Role of Antiplatelet Therapy in Stroke Prevention in Patients With Atrial Fibrillation

Abstract

Patients with atrial fibrillation are at increased risk of having a cardioembolic stroke. The use of oral anticoagulation is now well established to prevent strokes in patients with atrial fibrillation and a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [2 points], diabetes mellitus, prior stroke/transient ischemic attack or thromboembolism [2 points], vascular disease, age 65 to 74 years, and sex category) score of greater than 1, beyond sex. However, the role of antiplatelet therapy, specifically aspirin in low-risk patients or as an alternative to oral anticoagulation, remains controversial. The most recent US guidelines conflict with the European guidelines, which do not recommend antiplatelet monotherapy for stroke prevention irrespective of stroke risk. The aim of this review is to summarize published studies that question the role of aspirin in preventing strokes associated with atrial fibrillation. Overall, aspirin is found to play a limited role in the prevention of stroke in patients with atrial fibrillation and is associated with a similar risk of hemorrhagic events compared with anticoagulants. The benefit of dual antiplatelet therapy as an alternative to oral anticoagulation requires further study.

Hemostatic Potential Assessment of Patients With Liver Cirrhosis and Atrial Fibrillation by Low-Frequency Piezoelectric Thromboelastography

“…As parameters of aggregation activity t 1 and ICC were almost the same in patients of 2 groups, we made a conclusion that AF has no effect on platelet aggregation activity and such suggestion explains the low effectiveness of antiplatelet drugs for prevention of thrombotic complications in patients with AF. [18,19] Significant activation of secondary stage of coagulation and thrombin generation was observed due to an increase in the CTA parameter. The intensity of coagulation is largely determined by the activity of thrombin, which is the main enzyme activator of the whole coagulation process, as it participates in the conversion of fibrinogen to fibrin, activates platelets, coagulation factors V, VIII, XIII, tissue plasminogen factor, and, furthermore, participates in systemic inflammation.…”

Characteristics of warfarin under-prescription in older adults with atrial fibrillation

“…Anticoagulation also decreases morbidity and mortality rates associated with stroke [7] , [18] . When compared to antiplatelet therapy, anticoagulation decreases the risk of stroke with similar bleeding risk [19] . Despite the proven benefit and low risk of bleeding with falls, anticoagulants remain underutilized in the old adults (≥75 years old) [20] , [21] , [22] , [23] , [24] , [25] .…”