From the Guidelines
Daily low-dose aspirin (81 mg) can slightly increase the risk of hemorrhagic complications from falls, but the risk is relatively small compared to anticoagulants like Xarelto. For a patient with a history of cerebrovascular accident (CVA) who has discontinued Xarelto, the decision to use aspirin should balance stroke prevention benefits against bleeding risks. Aspirin increases bleeding risk by irreversibly inhibiting platelet function, which impairs clotting ability for 7-10 days (the lifespan of affected platelets) 1. The absolute increased risk of serious bleeding with low-dose aspirin is approximately 0.2-0.3% per year. For patients with prior stroke, the stroke prevention benefit often outweighs this bleeding risk. However, fall risk should be assessed and minimized through home safety evaluation, physical therapy for balance training, and appropriate assistive devices if needed. If falls occur frequently or the patient has multiple risk factors for bleeding, discuss with the prescribing physician whether aspirin's benefits outweigh its risks in this specific situation. The patient should be advised to seek immediate medical attention for any head injury after a fall, even if initially appearing minor. Some key points to consider when weighing the risks and benefits of aspirin in this patient include:
- The patient's history of CVA and the potential benefits of aspirin in preventing further strokes
- The patient's risk of falls and the potential consequences of a fall while taking aspirin
- The patient's overall health status and any other medications they may be taking that could interact with aspirin
- The results of a recent study on the use of aspirin for secondary prevention of venous thromboembolism, which found that anticoagulant therapy was more effective than aspirin in preventing recurrent VTE 1. It is essential to weigh these factors carefully and consider the individual patient's circumstances when making a decision about aspirin use. In general, the benefits of aspirin in preventing stroke and other cardiovascular events often outweigh the risks of bleeding, but this must be determined on a case-by-case basis. Ultimately, the decision to use aspirin in this patient should be made in consultation with the prescribing physician and should take into account the patient's unique needs and circumstances.
From the Research
Aspirin and Hemorrhagic Complications
- The provided studies do not directly address the question of whether 81 mg aspirin daily increases the risk of hemorrhagic complications from falls in a patient with a history of CVA who has been discontinued from Xarelto.
- However, studies have shown that combining antiplatelet and anticoagulant therapy can increase the risk of bleeding complications 2.
- The use of aspirin, an antiplatelet agent, may increase the risk of bleeding, especially when combined with other antithrombotic agents 3, 4, 5.
- A study on patients with blunt cerebrovascular injuries found that anticoagulation and antiplatelet agents were equivalent in preventing devastating injury-related strokes, but did not specifically address the risk of hemorrhagic complications from falls 6.
Risk of Bleeding Complications
- The risk of bleeding complications is a concern when using antithrombotic agents, especially in patients with a history of bleeding or at high risk of falls 2.
- The combination of aspirin and low-dose rivaroxaban has been shown to reduce the rate of recurrent ischemic events, but at the cost of increased bleeding 5.
- The use of proton pump inhibitor therapy may help reduce the risk of upper gastrointestinal bleeding in patients taking multiple antithrombotic agents 2.
Patient-Specific Considerations
- Patients with a history of CVA and those who have been discontinued from Xarelto may require careful consideration of their antithrombotic therapy to balance the risk of thrombotic events and bleeding complications 3, 4, 2.
- The decision to use aspirin or other antithrombotic agents should be made on a patient-specific basis, taking into account their individual risk factors and medical history 2.