Aspirin
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Aspirin
NIH - Aspirin “Prescription aspirin is used to relieve the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), osteoarthritis (arthritis caused by breakdown of the lining of the joints), systemic lupus erythematosus (condition in which the immune system attacks the joints and organs and causes pain and swelling) and certain other rheumatologic conditions (conditions in which the immune system attacks parts of the body). Nonprescription aspirin is used to reduce fever and to relieve mild to moderate pain from headaches, menstrual periods, arthritis, colds, toothaches, and muscle aches. Nonprescription aspirin is also used to prevent heart attacks in people who have had a heart attack in the past or who have angina (chest pain that occurs when the heart does not get enough oxygen). Nonprescription aspirin is also used to reduce the risk of death in people who are experiencing or who have recently experienced a heart attack. Nonprescription aspirin is also used to prevent ischemic strokes (strokes that occur when a blood clot blocks the flow of blood to the brain) or mini-strokes (strokes that occur when the flow of blood to the brain is blocked for a short time) in people who have had this type of stroke or mini-stroke in the past. Aspirin will not prevent hemorrhagic strokes (strokes caused by bleeding in the brain). Aspirin is in a group of medications called salicylates. It works by stopping the production of certain natural substances that cause fever, pain, swelling, and blood clots.”
NHS - Anti-platelets, aspirin, low dose “Antiplatelet medicines reduce the risk of clots forming in the blood. Normally, when there is a cut or break in a small blood vessel, a blood clot forms to plug the hole until the blood vessel heals. Small cells in the blood called platelets make the blood clot. When a platelet detects a damaged area of a blood vessel, it produces a chemical that attracts other platelets and makes them stick together to form a blood clot. Aspirin reduces the ability of the platelets to stick together and reduces the risk of clots forming. … Low dose aspirin should not be taken if you have: • an active peptic ulcer, • haemophilia or other bleeding disorder, or • an allergy to aspirin or to NSAIDs (for example, ibuprofen or diclofenac). Aspirin must not be given to anyone under 16 years old, unless under specialist advice. Low dose aspirin should be taken with caution if you have: • asthma, • uncontrolled high blood pressure, • had a previous peptic ulcer, • liver problems, or • kidney problems. Occasionally some people are advised to stop taking aspirin seven days before a planned operation. This should always be on the advice of your doctor or surgeon.”
NHS - Reye's syndrome “You should not give children under the age of 16 aspirin, or medicines that contain aspirin, unless your doctor specifically advises you to do so. Other names for aspirin include: • acetylsalicylic acid, • acetylsalicylate, • salicylic acid, and • salicylate. If your child or teenager has flu (influenza) or another viral infection, you should use ibuprofen or paracetamol to reduce their fever or relieve pain. Ibuprofen is not recommended if you have a history of asthma, kidney or liver disease. Some under-16s have specific conditions that need treatment with drugs that contain aspirin. If your child has one of these conditions, your doctor may decide that the benefit to their condition outweighs the risk of taking the aspirin-containing medicine. If your doctor advises your child to take aspirin, they will usually also advise your child to have the chickenpox and flu (influenza) vaccine, to reduce the risk of them developing Reye's syndrome. “
Should I take daily aspirin to prevent a heart attack or a stroke?
Highlighted Articles
Aspirin resistance: disparities and clinical implications. (Pharmacotherapy. 2008) “Aspirin is one of the most widely prescribed drugs for the prevention of thrombosis in patients with vascular disease. Yet, aspirin is unable to prevent thrombosis in all patients. The term "aspirin resistance" has been used to broadly define the failure of aspirin to prevent a thrombotic event. Whether this is directly related to aspirin itself through biochemical aspirin resistance or treatment failure, or if it is because of aspirin's inability to overcome the thrombogenic aspects of the disease process itself, has not been elucidated. This can have dramatic clinical implications for a variety of vascular disease subsets and is cause for concern, considering the high prevalence of aspirin use for both primary and secondary prevention. Disparities exist in the rates of aspirin resistance among certain patient populations, such as women, patients with diabetes mellitus, and those with heart failure, and across clinical conditions, such as cardiovascular and cerebrovascular disease.”
Aspirin for Women: Yes or No? (2007) "Women who regularly took high-dose aspirin … more than 14 adult-strength tablets a week -- did not get a health benefit. Instead, they were 43% more likely to die from hemorrhagic stroke compared with those who never took aspirin. Hemorrhagic stroke is stroke due to bleeding in the brain … Older women and women with pre-existing risk factors for heart disease got the largest benefit from regular low- or moderate-dose aspirin. … "There are suggestions here that there is a subgroup of women for whom regular aspirin makes sense," Chan tells WebMD. "But no one should take aspirin therapy on her own. This still requires a thorough discussion of individual risks and benefits with a doctor." … "These new findings by Chan et al. cannot overcome the accumulated evidence that aspirin is not particularly effective for the primary prevention of death from cardiovascular disease in women," Baron and colleagues note."
Aspirin may lower death risk in women (2007) "Aspirin in low to moderate doses may lower the risk of death in women, particularly those who are older and prone to heart disease, a 24-year study of nearly 80,000 women suggests. However, experts cautioned that the results are not definitive and that women should not take aspirin as a health preventive without talking to their doctor. In this long-running study of nurses who were middle-aged and older, women who took aspirin had a 25 percent lower risk of death compared with those who never took it. Aspirin-takers had a 38 percent lower risk of death from cardiovascular disease and a 12 percent lower risk of death from cancer. "
Aspirin Dose for the Prevention of Cardiovascular Disease (JAMA. 2007) "Conclusions Currently available clinical data do not support the routine, long-term use of aspirin dosages greater than 75 to 81 mg/d in the setting of cardiovascular disease prevention. Higher dosages, which may be commonly prescribed, do not better prevent events but are associated with increased risks of gastrointestinal bleeding."
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NIH NTP-CERHR: Common Concerns - Aspirin (Center for the Evaluation of Risks to Human Reproduction)
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Aspirin
General Information
NEWS:
Aspirin Appears To Help Lower Risk Of Stroke For Patients With Peripheral Artery Disease
Aspirin for the Prevention of Cardiovascular Disease
Aspirin Improves Survival In Women With Stable Heart Disease, According To Study “The study also provides new insight into aspirin dosing for women, suggesting that a lower dose of aspirin (81 milligrams, or mg) is as effective as a higher dose (325 mg). This is good news for women who might be concerned with internal bleeding, a well-known risk of aspirin that may be more likely with higher doses of aspirin, according to other studies. However, randomized clinical trials are needed to determine the optimal doses of aspirin in women with cardiovascular disease. … Compared to those who did not report taking aspirin, regular aspirin users had a 25 percent lower risk of death from cardiovascular disease and a 14 percent lower risk of death from any cause. Overall, aspirin use did not significantly decrease the risk of heart attack, stroke, or other cardiovascular events, except among women in their seventies. There were no significant differences in death rates or other outcomes between women taking 81 mg of aspirin compared to those taking 325 mg. “
Aspirin Linked to Brain Microbleeds “And then, "it is not clear at this point what significance we can attach to seeing microbleeds," Greenberg said. Some studies have shown an association between microbleeds and an increased risk of major bleeding events in the brain, but those studies have included only small numbers of people, he added. There also is some data indicating that microbleeds are associated with reduced brain function, but their role is unclear, because "they tend to travel together with other kinds of small-vessel brain disease," Greenberg said. "It's not clear at this point whether microbleeds are doing any substantial harm to the brain, but we do know that antiplatelet drugs help prevent heart attacks and strokes," Greenberg said. The most that can be said is that the study "is a little bit of a warning for us to think about antiplatelet drug therapy as a risk for hemorrhagic damage to the brain," he said. Therefore, there is no message to physicians yet about who should or should not be prescribed antiplatelet drugs such as aspirin, Greenberg said. "It's important not to overreact until we are sure of what gives people the best combination of benefit without much risk," he said.“
Aspirin: More Evidence That Low Dose is All That is Needed “The new USPSTF recommendations on the use of aspirin for primary prevention of heart disease are also published in the March 17, 2009, issue of the Annals of Internal Medicine. They also favor low-dose aspirin, pointing out that a dose of 75 mg/day seems as effective as higher dosages, but that the risk of gastrointestinal bleeding may increase with dose. In his editorial, Mehta notes that these guidelines were last published in 2002 and were based on trials with limited data on women, whereas the new recommendations incorporate the results of the landmark Women's Health Study (WHS), which showed no reduction in MI and death with aspirin but a significant reduction in stroke. The new recommendations thus advise use of aspirin in men to reduce MI and in women to reduce stroke. Mehta points out that a valuable feature of the new USPSTF recommendations is the emphasis on shared decision making: discussing the benefits and risks of initiating aspirin and individualizing decision making to the specific patient or situation. But he adds that there is one group of patients who should absolutely avoid aspirin--those who are at relatively high risk for intracranial bleeding.“
Benefit Of Aspirin For Healthy People Is Uncertain “The authors conclude: ‘Aspirin is of clear benefit for people who already have cardiovascular disease, but the latest research does not seem to justify general guidelines advocating the routine use of aspirin in all healthy individuals above a moderate level of risk for coronary heart disease.’ When prescribing aspirin to healthy individuals, it is important to consider the potential of such a policy to cause harm. Professor Baigent adds: ‘Drug safety really matters when making recommendations for tens of millions of healthy people. We don’t have good evidence that, for healthy people, the benefits of long-term aspirin exceed the risks by an appropriate margin.’ “
New Mechanism Identified for Beneficial Effects of Aspirin in Cardiovascular Disease
Regular Aspirin Use Reduces Risk for Colorectal Cancer Precursors
Use of Low-Dose Aspirin in Primary Prevention of Cardiovascular Events Not Recommended
ARTICLES:
JOURNAL ARTICLES:
Aspirin and acetaminophen: should they be available over the counter? (Curr Rheumatol Rep. 2009) “Traditional nonsteroidal anti-inflammatory drugs block cyclooxygenase (COX). They are the most widely used drugs for pain relief. They are indispensable for their effects but are condemned for their adverse drug reactions. Two COX inhibitors, acetaminophen and aspirin, are the most widely used over-the-counter drugs. They have low (but useful) therapeutic activity, but they are endowed with specific risks that are not seen with most other COX inhibitors. Both are lethal if taken in overdose. Each is stigmatized by severe adverse effects. Aspirin results in prolonged inhibition of blood coagulation, and acetaminophen can result in liver toxicity at normal dose and liver failure at higher dose. Both drugs cause many deaths every year.”
Aspirin and other non-steroidal anti-inflammatory drugs and risk of colorectal cancer: A Danish cohort study. (Cancer Causes Control. 2009)
Aspirin for the Primary Prevention of Cardiovascular Events (Diabetes Care 2009)
Aspirin to Prevent Cardiovascular Disease: The Association of Aspirin Dose and Clopidogrel With Thrombosis and Bleeding (Annals 2009)
Aspirin Use, Dose, and Clinical Outcomes in Postmenopausal Women With Stable Cardiovascular Disease (Circulation: Cardiovascular Quality and Outcomes. 2009) “Conclusions: After multivariate adjustment, aspirin use was associated with significantly lower risk of all-cause mortality, specifically, cardiovascular mortality, among postmenopausal women with stable CVD. No significant difference was noted between 81 mg and 325 mg of aspirin. Overall, aspirin use was low in this cohort of women with stable CVD.”
Aspirin for the Primary Prevention of Cardiovascular Events: An Update of the Evidence for the U.S. Preventive Services Task Force (Annals 2009) “Limitations: New evidence on aspirin for the primary prevention of CVD is limited. The dose of aspirin used in the RCTs varied, which prevented the estimation of the most appropriate dose for primary prevention. Several of the RCTs were conducted within populations of health professionals, which potentially limits generalizability. Conclusion: Aspirin reduces the risk for myocardial infarction in men and strokes in women. Aspirin use increases the risk for serious bleeding events.”
Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement (Annals 2009) “Recommendations: Encourage men age 45 to 79 years to use aspirin when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation) Encourage women age 55 to 79 years to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. (A recommendation) Evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older. (I statement) Do not encourage aspirin use for cardiovascular disease prevention in women younger than 55 years and in men younger than 45 years. (D recommendation).”
Bedtime Aspirin Lowers Ambulatory Blood Pressure “Blood pressure did not change after nonpharmacological intervention or after administration of aspirin upon awakening, the researchers note. In contrast, the authors report, systolic blood pressure decreased by 6 mm Hg and diastolic blood pressure decreased by 3 mm Hg in patients who took 100 mg aspirin at bedtime. Nearly three quarters (71%) of the patients who took aspirin at bedtime experienced at least a 3 mm Hg reduction in 24-hour systolic blood pressure, but only 6% showed an increase in blood pressure after treatment. Heart rate was unchanged in all treatment groups. "Aspirin given at the end of the activity cycle, but not upon awakening, could thus target the nocturnal peak of plasma renin activity, while enhancing the nocturnal trough in the production of nitric oxide," the investigators suggest.”
Non-steroidal anti-inflammatory drugs and risk of gastric and oesophageal adenocarcinomas: results from a cohort study and a meta-analysis. (Br J Cancer. 2009)
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