Aspirin is not recommended for the prevention of thromboembolism in NVAF due to decreased efficacy and no difference in bleeding risk compared to anticoagulant therapy. The Garfield-AF registry reports that NVAF patients on antiplatelet monotherapy for stroke prevention tend to have higher HAS-BLED scores suggesting that clinicians may be unfamiliar with guidelines and studies revealing similar bleeding risks of anticoagulants and antiplatelet agents. The AVERROES trial showed no significant difference in bleeding with apixaban vs. aspirin. A recent meta-analysis of 4 randomized controlled trials with greater than 20,000 patients, showed no significant difference in outcomes of major bleeding with therapeutic direct oral anticoagulant (DOAC) dosing vs. aspirin. Guidelines from the United States and Europe (CHEST 2018, ESC 2016 and AHA/ACC/HRS 2019) all recommend anticoagulants over antiplatelets and the ESC recommends against antiplatelet therapy used for stroke prevention in NVAF patients.
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