Aspirin vs apixaban and other blood thinners

[Astridnova]

Has anyone here with atrial fibrillation been prescribed aspirin rather than other blood thinners like apixaban? I would rather take aspirin but my cardiologist prefers apixaban. It seems like there is research that goes both ways. My GP rolls his eyes and says opinion changes from year to year. I have not suffered from AF since an ablation in Feb 2023, and my father died of a bleed on the brain...

[BenHall1]

Hiya,

To be blunt ......... if you contemplate taking Asprin for AF you must be mad ! You need to do your own independant research, don't just take my word. Basically, Asprin is not a good and effective approach in reducing stroke risks in AF patients. It's a known medical fact of life ......... for goodness sake go with the Apixaban - your cardio person knows what 's what ! Then ask your GP if he has an eye problem that needs attention if he rolls his eyes !! 😂

When I was first diagnosed back in 2010 ( aged 65 ) I was put on Warfarin, then last year my GP conned me into switching to Edoxaban. No problems with either.

As a matter of interest .......... why do you prefer Asprin? Is it solely because of your father ? or for some other reason. You do realise that uncontrolled or inadeqately controlled AF can often to lead to a stroke. I do suggest you much more research. I understand you are in Australia ......... are you aware of a Facebook Group called Atrial Fibrillation Support Australia ? ( I used to live in Oz but now am in UK but still follow at times the Oz Group I just mentioned ).

Well done you, 12 months out from your ablation. I hope it stays that way, but, AF being AF it may not, and also many of us can be asymptomatic ( like me ) whereby a patient can be in AF and not be aware of it or of any symptoms. Has your cardiologist ever discussed this with you?

Anyway, I wish you well and do hope that you have got this thing sorted permanently.

John

[Buffafly in reply to BenHall1]

🤣 Love the eye roll comment!

[Astridnova in reply to BenHall1]

Hi BenHall1, Thanks for your considered comments. They are useful. I have been doing my own research and this is part of it. As I mentioned, there seem to be articles favouring aspirin over apixaban and similar. Unfortunately big pharma has a lot to do with what trials are done and what is emphasised in the results, and cardiologists are like everyone else; they respond to fashion and sales pitches, only rarely actually looking at the data themselves. I'm trying to arm myself before I go to the cardiologist.

With regard to why I might prefer aspirin:

- I would prefer a blood thinner that is also an anti-inflammatory because it would help inflammatory pain I suffer from, and there is a risk in taking anti-inflammatories in conjunction with Apixaban.

- Aspirin doesn't make me bleed or bruise easily, so I would have thought it posed less risk of a brain bleed or any bleed compared to Apixaban, which does cause bruising and bleeding in response to very small injuries. Yes, my father's fatal brain-bleed is a strong factor. Hospital staff at the time said that he should not have been on blood thinners continuously for years. They implied there was a rule about this.

I know my stomach tolerates Aspirin well.

But I am taking on board your comments, and thank you again.

[CDreamer]

NEVER - aspirin is an anti-platelet, useful post thrombotic clot but not to prevent clots so not good as a prophylactic. In addition aspirin has a very high gastric bleed risk as well as a higher brain bleed risk, ok to take occasionally but not daily. You can find the studies which indicate this quite easily, do your own research.

Modern oral anticoagulants have a lower bleed risk and fewer side effects. There is absolutely no place for aspirin as a prophylactic medication to lower your risk of stroke when you have AF.

When considering your risks you should factor in many things, including your bleed risk and there is an algorithm used by doctors to do this - CHADSVASC v BLEED RISK.

Trust your cardiologist over your GP EVERY time as GP’s often are not always fully updated with the latest information. You will find some doctors who will still recommend aspirin but they are becoming fewer. It also depends whether or not your doctor (and you) are more scared of bleeds than clots.

Having had a TIA when not taking anticoagulants after 12 months free of AF following a successful ablation, I consider myself very lucky but took it as a warning - my risk of clot profile is high so no question for me, anticoagulants I will take for life. Ablation doe not reduce risk.

[Iamfuzzyduck]

I was prescribed aspirin in ER for a forty four hour afib attack with Hr around 180 bpm. I saw a cardiologist two days later who kept me on it and said he’d move me to a thinner if the echocardiogram showed bruising around the appendage. It was clear so I remained on aspirin. Two weeks later I saw an EP who laughed at the aspirin but kept me on it-wouldn’t let me stop it. A month later I saw a top EP who laughed at the aspirin but alao kept me on it. He prescribed Eliquis to take if I have another afib episode lasting 5 or more hours with the instructions to then stop aspirin. So I am still taking aspirin 🤦‍♀️. But I will stop on Tuesday because I will switch to the thinner in prep for an ablation. My stroke risk is 1 because I am a female…

[baba in reply to Iamfuzzyduck]

You only score one for female if you have scored at least one for something else.

[Iamfuzzyduck in reply to baba]

Maybe I didn’t have a score of 1, that part was a guess! But I have just checked and it does give me a score of one for being female

[Astridnova in reply to Iamfuzzyduck]

Thanks a lot Ms Iamfuzzyduck. The anecdotal stuff is really helpful. Do you have any leaky valves? That is a big factor in my stroke risk if I get return Afib attacks, but no so much if I don't. It's about the heart managing a more rapidly propelled volume of blood when there are a couple of small leaks. As long as my heartbeat is slow, my heart doesn't leak significantly, apparently.

[Iamfuzzyduck in reply to Astridnova]

No, I do not have leaky valves. I probably should have been placed on a thinner in ER but the fact I wasn’t and everything is OK means that I have stayed on aspirin but no one wants to commit to allowing me to stop it!

[MWIC in reply to Iamfuzzyduck]

Not sure why there are such different practices at play - no clue why you would be kept on aspirin (other than cost) and if you’ve been kept on it there’s clearly a thought you need anticoagulants. We also have to be conscious of the fact we’re not always aware of an onset of AFib or how long it lasts - many occur through the night - I had a chat with an EP on a private appt - he also had AFib and said no one could persuade him to not take Apixaban or change to another

[Iamfuzzyduck in reply to MWIC]

I know, I don’t want to take aspirin but i am stopping today and switching to Eliquis in preparation for an ablation.

I monitor it 24/7 with my Apple Watch. I am 57 so currently low risk for a stroke and I am not showing afib events. But different places do things differently I suppose…

[Auriculaire in reply to Iamfuzzyduck]

I had a TIA six months after the previous afib episode. I really do not understand why a n EP would laugh at the aspirin but keep you on it. I think aspirin is used much more in afib in America than in Europe. Maybe the high cost of the DOACs there and the inconvenience of testing with Warfarin.

[opal11uk]

Yes. I was, several years ago at the start of my P/A/F journey, 375 mg soluble Aspirin daily. I had a stroke months later and swear that the Aspirin saved me from it being more severe. I was then put on anti coags, namely Warfarin which I stayed on for 20 years now take a DOAC

[Still_Breathing]

I am on asprin and warfarin and digoxin as well as other meds too. All initially prescribed by my heart consultant and nothing has been changed by either of the 2 gp surgery's or the Pharmacist at the annual reviews.

I was told the asprin makes my blood less sticky.

Warfarin reduces the clots and digoxin makes the rhythm less erratic.

Bisoporol to reduce the rate.

And Ramapril to keep the pressure in check.

Atorvastatin for my cholesterol.

[Tapanac]

aspirin is not a blood thinner just anti platelets snd apixaban is an anticoagulant

Aspirin can give stomach problems and won’t help to prevent a stroke. Anticoagulants do help

Sorry short but phone battery needs charging (like my body)!!!!

[Astridnova in reply to Tapanac]

Platelets are part of coagulation, though. So it seems to me that both aspirin and apixaban are anticoagulants, although I cannot find out specifically which element of coagulation apixaban affects.

[Tapanac in reply to Astridnova]

aspirin are to do with platelets and make the blood a bit more "sticky loose". Anticoagulants of course are self explanatory. Aspirin (so I was told) wasn’t good for the stomach as eventually it can make tiny holes which lead to ulcers. They can’t stop a stroke, whereas anticoagulants help to prevent a stroke because as you probably know with Afib the blood goes into the heart, but it doesn’t come out enough so clots form and then can cause strokes.

I’m sure others on here are far more informative as I just talk in layman’s terms and repeat what my EP told me that apixaban is the kindest to brain and stomach

By the way our youngest grandaughter is called Astrid

[Auriculaire in reply to Astridnova]

The correct term for aspirin is anti aggregant ie to stops platelets clumping together. An anticoagulant acts on some part of the clotting cascade to slow down the clotting process.

[Astridnova in reply to Auriculaire]

I don't think the different terms are sufficiently precise to show a difference between an 'anti aggregant' (i.e. anti clotter) and an 'anticoagulant' (i.e. anti clotter). There may be some detail out there but I haven't found any yet.

[Hidden in reply to Tapanac]

Anticoagulants also can give stomach problems. I recently did a trial of Edoxoban and had that happen to me. When I asked the pharmacist about this she confirmed that all the anticoags can cause stomach probs.

[philologus]

There's a natural product called Nattokinase that's worth looking into.

It is made from fermented Natto which is a Japanese food.

[Astridnova in reply to philologus]

Thanks for that. I'll look into it. Aspirin is natural too. It comes from the bark of a tree. I think it was first made in Australia by Nicolas Aspro.

[philologus in reply to Astridnova]

It was a new one to me, but the UK seems to be one of the few places where it's not available through the Health system.

Most of the 'leading edge' people dealing with Covid and Long Covid recommend it.

[Tykelady]

When I was officially diagnosed with AF the first thing the specialist did was to change my daily aspirin dose to Edoxaban. My dose was later halved as my weight dropped below 60kg.

[Astridnova in reply to Tykelady]

Gee. My weight is 58kg. Am I taking too high a dose, I wonder. I'll ask the cardiologist.

[Hidden in reply to Astridnova]

Are you 80 or over? The criteria for the lower dose is two out of three between 80+, less than 60kgs and kidney problems I think it is.

[Anji46 in reply to Tykelady]

they cut mine by half and 9 days later I had a stroke . Now back in hospital with a bleed on the brain probably caused by anticoagalants which do carry that risk .

[dixiedad]

I take both as per doctor's advice. He says they are for different things,

BTW, Apixiban is an anti-coagulant (as I've been corrected here) not a 'blood thinner'.

[JOY2THEWORLD49]

Hi

As I understand it aspirin works differently to anti-co.agulants.

There was a time when all hypertension patients had baby aspirin with a BB Beta Blocker.

Now some hypertension patients have diuretics.

My stroke notes say "failed the aspirin test". I asked my Locum Dr and she said "you more tests than that little basic test".

Some take both baby aspirin and anti-co.agulant.

Our health s very personal. Personal provision is there for our own health regime with risks discussed or we find out from rezsearch, others etc.

Yes, a minefield.

We ave MANAGEMYHEALTH. Some like to be a part of their health programme. Others don't.

It makes the world go around.

Take carem JOY. 75. (NZ)

[Buzby62]

Please read this Anticoagulation and AF info sheet

api.heartrhythmalliance.org...

For info Eliquis is the original brand name for Apixaban and now it comes in many different brands.

Hope this helps

[Astridnova]

Visit to the GP. Further to my original post. One of the major concerns about apixaban that I did not mention (for some odd reason) was a deterioration in my vision, which seemed to date from back to the first prescribing. My opthalmologist had ordered a brain scan which showed that my brain was doing better than most brains its age.

However, importantly, I had ignored the possible contribution to the eyesight problem of bisoprolol - because I was already only taking a quarter of the lowest dose, at night, to avoid feeling fatigued.

In the past two weeks my energy levels started diving to a new low, despite my being involved in an exciting new project.

Last Wednesday I came home from the usual Wednesday volunteering in an art gallery and went straight to bed. As I lay in bed I checked bisoprolol and vision problems on the internet. Apparently such problems were extremely common.

I decided not to take apixaban or bisoprolol, but I did take 300mg of aspirin, blood clotting in mind. I slept through to morning, after a snack, and all through the next day, apart from having to go out on one important errand, during which I felt as if my feet were not really touching the ground. I came home and lay down in the bed and went back to sleep.

This morning I woke up feeling fairly normal. When I went into the bathroom to weigh myself and looked in the mirror, my reflection was strangely clear. In the past few months my reflection had been too blurry for me to identify much detail at all. Today I could see myself clearly without glasses, and better, of course, with glasses, which had begun not to help much.

I had an appointment at the GP's, (originally scheduled by me to see if I was bleeding to death) and had chosen the non-eye-rolling one because he has a certain down to earth diagnostic style. (They are both in the same clinic.)

Although the GP ordered full bloods to see if there might be a problem with internal bleeding, we both feel it is more likely that my problems have been due to the bisoprolol, even the tiny dose I've been taking.

I also asked about Apixaban and aspirin, noting how difficult it was to know if the newer thinners were really superior to aspirin or whether it was just big pharma hype. He said he had the same problem, but that most cardiologists he spoke with thought that regular aspirin was sufficient. He added that in the UK the prophylactic dose is 75mg whereas in Australia (where I am) it is 100mg. 300mg is used for breaking up clots when a stroke has happened.

So we made a plan where I will take 100mg aspirin and get myself a watch that tells the wearer if they are in afib. Note that my afib was probably caused by too higher dose of thyroid hormone, and I take considerably less now.