DTB advises against aspirin for primary prevention

[Gatekeeper]

The Drugs and Therapeutics Bulletin has published a review of the available evidence for aspirin in the primary prevention of cardiovascular disease (CVD) and concluded that use in this way is unjustified.

This review considers the recommendations made in various current guidelines and the historical evidence base in comparison to more recent research including the analysis conduct by the Antithrombotic Trialists’ Collaboration and published in the Lancet earlier this year.

A gender specific analysis that is considered found an absolute benefit of 4 cardiovascular events prevented in 1,000 women and 3 prevented in men over a 6.4 year period. This benefit was offset by 2.5 additional bleeding events per 1,000 women and 3 events in men.

These same data can be expressed in terms of number needed to treat (NNT) to prevent a cardiovascular event and number needed to treat to cause a harm (NNH) of a bleeding event. In women the NNT is 333 and the NNH is 400 while in men the figures are 270 and 303 respectively.

The authors of this review conclude that, “the currently available evidence does not justify the routine use of low-dose aspirin for the primary prevention of CVD in apparently healthy individuals, including those with elevated blood pressure or diabetes“. They recommend reviewing patients currently taking aspirin for primary prevention and advise against starting any new patients on primary prevention treatment with aspirin.

The balance of risk and benefit of aspirin in primary prevention appears to be a very fine line and continued use appears unjustified.
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Δημήτρη δεν κατάφερα να ενθυλακώσω το πλήρες άρθρο. Περιμένω ο σχόλιο σου.

[Argirios Argiriou]

NEJM

#VisualAbstract: Using low-dose #aspirin as a primary prevention strategy in older adults results in a significantly higher risk of major hemorrhage and does not result in a significantly lower risk of CVD than placebo. Full trial results: Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

[Argirios Argiriou]

Ενδιαφέρον σχόλιο συνάδελφου Καρδιολόγου στην παραπάνω φωτογραφία που αναδημοσίευσα και στην ομάδα ΙΑΤΡΟΙ ΘΕΣΣΑΛΟΝΙΚΗΣ στο facebook:

 Άν και η μελέτη έχει αρκετά «κενά» ,έρχεται να συμπληρώσει παλαιότερα δεδομένα που δείχνουν ότι το όποιο μικρό όφελος της χρόνιας λήψης ασπιρίνης στα πλαίσια πρωτογενούς πρόληψης αντισταθμίζεται απο τον κίνδυνο αιμορραγίας ...Βέβαια να μην ξεχνάμε ότι σε αντίθεση με τον αμφίβολο ρόλο της χρόνιας λήψης ασπιρίνης ως μέτρο πρόληψης καρδιαγγειακής νοσηρότητας ο ρόλος της στην προφύλαξη απο καρκίνο του παχέος εντέρου είναι σημαντικός.Ίσως ως ιατροί να αποθαρύνουμε τους ασθενείς μας για την χρήση του Salospir όταν δεν υπάρχει Κ/Α ιστορικό ή/και ΣΔ ,αλλά αντίθετα να συστήνουμε την χρόνια λήψη της προληπτικά σε εκείνους με οικογενειακό ιστορικό Ca παχέος εντέρου.

[Argirios Argiriou]

10/18/2018

Interpretation:

Among healthy elderly patients, low-dose aspirin therapy was not beneficial. Compared with placebo, aspirin did not improve disability-free survival or reduce major adverse cardiovascular events at a median of 4.7 years. Aspirin was associated with a significant increase in major bleeding, which was attributed to excess intracranial and upper gastrointestinal bleeding. Aspirin was also associated with an increase in all-cause mortality, which was attributed to excess cancer mortality. While the increase in all-cause and cancer mortality is compelling, these findings have not been observed previously and should likely be interpreted with caution.

The ARRIVE trial showed that among younger individuals with moderate risk of coronary heart disease, the use of aspirin was not beneficial.

The ASCEND Aspirin trial showed that among diabetic patients, aspirin reduced the incidence of major adverse cardiovascular events; however, this was somewhat counterbalanced by an increase in major bleeding.

While millions of individuals use aspirin for primary prevention, this routine practice is now questioned in light of recent randomized trial data.

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