Evaluation of the Benefits and Risks of Low-Dose Aspirin in the Secondary Prevention of Cardiovascular and Cerebrovascular Events

Weisman, Steven M.; Graham, David Y.

doi:10.1001/archinte.162.19.2197

Cited by 242 publications

(152 citation statements)

References 23 publications

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“…Comment: LDA treatment is associated with a high prevalence and incidence of peptic ulcer bleeding [126][127][128]. Among patients receiving LDA and clopidogrel, prophylactic use of PPI reduced the rate of upper GI bleeding (UGIB) [129].…”

Section: Commentmentioning

confidence: 99%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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The Japanese Society of Gastroenterology (JSGE) revised the evidence-based clinical practice guidelines for peptic ulcer disease in 2014 and has created an English version. The revised guidelines consist of seven items: bleeding gastric and duodenal ulcers, Helicobacter pylori (H. pylori) eradication therapy, non-eradication therapy, drug-induced ulcer, non-H. pylori, non-nonsteroidal anti-inflammatory drug (NSAID) ulcer, surgical treatment, and conservative therapy for perforation and stenosis. Ninety clinical questions (CQs) were developed, and a literature search was performed for the CQs using the Medline, Cochrane, and Igaku Chuo Zasshi databases between 1983 and June 2012. The guideline was developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Therapy is initially provided for ulcer complications. Perforation or stenosis is treated with surgery or conservatively. Ulcer bleeding is first treated by endoscopic hemostasis. If it fails, surgery or interventional radiology is chosen. Second, medical therapy is provided. In cases of NSAID-related ulcers, use of NSAIDs is stopped, and anti-ulcer therapy is provided. If NSAID use must continue, the ulcer is treated with a proton pump inhibitor (PPI) or prostaglandin analog. In cases with no NSAID use, H. pylori-positive patients receive eradication and anti-ulcer therapy. If first-line eradication therapy fails, second-line therapy is given. In cases of non-H. pylori, non-NSAID ulcers or H. pyloripositive patients with no indication for eradication therapy, non-eradication therapy is provided. The first choice is PPI therapy, and the second choice is histamine 2-receptor antagonist therapy. After initial therapy, maintenance therapy is provided to prevent ulcer relapse.

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Section: Commentmentioning

confidence: 99%

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

et al. 2016

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“…[1][2][3][4] The most plausible mechanism by which aspirin prevents ischemic events is by irreversible inhibition of the isoenzyme cyclooxygenase-1 (COX-1). 5 In the United States, nonaspirin nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used 6 for their analgesic, anti-inflammatory, and antipyretic effects.…”

mentioning

confidence: 99%

Inhibition of Clinical Benefits of Aspirin on First Myocardial Infarction by Nonsteroidal Antiinflammatory Drugs

et al. 2003

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“…As a matter of fact these cardiovascular disorders are emerging as leading drivers of untimely deaths and chronic disabilities in Nigeria [3][4][5][6][7] but most cases result from uncontrolled blood pressure and rarely due to occlusive atherosclerosis where platelets aggregation is pathologically involved. Furthermore, many risk assessment tools [58][59][60][61] used to determine therapeutic priorities and treatment intensity have not been extensively validated in Nigeria particularly as risk factors for adverse cardiovascular outcome do not have the same potency across all racial/ ethnic groups [75][76][77][78]. This disease heterogeneity suggest that blood pressure reduction should be a higher treatment priority in saving Nigerian lives than interventions like daily baby aspirin aimed at retarding the atherosclerotic process which is unlikely to deliver the same health benefits inmost black Nigerians with type 2 diabetes and or hypertension as observed elsewhere.…”

Section: Disease Mechanisms Of Hypertension/diabetesmentioning

confidence: 99%

“…Nevertheless, the evidence [59,61,79,80] indicating that daily babyaspirin can lower the risk of recurrent heart attack, stroke and other adverse atherosclerotic cardiovascular events i.e. prevent further attacks in people already affected, is persuasive.…”

Section: Evolution Of Aspirin Therapy In Diabetes/ Hypertensionmentioning

confidence: 99%

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Aspirin and Diabetes Care in Nigeria: Treatment or Exploitation?

Eo¹,

Oyejola²

2015

J Clinic Res Bioeth

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Cardiovascular disorders have become leading drivers of untimely deaths almost everywhere. Such deaths are however declining globally due to effective interventions. Low dose aspirin contributes to this reduction when used appropriately through minimization of the risk of coronary heart disease and other occlusive atherosclerotic syndromes that can complicate type 2 diabetes/or hypertension. One local study published in 2004 indicated that aspirin was prescribed for 33% of patients with type 2 diabetes. Since then, aspirin prescription, as part of standard therapy for type 2 diabetes/or hypertension, has risen steadily with some studies reporting this to be 66%-88%; These figures more than double those reported in jurisdictions overseas where occlusive atherosclerotic disorders commonly complicate type 2 diabetes and/or hypertension. Even so, recent transnational data show that cardiovascular deaths linked to type 2 diabetes and or hypertension are not abating in sub-Saharan Africa as in many other regions. This can suggest that interventions in black Africa, if any, maybe less than effective in comparison to areas where health outcomes are improving. Significantly, type 2 diabetes and/or hypertension can behave differently in many black groups within Africa such that occlusive atherosclerotic disorders are less common health consequences even with rising cholesterol levels. In the case of Nigeria, the evidence of cardiovascular health benefits of aspirin, as extensively described in groups overseas, appears hard to find for local cohorts. Indeed what the available data strongly suggest is that effective control of blood pressure is a higher treatment priority for saving Nigerian lives than interventions aimed at retarding the atherosclerotic process. Given these observations, the question ought to be asked whether or not low dose aspirin in type 2 diabetes/hypertension therapies, as locally practiced, is the best way of optimizing limited resources in saving Nigerian lives. This paper examines the evidence.

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Evaluation of the Benefits and Risks of Low-Dose Aspirin in the Secondary Prevention of Cardiovascular and Cerebrovascular Events

Abstract: Aspirin use for the secondary prevention of thromboembolic events has a favorable benefit-to-risk profile and should be encouraged in those at high risk.

Cited by 242 publications

References 23 publications

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

Evidence-based clinical practice guidelines for peptic ulcer disease 2015

Inhibition of Clinical Benefits of Aspirin on First Myocardial Infarction by Nonsteroidal Antiinflammatory Drugs

Aspirin and Diabetes Care in Nigeria: Treatment or Exploitation?

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