Dr. John Day, Cardiologist

Does Aspirin Prevent Atrial Fibrillation Strokes?

Unless you or someone close to you has experienced an atrial fibrillation stroke, the idea of taking a blood thinner might not be appealing. Many people are understandably worried about the risk of bleeding, and the financial aspect adds another layer of concern. For individuals without good drug coverage, popular blood thinners, like Eliquis or Xarelto, can cost a staggering $600 per month in the US, often surpassing the expense of a typical monthly car payment.

Considering these factors, it’s not surprising that I often get asked this question in my clinic: Can aspirin stop strokes caused by atrial fibrillation? Even though I wish the answer was yes, unfortunately, it’s probably not. In this article, we’ll explore the risk of strokes related to atrial fibrillation and look into the data about whether aspirin can actually prevent these strokes.

How Do Blood Thinners Prevent AFib Stokes?

Since atrial fibrillation raises the chance of having a stroke, doctors frequently recommend anticoagulants. These drugs, also known as blood thinners, aid in averting the formation of clots within your heart. The lower the risk of developing a blood clot in the left atrial appendage, a situation that may occur when the upper heart chambers stop beating during AFib, the less chance there is for a clot to dislodge and block the blood supply, leading to a lack of oxygen to the brain or other parts of your body.

Our Aspirin AFib Study

For a long time, aspirin was thought to be protective against stroke. It turns out, though, that this cheap and common remedy is actually not all that helpful. While it would be nice to think that lowering the risk of stroke was as easy as “an aspirin a day,” a study we did a few years ago demonstrated that aspirin, even in people at lower risk of stroke, simply doesn’t work very well for this purpose and, instead, puts AFib patients at risk in other ways by increasing their risk of bleeding both in the brain and elsewhere. So, In these 4,124 patients we studied, we found that not only did aspirin not help prevent strokes caused by AFib, but it also increased the chance of serious bleeding that could be life-threatening.

What Do the 2023 AFib Treatment Guidelines Say About Aspirin?

In the latest AFib treatment guidelines, the authors didn’t even give aspirin the time of the day. In fact, the wording was quite strong: “In patients patients with AF who are candidates for anticoagulation (blood thinners), aspirin as an alternative to anticoagulation (blood thinners) is not recommended to reduce stroke risk.”

Put simply, if you have enough risk factors for stroke due to AFib (CHADS-VASc score of 2 or higher), don’t even consider using aspirin as a replacement for your prescribed blood thinner. If you’re unsure on whether you should take a blood thinner or not for your AFib you can quickly CHADS-VASc Score.

Congestive heart failure: 1 point

High blood pressure: 1 point

Age 65 or higher: 1 point

Diabetes: 1 point

Stroke or TIA history: 2 point

Vascular disease (blockage in any artery): 1 point

Age 75 or higher: 2 points

Sex (female gender): 1 point

The goal with the CHADS-VASc scoring system is to keep your score as low as possible. If your score is zero blood thinners are not recommended. If your total score is 1 then blood thinners are optional. And if your CHADS-VASc score is 2 or higher the guidelines recommend blood thinners.

Aspirin is Still Important for Other Medical Conditions

While aspirin may not be especially helpful for preventing Afib strokes, it is still used for other conditions. For example, if you have had a stent placed in one of your arteries, then chances are that your physician wants you to take aspirin for the rest of your life. Likewise, if you have had a heart attack or a left atrial appendage occluding device to help prevent AFib strokes, like Watchman, your cardiologist will also probably want you to take aspirin for the rest of your life.

Putting it All Together

The take home message is that aspirin may not prevent AFib strokes but this medication is still used for other reasons. If your CHADS-VASc score is 2 or higher and you can’t take prescription blood thinners for whatever reason, talk to your cardiologist about other options.

Disclaimer

The information provided is for general informational purposes only. It is not intended as medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

About the Photo

The image included in this blog post captures a moment from a recent run I undertook. This stunning run unfolded on a snow-covered trail situated high above Soldier Summit in Utah during the enchanting sunset hours.