Appropriate Aspirin or Anticoagulant Use
Appropriate Aspirin Use
Low-dose aspirin is a proven and effective medication for secondary cardiovascular disease prevention.1,2,3 This includes treatment of patients with a history of heart attack, stroke, transient ischemic attack, vascular stent, or vascular surgery (including coronary artery bypass and surgical procedures for peripheral arterial disease).
Aspirin’s role in the secondary prevention of cardiovascular events is not in question and should be used barring significant contraindications. Data suggest that at least four million American adults not taking aspirin for secondary prevention as recommended.4
For people who have never had a cardiovascular event, aspirin is only recommended if they are at high risk and only after consultation with a clinician. It is not recommended that a person starts or stops taking daily low-dose aspirin without talking to their clinical team.
* Direct-acting oral anticoagulants
Appropriate Anticoagulant Use in Atrial Fibrillation
Atrial fibrillation is a heart arrhythmia. Some people with atrial fibrillation are unaware and have no symptoms. Others may have an irregular heartbeat, palpitations, fatigue, or shortness of breath. The risk for atrial fibrillation increases with age. High blood pressure, the risk for which also increases with age, accounts for at least 1 in 5 cases of atrial fibrillation.5 An estimated 12.1 million people in the U.S. will be living with atrial fibrillation by 2030.6
Atrial fibrillation significantly increases a person’s risk for stroke. When standard stroke risk factors are accounted for, atrial fibrillation is associated with a fivefold increased risk of ischemic stroke.5 Strokes related to atrial fibrillation tend to be more severe than strokes with other underlying causes.5
Oral anticoagulant medications, like warfarin, when appropriately prescribed and used, significantly reduce the risk of stroke in people with atrial fibrillation. In addition to warfarin, there are now several direct-acting oral anticoagulants (DOACs) that are FDA approved.7 National clinical practice guidelines recommend DOACs as first-line agents for most indications, including nonvalvular atrial fibrillation, especially among older patients with an elevated bleeding risk.8 However, data suggest that appropriate anticoagulation therapies are sub-optimally utilized among patients with atrial fibrillation.9
Tools and Resources
- AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update
This guideline from the American Heart Association (AHA) and American College of Cardiology Foundation (ACCF) recommends interventions for secondary cardiovascular disease prevention including daily aspirin for all patients with coronary artery disease unless contraindicated.
- 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons
This update includes information on new medications, thromboembolism protection devices, and device detection of atrial fibrillation.
- Aspirin for Prevention of Cardiovascular Disease
This Journal of the American Medical Association Patient Page provides information on aspirin use for patients who have a history of heart attack, stroke, coronary stent, or coronary artery bypass graft surgery who might benefit from taking aspirin for secondary cardiovascular event prevention.
- Aspirin and Heart Disease
This AHA fact sheet is for patients with a history of heart attack or stroke who may benefit from daily aspirin use.
- A Patient’s Guide to Taking Warfarin
This AHA guide provides patients with information about taking warfarin for atrial fibrillation.
- What Are Direct-Acting Oral Anticoagulants (DOACs)? [PDF – 422 KB]
This AHA fact sheet provides patients with information about taking DOACs for atrial fibrillation and includes an anticoagulation alert wallet card.
- Smith SC Jr, Benjamin EJ, Bonow RO, et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011 Nov 29;124(22):2458-73.
- Jones WS, Mulder H, Wruck LM, et al. Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease. N Engl J Med. 2021 May 27;384(21):1981-1990.
- Antithrombotic Trialists Collaboration: Meta-Analysis of randomized trials of anti-platelet therapy for the prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ. 2002; 324:71-86.
- Wall HK, Ritchey MD, Gillespie C, Omura JD, Jamal A, George MG. Vital Signs: Prevalence of Key Cardiovascular Disease Risk Factors for Million Hearts 2022 – United States, 2011-2016. MMWR Morb Mortal Wkly Rep. 2018 Sep 7;67(35):983-991.
- Centers for Disease Control and Prevention. Atrial Fibrillation. Accessed January 12, 2022. https://www.cdc.gov/heartdisease/atrial_fibrillation.htm
- Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013 Oct 15;112(8):1142-7.
- January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2019 Aug;16(8):e66-e93.
- Wheelock KM, Ross JS, Murugiah K, Lin Z, Krumholz HM, Khera R. Clinician Trends in Prescribing Direct Oral Anticoagulants for US Medicare Beneficiaries. JAMA Netw Open. 2021 Dec 1;4(12):e2137288.
- Hsu JC, Maddox TM, Kennedy KF, et al. Oral Anticoagulant Therapy Prescription in Patients With Atrial Fibrillation Across the Spectrum of Stroke Risk: Insights From the NCDR PINNACLE Registry. JAMA Cardiol. 2016 Apr 1;1(1):55-62.