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Aspirin 'not best' for preventing strokes Aspirin 'not best' for preventing heart problem
(10 days later)
Doctors are being told not to routinely prescribe aspirin for a common heart condition that increases stroke risk. Doctors should use newer medications rather than aspirin to treat a common heart problem, say new guidelines for the NHS in England and Wales.
Guidelines from the National Institute of Health and Care Excellence (NICE) are set to recommend other drugs instead for patients with an irregular heartbeat, called atrial fibrillation. The National Institute of Health and Care Excellence says blood-thinning drugs like warfarin are better for those with atrial fibrillation, which can increase a person's risk of stroke.
Warfarin or similar blood-thinning medicine is best, says NICE in draft advice to be finalised this month. Experts say most doctors are already doing this.
The advice will affect hundreds of thousands of patients.The advice will affect hundreds of thousands of patients.
But experts say most doctors already follow the advice to prescribe blood-thinners other than aspirin and that the guidelines are "playing catch-up" - this is the first time they will have been updated since they were first issued in 2006.
Stroke preventionStroke prevention
Atrial fibrillation (AF) is the most common heart rhythm problem, affecting up to 800,000 people - roughly one in 100 - in the UK. Atrial fibrillation (AF), which causes an irregular heartbeat, is the most common heart rhythm problem, affecting up to 800,000 people - roughly one in 100 - in the UK.
In AF, the heart cannot work as well as it should and blood clots can form, which, in turn, increases the risk of a stroke.In AF, the heart cannot work as well as it should and blood clots can form, which, in turn, increases the risk of a stroke.
Aspirin has been used for years to help protect patients from strokes, but mounting evidence suggests the drug's benefits are too small compared with other treatments.Aspirin has been used for years to help protect patients from strokes, but mounting evidence suggests the drug's benefits are too small compared with other treatments.
The NICE guidelines for England and Wales look set to say that although daily aspirin might still be beneficial for some patients, most should be offered something else as well or instead. The guidelines acknowledge this - it is the first time they will have been updated since they were originally issued in 2006.
According to its draft advice, NICE says warfarin or a newer type of oral anticoagulant is often best. The advice to switch from aspirin to a blood-thinning drug such as warfarin instead should prevent thousands of strokes.
The British Heart Foundation said most doctors were already doing this. Newer anticoagulants other than warfarin may be most suitable as they do not require regular monitoring, says NICE.
Experts say if aspirin is to be stopped, it should be stopped gradually and only under the advice of a doctor.
Prof Peter Weissberg, medical director at the British Heart Foundation, said: "Strokes caused by atrial fibrillation are both common and preventable but only if the abnormal heart rhythm is identified in the first place and if effective drugs are given to prevent blood-clot development.Prof Peter Weissberg, medical director at the British Heart Foundation, said: "Strokes caused by atrial fibrillation are both common and preventable but only if the abnormal heart rhythm is identified in the first place and if effective drugs are given to prevent blood-clot development.
"The revised NICE guidance reflects accumulating evidence that warfarin and the newer anticoagulants are much more effective than aspirin at preventing strokes."The revised NICE guidance reflects accumulating evidence that warfarin and the newer anticoagulants are much more effective than aspirin at preventing strokes.
"This does not mean that aspirin is not important and effective at preventing heart attacks and strokes in other circumstances. Patients who are unclear on whether or not they should continue to take aspirin should speak to their doctor.""This does not mean that aspirin is not important and effective at preventing heart attacks and strokes in other circumstances. Patients who are unclear on whether or not they should continue to take aspirin should speak to their doctor."
Prof Peter Elwood, an expert at Cardiff University, warned it could be unsafe to suddenly stop taking aspirin. "If aspirin is to be stopped, it should be stopped gradually," he said.Prof Peter Elwood, an expert at Cardiff University, warned it could be unsafe to suddenly stop taking aspirin. "If aspirin is to be stopped, it should be stopped gradually," he said.
Do I have atrial fibrillation (AF)?Do I have atrial fibrillation (AF)?