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Previous NHS advice is reversed as people with a common heart condition are told not to take aspirin to guard against stroke
10:00PM BST 17 Jun 2014
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More than than a million people with a common heart condition have been told not to take aspirin to guard against stroke, in a reversal of previous NHS advice.
New medical recommendations warn that the pills are ineffective in reducing the danger for those suffering heart rhythm disorders and that the risk of side-effects outweighs their benefits.
Up to 7,000 strokes and 2,000 premature deaths a year could be prevented if patients were put on new drugs instead, experts said.
Until now, adults suffering from atrial fibrillation have been advised to take a daily dose of aspirin – a blood thinning drug – as the heart condition often causes clots, leading to a risk of stroke that is five times higher than in other people.
But revised guidance from the National Institute of Health and Care (Nice) says a new generation of drugs is far better than aspirin at reducing the danger for such patients and is less likely to cause side effects including internal bleeding.
Patients are advised to seek advice from their GP before stopping their current medication, but the guidance recommends that anticoagulant drugs which prevent clots forming should be prescribed instead.
Several of the medications have only recently been recommended for NHS use, and medical advisers said thousands of lives could be saved if patients were switched to them. The advice recommends so-called “novel oral anticoagulants” including dabigatran etexilate and rivaroxaban as the best medication for those suffering from atrial fibrillation.
The condition becomes more common in later life, with one in 10 pensioners diagnosed with the disorder. It occurs when electrical impulses in the heart become jumbled, so that blood is pumped less effectively, increasing the chance of clots, which can cause strokes.
However, experts said aspirin remained the best drug for thousands of other patients, such as 1.5 million heart attack survivors, who are usually prescribed it alongside other medications, and for heart disease sufferers assessed with a high risk of stroke.
Prof Mark Baker, Nice’s director of clinical practice, called for significant changes in prescribing to save thousands of lives.
He said: “We know that around 7,000 strokes and 2,000 premature deaths could be avoided every year through effective detection and protection with anticoagulant drugs that prevent blood clots forming. Unfortunately only half of those who should be getting these drugs are.
“This needs to change if we are to reduce the numbers of people with AF who die needlessly or suffer life-changing disability as a result of avoidable strokes.”
Dr Campbell Cowan, chairman of Nice’s guideline development group, said: “Aspirin has been a bit of a smokescreen to anticoagulation. We now know it is not safer and it’s questionable whether it has any effect at all.” Nice said atrial fibrillation led to an estimated 12,500 strokes each year.
“Any stroke occurring in a patient with atrial fibrillation is a tragedy because it was preventable,” Dr Cowan said.
He said that patients with the heart problem should not take themselves off aspirin, but should make an appointment with their GP to find out which treatment is best for them.
The Nice guidelines, updated for the first time since 2006, suggest some patients with atrial fibrillation could still be given Warfarin, an earlier anti-coagulant. However, it suggests many patients will benefit from the new drugs, which need less monitoring and many of which have been introduced in this country since 2012.
Amy Thompson, senior cardiac nurse at the British Heart Foundation, said: “The new Nice guidelines reflect the growing body of evidence that warfarin and the newer anticoagulants are much more effective at preventing stroke than aspirin.
“But this does not mean aspirin is not an effective means of preventing heart attacks and strokes in other circumstances.”
The charity stressed that the advice from Nice relates specifically to the impact of aspirin on patients with atrial fibrillation, who have a high risk of clots within the heart, where anticoagulant drugs have been found to be more effective. Aspirin is still effective in reducing the risk of strokes from other causes, they stressed.
The drug is recommended by GPs for heart disease sufferers at high risk of stroke. However it is not usually advised for those assessed as low risk, because it can cause ulcers and bleeding.
The causes of atrial fibrillation are not fully understood.
The condition affects more men than women, becoming more common with age, and in those with other heart conditions such as high blood pressure or clogged arteries.
Most sufferers will have some symptoms ranging from palpitations to dizziness but as many as a third have no obvious signs of the condition, research for the new guidelines showed.
