–37% increase in events seen after discontinuation in Sweden People who quit taking aspirin have an increased risk for a cardiovascular event, a large national registry has shown. The use of aspirin for primary prevention against cardiovascular disease has fallen from favor in recent years but aspirin for secondary prevention is still broadly popular and…
Serious Bleeding Risk With Aspirin Soars With Age
June 14, 2017 by 1 Comment
–Routine PPI use might cut the risk of major bleeds in people over 75. Older people who take aspirin to prevent a recurrent cardiovascular event should take a proton-pump inhibitor to lower their risk of serious bleeding complications, say the authors of a new study published in the Lancet. After a transient ischemic attack, ischemic…
In Which I Go Under The Knife And Learn About Medicine In The Real World
January 27, 2017 by 7 Comments
I’m not a doctor but I thought I knew something about anticoagulation. Over the course of a career covering cardiology I’ve written countless stories about heparin, warfarin, the low molecular weight heparins, and the new oral anticoagulants. So when I had bilateral total knee replacement a few weeks ago I thought I knew what to…
USPSTF Updates Aspirin for Primary Prevention Recommendation
April 11, 2016 by 1 Comment
–But many experts think the evidence base is slim at best. The U.S. Preventive Services Task Force (USPSTF) finalized the update to its guidelines regarding the use of aspirin for the primary prevention of cardiovascular disease and colorectal cancer. The USPSTF is now recommending that people between the ages of 50 and 59 who are at increased…
Common Pain Drugs Linked To More Problems After A Heart Attack
February 24, 2015 by Leave a Comment
The cardiovascular safety of nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and diclofenac has been the subject of considerable uncertainty and controversy. Now a new study published in JAMA raises specific concerns about the safety of these drugs in the highly vulnerable population of people who have had a recent heart attack. … Click here to read the full…
AstraZeneca Drug Improves Outcomes After Heart Attacks
January 14, 2015 by Leave a Comment
For the first time a very large trial has shown that dual antiplatelet therapy (DAPT) improves cardiovascular outcomes when given to patients one to three years after a heart attack. Because it has been shown previously to reduce the high risk of recurrent events for up to a year following a heart attack, DAPT is considered to be…
Millions Of Americans Taking Aspirin When They Shouldn’t
January 12, 2015 by Leave a Comment
More than a third of US adults– more than 50 million people– now take aspirin for the primary and secondary prevention of cardiovascular disease. (Primary prevention is the prevention of a first event; secondary prevention is the prevention of a recurrent event.) Although it was once broadly recommended, because of the increased risk of bleeding…
Women: Don’t Use Aspirin For Routine Prevention Of Heart Attacks, Stroke, And Cancer
December 5, 2014 by Leave a Comment
Although once widely recommended, aspirin for the prevention of a first heart attack or stroke (primary prevention) has lost favor in recent years, as the large number of bleeding complications appeared to offset the reduction in cardiovascular events. But at the same time evidence has emerged demonstrating the long-term effect of aspirin in preventing colorectal cancer,…
Large Japanese Trial Casts Further Doubt On Aspirin To Prevent A First Heart Attack
November 17, 2014 by Leave a Comment
Although once quite popular, the use of aspirin to prevent a first heart attack has grown less popular in recent years as evidence has accumulated that the small benefits are outweighed by the increased risk of bleeding. Now a large trial from Japan has once again failed to provide any evidence to support the use…
FDA Advisory Panel Offers Cautious Support For Polypill
September 10, 2014 by Leave a Comment
The controversial polypill took one step closer to reaching the US market after receiving a mostly positive reception from the FDA’s Cardiovascular and Renal Drugs Advisory Committee on Wednesday. The idea for the polypill– which in this case would be composed of aspirin, a statin, and one or more blood pressure drugs– has been kicking around for…
FDA Comes Out Against Aspirin To Prevent First Heart Attacks
May 5, 2014 by 1 Comment
In the latest development in a long-simmering debate, the FDA has announced that aspirin should not be marketed for the prevention of a first heart attack or stroke in people with no history of cardiovascular disease. The announcement follows FDA’s rejection on Friday of Bayer Healthcare’s decade-old petition requesting approval of a primary prevention indication. [PDF of FDA rejection letter]…
Aspirin and Clonidine Fail to Help Surgery Patients
March 31, 2014 by Leave a Comment
Heart attacks (myocardial infarctions) are among the most common and serious side effects of noncardiac surgery. An effective regimen to minimize this risk has been the subject of considerable debate in recent years. The controversy was recently exacerbated because the recommendation to use beta-blockers in this setting was based on research which has now been…
Some Patients With Minor Stroke Or TIA May Benefit From Early Clopidogrel And Aspirin
June 26, 2013 by Leave a Comment
Some people with minor ischemic stroke or transit ischemic attack (TIA) may benefit from dual antiplatelet therapy with aspirin and clopidogrel, according to a large new study from China published in the New England Journal of Medicine. In the immediate period following a TIA or minor stroke people are at high risk for having a major stroke. Aspirin…
Study Suggests Aspirin Resistance May Not Be Real
December 5, 2012 by 1 Comment
Is it resistance or pseudoresistance? According to a new study published in Circulation, aspirin resistance may be a myth, an artifact of the enteric coating of most aspirin tablets. The coating, which is designed to prevent gastrointestinal side effects caused by aspirin, may delay or conceal the effects of the drug, the study suggests, but the antiplatelet effects of…
ARCTIC Blows A Cold Wind On Platelet Function Tests
November 4, 2012 by 1 Comment
The use of platelet-function tests to monitor and guide antiplatelet therapy in PCI patients has sparked heated debate. Cardiologists have sought to reconcile biological plausibility with the absence of clinical evidence. Now the ARCTIC (Assessment by a Double Randomization of a Conventional Antiplatelet Strategy versus a Monitoring-guided Strategy for Drug-Eluting Stent Implantation versus Continuation One…
ASPIRE: Aspirin An Attractive Alternative After First VTE
November 4, 2012 by Leave a Comment
It is unclear what the best approach is for the long-term treatment of people who have had a first unprovoked episode of venous thromboembolism (VTE). Although warfarin is effective at preventing a recurrence, it is inconvenient and raises the risk for bleeding. Newer anticoagulants have not been tested or approved for this population. The ASPIRE…
WOEST: Get Rid Of The Aspirin In Triple Therapy
August 28, 2012 by 1 Comment
According to current guidelines and clinical practice, PCI patients already taking an oral anticoagulant generally end up on triple therapy comprising the anticoagulant plus clopidogrel and aspirin. However, there is no supporting evidence base for this approach and the triple therapy regimen is known to increase bleeding complications. Now a new study– the first randomized…
Real World Bleeding Risk Of Aspirin In Primary Prevention Examined
June 6, 2012 by Leave a Comment
A new study published in JAMA provides substantial new evidence about the real world effects of aspirin, including the risk of bleeding, in a broad population. The study also sheds important new light on the effects of aspirin in a diabetic population. Giorgia De Berardis and colleagues analyzed data from more than 4 million people in…
Aspirin Found To Prevent Recurrent Venous Thromboembolism
May 24, 2012 by 1 Comment
Aspirin can help prevent the recurrence of venous thromboembolism (VTE) after discontinuation of anticoagulation therapy, according to results of the WARFASA (the Warfarin and Aspirin) study published in the New England Journal of Medicine. Following 6 to 18 months of oral anticoagulation, 403 patients with first-time unprovoked VTE were randomized to aspirin (100 mg daily) or placebo…
WARCEF: No Advantage For Warfarin Over Aspirin In Heart Failure
May 3, 2012 by 1 Comment
A new study offers “no compelling reason” to use warfarin instead of aspirin in heart failure patients who don’t have atrial fibrillation. In a paper published in the New England Journal of Medicine, Shunichi Homma and members of the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) study group report the results of a trial…
Meta-Analysis Adds New Evidence For Cancer Benefits Of Daily Aspirin
March 20, 2012 by 1 Comment
Although daily aspirin was originally proposed to reduce cardiovascular events, the effects on cancer of daily aspirin have become increasingly apparent while the vascular benefits, especially in primary prevention, have become less clear. Now a new meta-analysis in the Lancet adds significantly new details to our understanding about the effects of aspirin and increases the…
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