in the double therapy group also had fewer thrombotic events or deaths , including fewer MI, stroke, and stent thrombosis events.
As shown in , a number of subsequent trials compared variable numbers of antithrombotic medications, different anticoagulants , and different dosages of anticoagulants .
Although the data on anticoagulation alone versus anticoagulation plus single antiplatelet therapy are limited for patients with stable CAD, there is more robust evidence that aspirin may have net clinical harm for primary prevention of atherosclerotic disease. This is particularly true for patients taking chronic anticoagulant therapy but without a clear indication for concurrent antiplatelet treatment. Efforts to reduce aspirin use in this population may lead to reductions in medication-related adverse events, including hospitalizations.