Managing the risk of stroke is the front-and-center concern for most afib patients. And, of course, most of us are taking blood thinners in the hopes of doing just that.
A recent article in The Healthcare Blog points out that taking warfarin can reduce the risk of stroke by about 10%. The doctor who wrote the blog advocates the use of aspirin for patients who have a low risk of stroke.
It seems the truth might be a little more nuanced.
But that’s the least of the risks to consider. The reason for aspirin or warfarin anticoagulation is to prevent clots and thereby embolic strokes. Both work, warfarin better than aspirin, but neither agent works perfectly. However, when aspirin fails the stroke is likely to be an uncomplicated embolic stroke; a blood clot blocks a vessel in the brain causing damage to the brain downstream by depriving that area of the brain of oxygen-carrying blood.
Most recover partially or fully from embolic strokes. But when the blood is thinned by warfarin, there is a risk of bleeding into the damaged brain converting a simple embolic stroke into a catastrophe with little likelihood of recovery.
So what are we to make of these seemingly conflicting bits of advice?
It looks like aspirin doesn’t do much to prevent stroke, but it can lessen the severity of stroke, offering you something that is easier to survive, easier to recover from, and less severe. Warfarin reduces your risk of stroke…but if you get one anyway you could be in big trouble.
Thus, if you are at a low risk for stroke in the first place aspirin might just be the right choice. However, if you have a high risk of stroke then you’ll want to prevent that stroke with something a little stronger than aspirin, even if the stroke could be more severe if it happens anyway.
At least, that is how I took it when I looked at these articles side-by-side. Do you agree?