Applies whatever the score Always
af-aspirin-not-substituteNo one has reached this rule yetAspirin is not an alternative to anticoagulation
No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.
Word for word, as generated for the example person below. Figures in the text are theirs.
Aspirin is not a substitute for a blood thinner in atrial fibrillation. If you are on aspirin instead of anticoagulation to prevent an AF stroke, that is worth questioning directly.
This is the most consequential misunderstanding in AF care. Aspirin is markedly less effective than anticoagulation at preventing the clots that form in a fibrillating atrium, while still carrying meaningful bleeding risk — so it offers a fraction of the protection at much of the cost. The guideline explicitly recommends against aspirin, alone or with clopidogrel, as an alternative to anticoagulation in someone who is a candidate for it. Plenty of people are still on that arrangement from an earlier era.
Outcome-provenTested in randomised trials measuring heart attacks, strokes, or death, not a stand-in for them.· Class III· Level A· checked 2026-09-12
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation · Class III (not recommended) — ask before changing anything
If someone raises your bleeding risk as a reason not to anticoagulate, the right response is to fix what can be fixed rather than to skip the drug.
Bleeding-risk scores are meant to flag modifiable contributors, not to identify people who should go without protection — and in most people the stroke risk being prevented outweighs the bleeding risk being added. The modifiable parts are concrete: get blood pressure to goal, cut alcohol, stop routine NSAIDs like ibuprofen and naproxen, review any interacting medication, and treat anaemia or a bleeding source if one exists. A genuinely uncontrolled bleeding problem is a different conversation, and left atrial appendage closure exists for it.
Guideline consensusRecommended by the guideline writing committee, drawing on trials plus expert judgement where trials run out.· Class I· checked 2026-09-12
2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation · Class I
“Atrial fibrillation, blood thinner not yet discussed” — an illustrative profile, not a real user.
Asked after: Atrial fibrillation
Cited by the recommendations above.
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Runs in lib/engine/afPathway.ts as af-aspirin-not-substitute.