Atrial Fibrillation: When Can You Stop Taking Aspirin?

Why might someone with atrial fibrillation stop aspirin?

Deprescribing means reassessing whether a medicine still has a useful role. Aspirin limits platelet clumping, while anticoagulants interfere with blood-clotting pathways. Combining these approaches can be necessary after a heart attack or coronary stent, but the balance changes as the immediate coronary risk recedes. Continuing both indefinitely can expose patients to avoidable bleeding.

A June 2026 American College of Cardiology statement addresses this transition: patients taking aspirin for stable coronary disease more than a year after a coronary event or procedure may be able to discontinue it when anticoagulation becomes necessary for atrial fibrillation. A clinician must first establish whether another reason for antiplatelet treatment remains. [ACC antiplatelet therapy statement](https://www.jacc.org/doi/10.1016/j.jacc.2026.05.037)

What did clinical trials find about anticoagulation alone?

The EPIC-CAD trial, published in 2024, randomized 1,040 adults with atrial fibrillation and stable coronary disease to edoxaban alone or edoxaban plus one antiplatelet medicine. At 12 months, estimated rates of major or clinically relevant nonmajor bleeding were 4.7% and 14.2%, respectively. The broader outcome combining bleeding, death and cardiovascular events also favored edoxaban alone. Major ischemic events appeared similar, but that does not establish identical protection against every individual outcome. [EPIC-CAD trial](https://www.nejm.org/doi/10.1056/NEJMoa2407362)

EPIC-CAD was conducted in South Korea, was open-label with masked outcome assessment, and received pharmaceutical-company support among its funding sources. It tested removal of an antiplatelet medicine, which was not necessarily aspirin in every participant. Its findings should therefore be interpreted within the population and treatment strategy studied.

The earlier AFIRE trial, published in 2019, studied 2,236 patients in Japan. Rivaroxaban alone met the trial's criterion for preserving efficacy on a combined cardiovascular and mortality outcome and caused less major bleeding than combination treatment. AFIRE stopped early because mortality was higher in the combination group; early termination is also a limitation when interpreting the results. These are established trial findings informing current prescribing, rather than newly announced September results. [AFIRE trial](https://www.nejm.org/doi/full/10.1056/NEJMoa1904143)

Who needs a medication review before stopping aspirin?

The 2023 joint US atrial fibrillation guideline recommends anticoagulation alone over combination treatment for patients more than one year after coronary revascularization, or with coronary disease that does not require revascularization, provided they have no history of stent thrombosis. This is a defined clinical recommendation, not a rule that everyone with a previous heart attack should stop aspirin. [ACC/AHA/ACCP/HRS atrial fibrillation guideline](https://www.jacc.org/doi/10.1016/j.jacc.2023.08.017)

People with a recent heart attack, recent stent placement or previous clotting inside a stent need an individualized plan. A review should establish why each antithrombotic medicine was prescribed and whether its intended treatment period has ended. Patients should arrange that review before changing either medicine. If aspirin is discontinued, the prescribed anticoagulant generally continues; aspirin withdrawal does not mean that atrial fibrillation or its stroke risk has resolved.