Does Stopping Aspirin Differ Fundamentally From Not Starting Aspirin in the Primary Prevention of Cardiovascular Disease Among Older Adults?

Murphy, Ella; McEvoy, John W.

doi:10.7326/m22-0550

Ann Intern Med

2022

DOI: 10.7326/m22-0550

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Does Stopping Aspirin Differ Fundamentally From Not Starting Aspirin in the Primary Prevention of Cardiovascular Disease Among Older Adults?

Ella Murphy

John W. McEvoy

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Cited by 5 publications

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“…Almost half of these individuals were aged > 70 years and, therefore, at an increased risk for bleeding. 6 With the recent studies and changes in guidelines highlighting a higher risk rather than benefit with the use of aspirin for primary prevention, the current use of aspirin for primary prevention in the United States needs to be readdressed.…”

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Evaluation of the Appropriateness of Aspirin Therapy in a Veteran Population

Joseph¹

2023

Federal Practitioner

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Background: Aspirin is commonly used for primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD) but may cause more harm than benefit. This study aimed to assess the percentage of patients who were inappropriately prescribed aspirin in the veteran patient population and to assess safety outcomes associated with inappropriate aspirin use. Methods: Retrospective chart reviews were conducted on up to 200 patients with active prescriptions for 81-mg aspirin tablets filled between October 1, 2019, and September 30, 2021, at the Captain James A. Lovell Federal Health Care Center in Illinois. The primary endpoint was the percentage of patients inappropriately on aspirin therapy and whether these patients were being followed by a clinical pharmacy practitioner. Each patient record was reviewed to determine the appropriateness of aspirin therapy by assessing the indication for use. Safety data were collected for patients who were deemed to be using aspirin inappropriately, including documentation of any major or minor bleeding events.Results: A total of 105 patients were included in this study. For the primary endpoint, 31 patients (30%) had a possible ASCVD risk and were taking aspirin for primary prevention, while 21 patients (20%) had no ASCVD and were taking aspirin for primary prevention. For the secondary endpoint, 25 patients were aged > 70 years, 15 patients were concurrently taking medications that might increase bleeding risk, and 11 patients had chronic kidney disease. Looking at the entire study patient population, for the safety endpoint, 6 patients (6%) experienced a major bleeding event while on aspirin, and 46 (44%) experienced a minor bleeding event while on aspirin. Conclusions: Common factors seen in this study to warrant deprescribing aspirin for primary prevention included individuals aged > 70 years, concurrent use of medications that increase bleeding risk, and patients with chronic kidney disease. By assessing ASCVD and bleeding risks and having a risk/benefit discussion with patients and prescribers, aspirin used for primary prevention can be appropriately deprescribed when the risks of bleeding outweigh the benefits.

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confidence: 99%

Evaluation of the Appropriateness of Aspirin Therapy in a Veteran Population

Joseph¹

2023

Federal Practitioner

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Triggering of ST-elevation myocardial infarction by ultrafine particles in New York: Changes following Tier 3 vehicle introduction

Yount

Utell

Hopke

et al. 2023

Environmental Research

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An international perspective on low-dose aspirin for the primary prevention of myocardial infarction

Dasa

Pepine²,

Pearson³

2023

International Journal of Cardiology

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Does Stopping Aspirin Differ Fundamentally From Not Starting Aspirin in the Primary Prevention of Cardiovascular Disease Among Older Adults?

Cited by 5 publications

References 10 publications

Evaluation of the Appropriateness of Aspirin Therapy in a Veteran Population

Evaluation of the Appropriateness of Aspirin Therapy in a Veteran Population

Triggering of ST-elevation myocardial infarction by ultrafine particles in New York: Changes following Tier 3 vehicle introduction

An international perspective on low-dose aspirin for the primary prevention of myocardial infarction

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