Over one-third of patients with atrial fibrillation (AF), who have a moderate to high risk for stroke are prescribed aspirin to lower this risk instead of oral anticoagulants, even though aspirin has no benefit for the prevention of thromboembolism related to AF.
A newly published analysis of data from the American College of Cardiology's PINNACLE registry involving AF patients has found that almost 40% of patients were treated with aspirin alone instead of an oral anticoagulant. After multivariable adjustment, patients prescribed aspirin were found to be also more likely to have other risk factors for cardiovascular disease than those prescribed an oral anticoagulant.
There is good evidence now that aspirin is not an anticoagulant, and that it does not prevent stroke due to AF.
While the American College of Cardiology/American Heart Association (ACC/AHA) still "give tepid support" to the use of aspirin in patients with a low risk for stroke (CHA2DS2-VASc ≤1), other guidelines, including those from the European Society of Cardiology (ESC) and NICE in the United Kingdom, no longer recommend aspirin for AF-related thromboembolism prevention.