NOAC in combination with Antiplatelet

[Bahman]

HI to all !! I am new to the forum .

I have just been diagnosed with PAF (paroxysms atrial fibrillation) . My AF lasts for 48 hours at heart rate of 85bp I have had two or three such attacks since January 2016.

I have not started on my NOAC medication as yet , due to go to NOAC clinic on Friday .

As I have had long standing heart problems ( Heart attack , Stents, Instent thrombosis , Cardiac by-pass ) I have been on Clopidogrel and Aspirin for about 10 years . Now my NHS cardiologist is recommending I should go onto NOAC with CLopidogrel . Where as my previous private cardiologist recommends NOAC plus Aspirin . I can not find any information on what rout to take . NHS and NICE guidelines are not very clear . I personally prefer NOAC plus Aspirin on the basis that Aspirin has other benefits besides its antiplatelet properties . However I understand that coming off Clopidogrel at once could be dangerous and one needs to be weaned off it , especially after such a long period.

So, please help me by let me know if you have had such experience or have info. on this subject ?

Best regards

Bahman

[BobD Volunteer]

I really do not think any of us here are qualified to make that call Bahman particularly since your two cardiologists disagree, My only thought is that aspirin also has the ability to cause harm in the form of stomach irritation or bleeding, not good on anticoags.. Never having taken Clopidogrel I can't comment on that.

[Bahman in reply to BobD]

Thank you for that ! I understand what you are saying . I am on proton pump tablets which reduces the acid in your stomach and therefore reduces the impact of Aspirin .

Clearly , I am hoping to hear from members who have been on dual antiplatelet therapy ie Clopidogrel + Aspirin and had to also go onto anticoagulation tablet due to on set of AF !!

[Goldfish_]

A complex decision. There isn't clear evidence and there is a case for warfarin I believe. See what you think of this circinterventions.ahajourna...

[Bahman in reply to Goldfish_]

Thank you Goldfish . a very useful site .

[Mazza23]

I take Apixaban and on the pack it says aspirin must not be taken

[Dadog]

Yes, I would agree about the aspirin. Any of the anti inflammatories are on my no-no list. It beats me that there is such diverse opinion on how AF should be treated. GPs don't really know enough about it and even the EPs and Cardios seem undecided and at odds with eachother. Yes, it's a fairly new complaint to be taken seriously and yes, we are all different - but surely there should be some sort of concerted and basic pathway toward its treatment? ......or is it that I'm feeling a bit crusty this morning?!

[PeterWh in reply to Dadog]

We all have to recognise that in reality AF is very much in its infancy as a medical division or speciality and that things do and are changing and that different medics will have different ideas. Also it is an area that 30 years ago only warrented one or two hours lecture time. This is also coupled to the fact that AF comes in loads of shapes and sizes, affects us all so differently and also affects any of us quite differently from one day to the next.

Also one EP may get an idea or see some sort of pattern and then this is looked into and may develop into an initial study then a larger one and so forth. Just look st the number of papers in the last five years.

[Dadog in reply to PeterWh]

That's pretty well what I said. Peter; but we still have doctors giving out aspirin in place of an anticoag. In my last bout, I was sent away by a GP with 5Mg Bisoprolol and nothing else. That was in 2012. I had to take myself off to A&E for full treatment.

My first AF introduced itself in December 1970 and I was regularised in hospital and sent away with beta blockers and digoxin. Much the same as today. That was 46 years ago.

As many on this forum have been told, AF won't kill you - and I wonder, sometimes, if we are prioritised a little low on the list.

David

[PeterWh in reply to Dadog]

There is a mixture here. In the USA many medics still consider aspirin as an anticoagulant whereas here in the UK NICE have clearly said no. Unfortunately some GPs are behind the times and certainly do not check why people are taking aspirin. Unfortunately many people are buying over the counter of not having a medication review.

[dave205]

check out the following site that will show your stroke risk and bleed risk.

sparctool.com/

[Dadog]

Agreed. I think it is important to be as proactive on one's treatment as possible. Interest is often reflected back. Our feedback to our doctors is helpful and important.

[Bahman]

Thank you all for your kind guidance . All those who have drug eluted stents or Acute Coronary Syndrome (ACS) are put on antiplatelet medication some for 12 month and some for lifelong . Therefore when they develop AF ,they need to be treated with anticoagulants (NOAC) which work differently to the antiplatelet medication ( aspirin and /or clopidogrel ) . ie one is not a substitute for the other . These individuals must have both sets of the medication the NOAC to prevent strokes and the other ie aspirin and or clopidogrel to prevent heart attack. I am sure the medics have got round this problem some how !!?

Bahman

[Goldfish_ in reply to Bahman]

My understanding from the article linked previously was that there is a case for dual anti platelet (aspirin plus clopidogrel) plus warfarin if there is a combination of acute coronary syndrome, drug eluding stent and atrial fib. As yet there is not adequate trial data on Noacs with dual anti platelet . Presumably there may be an increased bleeding risk and the drug is not reversible, so all in all not an easy decision, but this has been an interesting discussion. Aspirin still has an important place in mi prevention, but not for stroke prevention.

[Bahman]

I have just been to the anticoagulation clinic , which is a large unit in our hospital (North London) . The specialist nurse was extremely knowledgeable and as it was my first visit he spent a good hour explaining in detail my medications and at one time he thought better to check with his boss . However I am to start my NOAC (Apixaban) plus Aspirin as of tomorrow . He assured me that they have had many cases such as mine and , I do not need to be weaned off clopidogrel . So here we go .... clearly I am anxious about this combination of drugs and its side effect on internal bleeding . I have been on DAPT for the past 10 years without any bleeding problems .