Blood Thinners Do Not Lower Risk of Stroke Among Low Risk Patients

Highlights:

Blood thinners are a popular form of therapy for people considered to be at risk for strokes; however, a new study finds that they could do more harm than good for the patient
The use of this therapy on low risk stroke patients shows that they could be at an increased risk of death and bleeding
Low risk patients who did not receive anticoagulant therapy had a lower risk of death and bleeding

Antithrombotic therapy is prescribed for patients at risk for stroke; however, a large, community-based study has shown that this therapy does not lower the risk of having a stroke among low-risk atrial fibrillation patients within a period of 5 years. These patients were found to be better without the therapy.

A research team from the Intermountain Medical Center Heart Institute in Salt Lake City presented this study at the 66th Annual Scientific Session of the American College of Cardiology held in Washington, D.C.

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Stroke is a brain attack, which occurs when the blood supply to the brain is interrupted. It affects all age groups; according to the WHO, 15 million people are affected by stroke annually.

‘Anticoagulation or antiplatelet therapies do not decrease the risk of strokes in low-risk patients, but on the contrary increase their risk of bleeding and death.’

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Antithrombotic Therapy

Antithrombotic therapy involves the use of drugs that lower the occurrence of blood clots. These are usually administered either for prevention or to treat potentially life threatening blood clots.

CHA2DS2

The current study overwrites some of the popularly held beliefs about the use of antithrombotic therapy. The European Cardiology Society states that the CHA2DS2 VASc score for patients on antithrombotic therapy and with stroke risk factors are

A score of 1 or more for men
A score of 2 or more for women

The Intermountain Medical Center Heart Institute states patients with a

CHADS2 score of 0 to 1 and
CHA2DS2 VASc of 0 to 2

suffered from higher rates of stroke and bleeding when they were administered with antithrombotic therapy.

CHADS2 is an acronym in which

"C" stands for congestive heart failure
"H" stands for high blood pressure
"A" stands for age which is 75 or above
"D" stands for diabetes
"S" stands for stroke
"2" stands for previous history of stroke

Additional characters in CHA2DS2 VASc are

"A2" that stands for >75 or above
“V” that stands for vascular disease
“A” that stands for 65-74 years
“Sc” that stands for the sex category

Hence, VASc stands for a female who is within 65-75 years with vascular disease.

Stroke Risk Calculator
Stroke Risk Calculator checks if you have hypertension, diabetes and heart failure and predicts the risk of stroke (cerebrovascular accident) in next 10 years.

Dr. Victoria Jacobs from the Intermountain Medical Center Heart Institute researcher said that the use of antiplatelet or anticoagulation therapies was controversial even among the medical community. According to the doctor, there is no common consensus about the use of these therapies but there are important insights that were gained form the current study.

56,723 patients who suffered from atrial fibrillation were included in the study and they had a CHADS2 score of 0-1 and a CHADS2 VASc scores of 0-2. There were different groups of patients based on the use of aspirin, warfarin and clopidogrel.

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5 Year Follow up

After 5 years, the findings of the study showed that

Group 1: patients on Aspirin vs patients not on Aspirin

4.6% of patients who were on Aspirin suffered a stroke
2.3 % of patients who did not have Aspirin suffered a stroke
17.6 % of patients on Aspirin had significant bleeding
11.5 % of patients who did not have Aspirin had bleeding

Group 2: patients on Warfarin vs patients not on Warfarin

5.7 % of patients on Warfarin suffered a stroke after a period of five years
2.6 % of patients not on Warfarin suffered a stroke after a period of five years
22.3 % of patients on Warfarin had significant bleeding
12.3 % of patients not on Warfarin had significant bleeding

The study has shown that the use of antiplatelet therapy does not reduce the risk of having a stroke among patients at low risk, however, it is shown to increase the risk of death and bleeding.

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Dr. Jacobs added that such studies were necessary to identify the optimal therapies for low risk patients.

Stroke

A stroke requires immediate medical attention since it reduces blood flow to a particular part of the brain. The brain cells in that region begin to die within minutes of losing oxygen supply and lose their functionality

There are two types of stroke:

Ischemic stroke- This type of stroke results from a blood clot which plugs or blocks a a blood vessel to the brain.
Hemorrhagic stroke- In hemorrhagic stroke, blood vessel breaks and bleeds into the brain.

"Mini-strokes" are transient ischemic attacks (TIAs) which occur when the supply of blood to the brain is interrupted for a short period of time.

Symptoms of Stroke

The symptoms of stroke are as follows:

Sudden weakness or loss of sensation on a part or whole of the face, leg or arm
Sudden difficulty in speaking or understanding
Sudden difficulty of sight in one or both the eyes
Sudden difficulty in walking, loss of balance, dizziness or poor coordination
Sudden development of intense headache

In the event of any of these symptoms occurring, the patient should be taken to the emergency room of the hospital immediately. Normally, patients are required to take blood thinners to lower the risk of clot; however, the current study has shown that the use of anti-coagulants could increase the risk for bleeding and death among low risk patients.

References:

Stroke - (https://medlineplus.gov/stroke.html)

Source-Medindia