Antiplatelet Therapy
This section examines the current use of antiplatelet therapy/ASA for stroke prevention in patients with AF, and discusses the most recent guideline recommendations
In this section:
Current usage
Although the use of antiplatelet therapy (including ASA, aspirin) for stroke prevention in patients with AF is increasingly limited, patients with AF are still treated with antiplatelets without an indication for therapy:1
- Although antiplatelet agents reduce the risk of stroke in patients with AF,2,3 they are less effective than anticoagulant therapy3
- In the AVERROES study, apixaban was superior to ASA for stroke prevention and was associated with a similar rate of major bleeding4
Guideline recommendations
Recent guidelines have highlighted the limited risk–benefit of antiplatelet therapy for stroke prevention based on the efficacy profile and potential for causing serious bleeding events:
- ESC 2020 guideline update: Antiplatelet therapy alone is not recommended for stroke prevention in patients with AF5
- The American Heart Association/American College of Cardiology/Heart Rhythm Society (AHA/ACC/HRS) 2019 guideline update does not provide guidance on antiplatelet therapy for stroke prevention in patients with AF6
References
- Verheugt FWA, Gao H, Al Mahmeed W et al. Characteristics of patients with atrial fibrillation prescribed antiplatelet monotherapy compared with those on anticoagulants: insights from the GARFIELD-AF registry. Eur Heart J 2018;39:464–473. Return to content
- Active Writing Group of the ACTIVE Investigators, Connolly S, Pogue J et al. Clopidogrel plus aspirin versus oral anticoagulation for atrial fibrillation in the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events (ACTIVE W): a randomised controlled trial. Lancet 2006;367:1903–1912. Return to content
- The ACTIVE Investigators. Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med 2009;360:2066–2078. Return to content
- Connolly SJ, Eikelboom J, Joyner C et al. Apixaban in patients with atrial fibrillation. N Engl J Med 2011;364:806–817. Return to content
- Hindricks G, Potpara T, Dagres N et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). Eur Heart J 2020: doi:10.1093/eurheartj/ehaa612. Return to content
- January CT, Wann LS, Calkins H et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation 2019;140:e125–e151. Return to content
See Also
Peripheral Artery Disease: causes and consequences
See Also
Coronary Artery Disease: causes and consequences
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Updated date 10/10/2022
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