New data on aspirin discontinuation may challenge current international guidelines on the use of the drug for primary prevention of atherosclerotic cardiovascular disease. The recent meta-analysis was published by Campbell et al in Circulation. Aspirin is currently recommended among high-risk patients who have previously experienced atherosclerotic cardiovascular disease; however, guidelines have recently ceased recommending aspirin as primary prevention because of findings from three 2018 clinical trials demonstrating an increased risk of major bleeding with use of the agent. In the new study, investigators analyzed data from the 2018 studies, which involved over 47,000 patients from 10 countries. They identified a group of 7,222 patients who had initiated aspirin to prevent their first heart attack or stroke prior to the commencement of the trials. Compared with those who continued aspirin use, patients who discontinued the drug had a higher risk of atherosclerotic cardiovascular disease (12.5% vs 10.4%). Further, the patients who were prescribed aspirin as preventive treatment but discontinued the drug without consulting their physicians were 28% more likely to experience atherosclerotic cardiovascular disease. In a companion press release on the findings from the University of Galway, the study authors concluded: “We challenged the notion that aspirin discontinuation is a one-size-fits-all approach. Our findings of the benefit of aspirin in reducing [atherosclerotic cardiovascular disease] without an excess risk of bleeding [show that] it seems reasonable that [patients] already safely treated with low-dose aspirin for primary prevention may continue to do so, unless new risk factors for aspirin-related bleeding develop.”
New Study Could Alter Best Practices in Use of Aspirin as Primary Prevention for Cardiovascular Disease
Conexiant
April 30, 2024