Experts at Nice say using anticoagulants, not antiplatelets like aspirin, could avert 7,000 strokes and 2,000 deaths a year
Aspirin
should no longer be used to try to prevent strokes in people with a
common heart rhythm disorder as it is ineffective and has acted as a
"smokescreen", preventing people from getting the right treatment,
government experts say.
The advice, published on Wednesday, affects 100,000 people with atrial fibrillation, which causes the heart to beat irregularly and sometimes too fast, and who are taking aspirin. They have been advised by the National Institute for Health and Care Excellence (Nice) to see their GP to discuss alternative medication.
The experts say the majority of people with atrial fibrillation, which is believed to affect more than a million people in Britain – about a quarter of them undiagnosed – and is a condition that increases the risk of stroke fivefold, should be given anticoagulants. This overrides previous advice, issued in 2006, which approved antiplatelets such as aspirin.
Campbell Cowan, chair of the group that drew up the health guidance, said: "Aspirin has been a little bit of a smokescreen to anticoagulation. We now know that aspirin is not safer and it is questionable whether it has any effect at all, so aspirin is no longer recommended for stroke prevention."
Nice said that strokes among people with atrial fibrillation were "highly preventable" and 7,000 a year could be averted if treated with anticoagulants, as well as 2,000 premature deaths.
The now superseded 2006 guideline on atrial fibrillation was the only one in which Nice recommended use of aspirin in primary prevention. It still recommends the drug for management of patients with a combination of heart failure and coronary heart disease and those who have suffered a transient ischaemic attack, or mini-stroke.
Only half of those who should be on anticoagulants are getting them at present, according to the experts. "Any stroke occurring in a patient with atrial fibrillation is a tragedy because it was preventable," said Cowan.
Because of the risk of bleeding, the guidance group does not recommend anticoagulants for people at low risk of stroke or with a high risk of bleeding, both of which can be calculated using new tools published by Nice. Cowan said that only about 6% of people with atrial fibrillation would not get anticoagulants under the new guidelines. The risk of bleeding is believed to be one reason why many GPs have favoured aspirin, which has been given to people with atrial fibrillation for 20 years, but the guidance group found that aspirin carried an increased chance of bleeding.
Despite the findings, Cowan warned patients against any knee-jerk reaction as they might have been given aspirin for another reason, such as coronary heart disease. "They need to continue on aspirin," he said. "They can't assume they are taking aspirin for their atrial fibrillation so they should consult with the doctor."
The low uptake of anticoagulants in the past has also been attributed to the fact that the most common variety, warfarin, requires regular monitoring and dose adjustments to ensure it works properly, making it unsuitable for elderly patients who have mobility problems or are housebound.
The Nice experts recommend increased uptake of a new generation of oral anticoagulants, which are more expensive than warfarin but require less regular monitoring and dose adjustments.
The experts say that the drugs should be made available not just to those at risk not currently on anticoagulants but to those on warfarin who have poor monitoring, estimated to be a third of the total taking the drug.
Stephen Whitehead, chief executive of the Association of the British Pharmaceutical Industry, welcomed Nice's guidance but said Britain was lagging behind Europe when it came to uptake of new oral anticoagulants. He called on clinicians to "ensure that they do not prevent patients, who would benefit from these medicines, having access to them".
The advice, published on Wednesday, affects 100,000 people with atrial fibrillation, which causes the heart to beat irregularly and sometimes too fast, and who are taking aspirin. They have been advised by the National Institute for Health and Care Excellence (Nice) to see their GP to discuss alternative medication.
The experts say the majority of people with atrial fibrillation, which is believed to affect more than a million people in Britain – about a quarter of them undiagnosed – and is a condition that increases the risk of stroke fivefold, should be given anticoagulants. This overrides previous advice, issued in 2006, which approved antiplatelets such as aspirin.
Campbell Cowan, chair of the group that drew up the health guidance, said: "Aspirin has been a little bit of a smokescreen to anticoagulation. We now know that aspirin is not safer and it is questionable whether it has any effect at all, so aspirin is no longer recommended for stroke prevention."
Nice said that strokes among people with atrial fibrillation were "highly preventable" and 7,000 a year could be averted if treated with anticoagulants, as well as 2,000 premature deaths.
The now superseded 2006 guideline on atrial fibrillation was the only one in which Nice recommended use of aspirin in primary prevention. It still recommends the drug for management of patients with a combination of heart failure and coronary heart disease and those who have suffered a transient ischaemic attack, or mini-stroke.
Only half of those who should be on anticoagulants are getting them at present, according to the experts. "Any stroke occurring in a patient with atrial fibrillation is a tragedy because it was preventable," said Cowan.
Because of the risk of bleeding, the guidance group does not recommend anticoagulants for people at low risk of stroke or with a high risk of bleeding, both of which can be calculated using new tools published by Nice. Cowan said that only about 6% of people with atrial fibrillation would not get anticoagulants under the new guidelines. The risk of bleeding is believed to be one reason why many GPs have favoured aspirin, which has been given to people with atrial fibrillation for 20 years, but the guidance group found that aspirin carried an increased chance of bleeding.
Despite the findings, Cowan warned patients against any knee-jerk reaction as they might have been given aspirin for another reason, such as coronary heart disease. "They need to continue on aspirin," he said. "They can't assume they are taking aspirin for their atrial fibrillation so they should consult with the doctor."
The low uptake of anticoagulants in the past has also been attributed to the fact that the most common variety, warfarin, requires regular monitoring and dose adjustments to ensure it works properly, making it unsuitable for elderly patients who have mobility problems or are housebound.
The Nice experts recommend increased uptake of a new generation of oral anticoagulants, which are more expensive than warfarin but require less regular monitoring and dose adjustments.
The experts say that the drugs should be made available not just to those at risk not currently on anticoagulants but to those on warfarin who have poor monitoring, estimated to be a third of the total taking the drug.
Stephen Whitehead, chief executive of the Association of the British Pharmaceutical Industry, welcomed Nice's guidance but said Britain was lagging behind Europe when it came to uptake of new oral anticoagulants. He called on clinicians to "ensure that they do not prevent patients, who would benefit from these medicines, having access to them".
Story Source
http://www.theguardian.com
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