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TIAs and Stroke :AF and Carotid Artery Stenosis (CAS) : Anticoagulants (AC) plus Aspirin

This is what I believe to be the case in these matters.

1. Ischaemic stroke and TIAs are strongly associated with both AF and CAS

2. AC reduce TIAs and stroke in AF. Aspirin not so helpful,

3. Aspirin recommended for TIAs due to CAS.

I'm just guessing now but I suppose some people have both AF and CAS. I see the logic of taking both an AC and Aspirin together. My excellent EP recommended I continue Warfarin combined with Aspirin, the latter being better for primary prevention of generalised atherosclerosis. I had taken this combination for 6 years without a problem but my new GP ruled against the Aspirin, because of the risk of causing a GI tract bleed.

Yes, Yes but what is your question Badger, said Toad.

Well Toad, my question is this

1. Perhaps we should not assume that Aspirin has no role in AF with TIAs

2. Perhaps my EP was right to recommend AC plus Aspirin (perhaps enteric coated) in some older AFers who are more likely to have atherosclerosis

Those are not questions Badger and even if they were you only get to ask one question, said Toad.

Shut up Toad, said Badger.

10 Replies

like your post Badger!

There is some interesting work now on dual and triple therapy for people who have stents used to widen arteries- they seemed to find low dose AC combined with clopidogerol was the safest from the point of view of bleeding. ( these were not AF patients)

The point here is that they had removed aspirin ( which is also anti platelet like Clopidogerol and it had caused more bleeding- so Asprin is not really the flavour of the month at present!!

I think you need yet a third opinion but feel your GP may well be on the right lines here!) Don't take my non medical word for it!!)


No Rosy, no further opinion needed. You have brought me up to date. No aspirin for Badger.


So what does Ratty think about all this?


O my lord!

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Bob explained the role of Asprin to me yesterday, I had actually forgotten lol and I too was taking the combination of Warfarin and Asprin after my stroke (having taken Asprin before, I in my wisdom decided to stop taking Asprin because all of my life I had been drug adverse, taking nothing for headaches etc.etc., and here I was at that time on Warfarin/Asprin/various beta blocker and a water tablet........just too many so I dropped the Asprin. As you get older memory dims so I had forgotten this until Bob posted about the humble Asprin and reminded me that Asprin and Warfarin worked in different ways. ps I always took Asprin after eating so as to avoid GI problems.

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Yes Opal. My understanding is that if there are any reasons why the blood supply is compromised such as a stent, artificial valve or due to stenosis then aspirin helps. It stops the blood sticking to those areas (or the stent or artificial valve etc ) and almost acts as a blood thinner to ease the flow. . (Bet you never thought you would see me use that phrase.) Anticoagulants prevent clots forming on the sticky bits.

So if a patient has had a heart attack then aspirin or similar anti platelet will be added to AC treatment. Aspirin alone has been used for years for people with other heart conditions and works wonderfully well but does not prevent clots in people with AF.

My understanding is that due to the large volume available in the atrium, AF related thrombii can be very large thus causing massive damage when they get into the brain.


Warfarin is an anticoagulant.

Natto(fermented soy beans organic, used by whole Japan)is antyplatelet.


Thank you Badger,said Ratty!

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Trying to make sense of this thread, but even an internet search will not tell me easily what CAS stands for (other than very many non-medical subjects).

Ah, sorry, it's in the title. I did find this in the medical dictionary:

CAS Abbreviation for:

calcified aortic stenosis

Canadian AIDS Society

Canadian Andropause Society

Canadian Anesthesiologists’ Society

Cancer Attitude Survey

carbonic anhydrase


cardiac adjustment scale

Care Assessment Schedule (Medspeak-UK)

carotid angioplasty and stenting

carotid artery stenosis

carotid artery stenting


Central Alerting System, see there (Medspeak-UK)

central anticholinergic syndrome

central auditory system

Chemical Abstract Service (Medspeak-UK)

clinical asthma score

Cognitive Assessment Scale

cold agglutinin syndrome

Community Accountancy Service (Medspeak-UK)

congenital alcohol syndrome

continuous androgen supression

Controls Assurance Statement (Medspeak-UK)

coronary artery spasm

coronary artery stenosis

coronary atherosclerosis


That has made Ratty smile!


I think the clue is in the title of Badger's post.

Carotid Artery Stenosis (CAS).

All above my head.



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