Updated NICE guidelines no longer recommend aspirin use alone, solely to reduce the risk of stroke in patients with AF. It is estimated that up to 40% of patients diagnosed with AF have been prescribed aspirin. While some patients with AF may be taking aspirin for other comorbidities, many are likely to have been prescribed aspirin solely for stroke prevention. Multiple anticoagulant treatments are recommended by NICE, yet in 2013 only 36% of patients with known AF admitted to hospital with a stroke were taking an anticoagulant. 

In the updated guideline non-vitamin K oral anticoagulants (NOACs) - apixaban, dabigatran and rivaroxaban - are recommended as first-line treatment options for stroke prevention in non-valvular AF alongside warfarin, for patients with a CHADS-VASc22 score of two or more, taking bleeding risk into account.

NICE assessed the evidence for benefit and cost-effectiveness of anticoagulation and antiplatelet agents both alone and in combination to help reduce the risk of stroke in patients with AF. The data showed that antiplatelet therapy has limited benefit and anticoagulation treatment compared to antiplatelet treatment is more clinically beneficial. The data reviewed included multiple studies of warfarin versus aspirin which demonstrated warfarin as superior to aspirin.  

Martin Cowie, Professor of Cardiology at Imperial College London and Honorary Consultant Cardiologist at the Royal Brompton Hospital, London comments: “Now that aspirin is no longer recommended for stroke prevention in AF in the updated NICE guidelines, coordinated multidisciplinary efforts by cardiologists, GPs and specialist nurses are needed to ensure that the changes are reflected in clinical practice as early as possible. We need to make sure all recommended anticoagulant treatment options are available and discussed with patients to determine the most suitable option for them.”

Related reading: Anticoagulation conference report