I get this question a lot from my readers: Is aspirin enough for afib to prevent strokes? I used the video above by Dr. Sanjay Gupta, a Consultant Cardiologist at York Cardiology, as my inspiration for this question of the week. Be sure to follow Dr. Gupta on his Facebook page. He produces some amazing videos, which I will be featuring on this blog in the coming weeks.
Aspirin is often recommended by doctors for people with afib. I suspect there are many afibbers reading this blog that are taking aspirin in hopes of preventing a stroke. As you’ll soon discover, taking aspirin may not be the best idea.
For the longest time, aspirin has been hailed as some sort of miracle drug. However, as Dr. Gupta points out in his video, somewhere we have forgotten that aspirin isn’t a harmless drug and can cause serious problems.
Long-Term Problems of Taking Aspirin
The primary long-term problem of taking daily aspirin is that it increases the risk of bleeding from the stomach 12-fold. You’re 12 times more likely to have a significant bleed in the stomach as a result of taking daily aspirin long-term.
To protect the stomach against aspirin, patients may be prescribed proton pump inhibitors such as Omeprazole (Prilosec) and Lansoprazole (Prevacid). These drugs reduce the gastric acid production in the stomach. While that might help to mitigate the effects of aspirin, it introduces additional problems.
As human beings we are supposed to produce gastric acid. This acid is necessary to digest our food and absorb vital nutrients from our food. If you reduce gastric acid production you may reduce the absorption of some important minerals such as magnesium. And as you know, magnesium is an afibber’s best friend!
Only People with These Heart Problems Should Take Aspirin
Hint: Having Atrial Fibrillation Isn’t One of Them!
According to Dr. Gupta, there are only two groups of people with heart problems where taking daily aspirin makes sense – and atrial fibrillation isn’t one of them! Here’s Dr. Gupta’s take…
Group 1: Atherosclerosis, Angina, Heart Attack, Stents
If you have hardening and narrowing of the heart arteries (atherosclerosis), they say aspirin is helpful although the evidence is not great but people use it and it’s a reasonable thing to take aspirin.
If you’ve had angina, a heart attack, bypasses, or stents then it’s reasonable to take aspirin. In fact, it’s really really important to take aspirin if you have had stents or bypasses within a year.
Dr. Gupta does NOT advocate anyone coming off their aspirin if they have had heart artery narrowing, stents, or bypasses in the past year. Even if it’s been longer than a year it’s really important to talk to your doctor about it before discontinuing aspirin because it can be dangerous! For these patients, there is definitely a role for aspirin.
Group 2: Strokes
If you’ve had a stroke then it’s reasonable to take aspirin because aspirin has an antiplatelet effect. It can help reduce blood clotting and therefore it can reduce the likelihood of blockages in the blood vessels.
Group 3: Atrial Fibrillation
This is the group of people where aspirin is not advised! As previously mentioned, aspirin has an antiplatelet effect. It essentially helps to make the blood “less sticky.” As a result, people with afib will take aspirin thinking it will help prevent an afib-related stroke.
According to Dr. Gupta’s video, the evidence now is overwhelmingly against the use of aspirin for people with atrial fibrillation. Aspirin has no role in reducing strokes in people with afib. You are not going to get any benefit in terms of reducing the risk of stroke and you’re exposing yourself to a risk of bleeding.
Unless you fall into the first two groups, Dr. Gupta doesn’t believe you should be taking aspirin. Regardless of your situation, however, Dr. Gupta encourages you to talk to your doctor about aspirin if you’re currently taking it (or are considering taking it).
Tell your doctor you’ve heard about the risks of taking aspirin and you want to understand if it’s reasonable to be taking it considering your specific heart issue. If you are in groups one and two, then it’s probably very reasonable to take aspirin. Aside from those two groups, however, you may be putting yourself at an unnecessary bleeding risk. Do your research and talk to your doctor!
Other Resources on Aspirin for Afib
Article: Aspirin Often Wrongly Prescribed for Atrial Fibrillation
Article: Aspirin Not an Effective Treatment for Atrial Fibrillation, Study Suggests
PDF: Aspirin: Friend or Foe?
This is an older resource (2006) but concluded even way back then that aspirin shouldn’t be used for the prevention of stroke for people with atrial fibrillation.
Video: Dr. Albert Waldo of Case Western Reserve University comments on aspirin for atrial fibrillation