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aspirin
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Aspirin is used as an:

  • analgesic
  • antipyretic
  • antirheumatic
  • antiplatelet agent

It has an anti-inflammatory action and is useful in minor trauma.

Secondary prevention of cardiovascular disease:

  • low-dose aspirin (75mg daily) is recommended indefinitely for long-term secondary prevention following a myocardial infarction (MI), and in people with symptomatic peripheral arterial disease (PAD).

Primary prevention of cardiovascular disease:

  • for primary prevention of cardiovascular (CV) events, low-dose aspirin (75mg daily) should be considered for all patients over the age of 50 at high risk of coronary heart disease (CHD) (10-year CHD risk of 15% or more) provided hypertension is controlled.

Notes:

  • secondary prevention of cardiovascular disease:
    • a systematic review and meta-analysis of 195 randomised controlled trials (RCTs) (n=144,051) conducted by the Antithrombotic Trialists' Collaboration (2) provides evidence for the benefits of antiplatelet drugs, primarily aspirin, in preventing CV events in high-risk patients
      • serious CV events (non-fatal MI, non-fatal stroke or vascular death) occurred in 10.7% of patients on antiplatelet therapy compared with 13.2% of patients in the control groups (P<0.0001)
        • significant relative risk reductions were shown for individual primary outcome events (non-fatal MI 34%; non-fatal stroke 25%; vascular death 15%; all P<0.0001)
        • the study authors concluded aspirin (or another oral antiplatelet drug) is protective in most types of patient at increased risk of occlusive vascular events, including those with an acute myocardial infarction or ischaemic stroke, unstable or stable angina, previous myocardial infarction, stroke or cerebral ischaemia, peripheral arterial disease, or atrial fibrillation. Low dose aspirin (75-150 mg daily) is an effective antiplatelet regimen for long term use, but in acute settings an initial loading dose of at least 150 mg aspirin may be required
    • a smaller meta-analysis revealed (3):
      • treatment of 1000 patients for an average of 33 months would prevent 33 cardiovascular events, 12 nonfatal MIs, 25 nonfatal strokes, and 14 deaths, and cause 9 major bleeding events
  • dose of aspirin in the prevention of cardiovascular disease:
    • a systematic review concluded that "..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..." (2)

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