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Spectator Health

The Aspirin dilemma: should you stop taking it?

24 June 2014

11:04 AM

24 June 2014

11:04 AM

You may be feeling confused following recent press reports that Aspirin is no longer recommended as stroke prevention. Those who take Aspirin may be more panicked than confused, if so stay calm and breathe (feel free to utilise a paper bag if you think it might help, I try not to judge).

To answer the question of why your doctor is giving or not giving you Aspirin requires an understanding of what it does. Aspirin blocks a set of enzymes which are required to initiate a series of complicated events in the body that allow platelets to become active in your blood and plug up any small breaks in blood vessels. The logic is that a dose of Aspirin will also prevent blood vessels getting clogged up with platelets in the brain which might cause a stroke.

The major downside of Aspirin is that the same enzyme system helps protect your stomach from the acid it produces: limit this and you risk stomach ulcers. There’s also the risk that any time you thin the blood you increase the risk of bleeding from anywhere.

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None of this information is new, so what has changed? Well, in recent years, the medical establishment have seen a move away from Aspirin, due to these limited and unfavourable side effects. It is now chiefly used long term for patients who have already had a heart attack to prevent another, diabetics with risks of heart disease and some patients who have atrial fibrillation. People with AF are who the new guidance particularly relates to.

Doctors have been using a scoring system for some time that is affectionately known as the ‘CHA₂DS₂VASc stroke risk score’ to judge the risk of stroke occurring in patients with AF. Updated guidance from NICE states that Aspirin should no longer be used on its own to prevent stroke in these patients. This is different to stating that Aspirin should not be used at all!

The NICE guidance appraised available research and concluded that the most beneficial therapy for those at risk of stroke is to use drugs like Warfarin known as anticoagulants. The guidance actually ranked the drugs treatments from most to least effective, with dual anti-platelet therapy in second place (in English that would be Aspirin plus a similar drug delightfully called clopidogrel), and Aspirin alone in third place. So although of limited benefit, it is still considered overall to be better than nothing.

The guidance however, recommends more invasive treatments in those that cannot tolerate Warfarin and similar drugs, and no longer recommends anti-platelets for stroke prevention. This should not be interpreted as aspirin being of no use if you are taking it for this reason, but it does highlight a need for a discussion at your next appointment with your cardiologist or GP to see what is right for you and if you are getting the ‘gold standard’ treatment.

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