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Latest & greatest articles for aspirin
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Acetylsalicylic acid (ASA) more commonly known as aspirin is a painkiller that has a wide range of uses. It is frequently used to treat fever, mild pain, tooth aches, headaches and muscle aches. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and can be used in the management of conditions such as heart attack, arthritis, blood clots and stroke. Aspirin, has been used for thousands of years, initially extracted from the leaves of willow trees.
Aspirin works in much the same way as other NSAIDs but has additional properties, such as antiplatelet activity which can make it additionally useful. More recently aspirin has been linked with cancer prevention. But the potential benefits of aspirin need to be weighed against the potential side effects, which includes gastrointestinal bleeding and Reye’s syndrome. It should be noted that aspirin should not be used in people who are allergic to drugs such as ibuprofen or a more generalized intolerance to NSAIDs. It should also be used cautiously in asthmatics and/or those with bronchospasm associated with NSAID use.
Research evidence, clinical trials and guidelines on Aspirin
Effect of a Single Aspirin Dose Prior to Fecal Immunochemical Testing on Test Sensitivity for Detecting Advanced Colorectal Neoplasms: A Randomized Clinical Trial. Fecal immunochemical tests for hemoglobin are widely used for colorectal cancer (CRC) screening. Observational studies suggested that sensitivity of fecal immunochemical tests for detecting advanced neoplasms could be increased by acetylsalicylicacid (aspirin), especially among men.To evaluate the potential to increase sensitivity (...) of fecal immunochemical tests by administering a single 300-mg oral aspirin dose 2 days before stool sampling.A randomized, placebo-controlled, double-blind trial was conducted in 14 gastroenterology practices and 4 hospitals in Germany, and included 2422 men and women aged 40 to 80 years scheduled for colonoscopy, with no recent use of aspirin or other drugs with antithrombotic effects (enrollment from June 2013 to November 2016, and final follow-up January 27, 2017).Administration of a single tablet
Optimal Duration of Aspirin Plus Clopidogrel After Ischemic Stroke or Transient Ischemic Attack Background and Purpose- The role of aspirin plus clopidogrel (A+C) therapy compared with aspirin monotherapy in patients presenting with acute ischemic stroke (IS) or transient ischemic attack remains uncertain. We conducted this study to determine the optimal period of efficacy and safety of A+C compared with aspirin monotherapy. Methods- Ten randomized controlled trials (15 434 patients) were (...) selected using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (inception June 2018) comparing A+C with aspirin monotherapy in patients with transient ischemic attack or IS. The primary efficacy outcome was recurrent IS, and the primary safety outcome was major bleeding. The secondary outcomes were major adverse cardiovascular events (composite of stroke, myocardial infarction, and cardiovascular mortality) and all-cause mortality. We stratified analysis based
Does an ASA a day really keep the doctor away? March 18, 2019 Does an ASA a day really keep the doctor away? Clinical Question: Is ASA effective for reducing cardiovascular events in patients without pre- existing cardiovascular disease? Bottom Line: Three recent large, randomized, controlled trials (RCTs) of moderate risk, elderly, and diabetic patients do not support use of ASA for primary prevention. The potential absolute benefit of ~1% (only found in one study) is offset by similar (...) increase in major bleeding. All-cause and cancer mortality was either unchanged or increased with ASA. Routine use of ASA for primary cardiovascular prevention should be discouraged. Evidence: • Three large, high quality, placebo controlled RCTs of ASA 100 mg/day. o ARRIVE: RCT of 12,546 patients at moderate cardiovascular risk [10-year risk 10-20% (mean 17%)]. 1 Predominantly males (70.5%), mean age 64 years. After 5 years: ? No difference in: ? Composite cardiovascular events: 4.3% versus 4.5
Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer 1 Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer Interim Guidance from the Kaiser Permanente National Integrated Cardiovascular Health (ICVH) Work Group October 5, 2018 Three randomized clinical trials (ARRIVE 1 , ASCEND 2 , and ASPREE 3 ) recently published results on aspirin use in patients without known Atherosclerotic Cardiovascular Disease (ASCVD). The studies looked at benefits including (...) cardiovascular event prevention, and risks including serious bleeding events. Overall the studies suggest that aspirin lacks net benefit (total benefits minus total harms) beyond age 70, and there is low net benefit in younger adults. USPSTF 2016 aspirin recommendations point to highest net benefit for aspirin in adults age 50-59 (lower bleeding risk than older patients) with 10-year ASCVD risk* >10%. The National Kaiser Permanente Aspirin recommendations will be formally updated following a comprehensive
Use of Low-Dose Aspirin and Mortality After Prostate Cancer Diagnosis: A Nationwide Cohort Study. Recent studies suggest that aspirin use may improve survival in patients with prostate cancer.To assess the association between postdiagnosis use of low-dose aspirin and prostate cancer mortality.Nationwide cohort study.Denmark.Men with incident prostate adenocarcinoma between 2000 and 2011.Nationwide registry data on tumor characteristics, drug use, primary prostate cancer therapy, comorbidity (...) , and socioeconomic parameters. Postdiagnosis use of low-dose aspirin (75 to 150 mg) was defined as 2 or more prescriptions filled within 1 year after prostate cancer diagnosis. Follow-up started 1 year after prostate cancer diagnosis. In secondary analyses, low-dose aspirin use was assessed within exposure periods of 5 or 7.5 years after prostate cancer diagnosis.Of 29 136 patients (median age, 70 years), 7633 died of prostate cancer and 5575 died of other causes during a median follow-up of 4.9 years
The history behind aspirin The History Behind Aspirin 81 – Clinical Correlations Search The History Behind Aspirin 81 February 22, 2019 4 min read By Joshua Novack Peer Reviewed Patients often come into clinics on a grocery list of medications. Common prescriptions include lisinopril 20 mg, amlodipine 2.5 mg, metformin 500 mg, and aspirin 81 mg. One dosage stands out from the others. While most medications come in dosages of round numbers or common decimals, low-dose aspirin has a standard dose (...) of 81 mg. Why is aspirin available at a dose of 81 milligrams? The answer is historical in nature and is rooted in a medieval and now defunct system of measurement called the apothecary system of weights and measures. The full explanation of aspirin 81 requires some background information on the apothecary system and is best explained in comparison to the more familiar metric system. The apothecary system of weights and measures was developed and formalized in England and France during the early
Predicting Bleeding Risk to Guide Aspirin Use for the Primary Prevention of Cardiovascular Disease: A Cohort Study. Many prognostic models for cardiovascular risk can be used to estimate aspirin's absolute benefits, but few bleeding risk models are available to estimate its likely harms.To develop prognostic bleeding risk models among persons in whom aspirin might be considered for the primary prevention of cardiovascular disease (CVD).Prospective cohort study.New Zealand primary care.The study (...) cohort comprised 385 191 persons aged 30 to 79 years whose CVD risk was assessed between 2007 and 2016. Those with indications for or contraindications to aspirin and those who were already receiving antiplatelet or anticoagulant therapy were excluded.For each sex, Cox proportional hazards models were developed to predict major bleeding risk; participants were censored at the earliest of the date on which they first met an exclusion criterion, date of death, or study end date (30 June 2017). The main
submission rivaroxaban (Xarelto ® ) is accepted for restricted use within NHSScotland. Indication under review: Co-administered with acetylsalicylicacid for the prevention of atherothrombotic events in adult patients with: - coronary artery disease, or - symptomatic peripheral artery disease at high risk of ischaemic events. SMC restriction: use in patients with stable coronary artery disease that does not require dual antiplatelet therapy. Addition of rivaroxaban to low-dose aspirin (acetylsalicylic (...) acid) reduced the incidence of a composite outcome that included stroke, cardiovascular death and myocardial infarction, mainly due to reductions in stroke and cardiovascular death. It also increased the incidence of major bleeding. Chairman Scottish Medicines Consortium www.scottishmedicines.org.uk 2 Indication Co-administered with acetylsalicylicacid (aspirin) for the prevention of atherothrombotic events in adult patients with: - coronary artery disease, or - symptomatic peripheral artery
Prediction of individual life-years gained without cardiovascular events from lipid, blood pressure, glucose, and aspirin treatment based on data of more than 500 000 patients with Type 2 diabetes mellitus Although group-level effectiveness of lipid, blood pressure, glucose, and aspirin treatment for prevention of cardiovascular disease (CVD) has been proven by trials, important differences in absolute effectiveness exist between individuals. We aim to develop and validate a prediction tool
Rivaroxaban, Aspirin, or Both to Prevent Early Coronary Bypass Graft Occlusion: The COMPASS-CABG Study Patients with recent coronary artery bypass graft (CABG) surgery are at risk for early graft failure, which is associated with a risk of myocardial infarction and death. In the COMPASS (Cardiovascular OutcoMes for People Using Anticoagulation StrategieS) trial, rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily compared with aspirin 100 mg once daily reduced the primary major (...) adverse cardiovascular events (MACE) outcome of cardiovascular death, stroke, or myocardial infarction. Rivaroxaban 5 mg twice daily alone did not significantly reduce MACE.This pre-planned substudy sought to determine whether the COMPASS treatments are more effective than aspirin alone for preventing graft failure and MACE after CABG surgery.The substudy randomized 1,448 COMPASS trial patients 4 to 14 days after CABG surgery to receive the combination of rivaroxaban plus aspirin, rivaroxaban alone
Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis. The role for aspirin in cardiovascular primary prevention remains controversial, with potential benefits limited by an increased bleeding risk.To assess the association of aspirin use for primary prevention with cardiovascular events and bleeding.PubMed and Embase were searched on Cochrane Library Central Register of Controlled Trials from the earliest (...) available date through November 1, 2018.Randomized clinical trials enrolling at least 1000 participants with no known cardiovascular disease and a follow-up of at least 12 months were included. Included studies compared aspirin use with no aspirin (placebo or no treatment).Data were screened and extracted independently by both investigators. Bayesian and frequentist meta-analyses were performed.The primary cardiovascular outcome was a composite of cardiovascular mortality, nonfatal myocardial infarction
A new look at low-dose aspirin: Co-administration with tamoxifen in ovulation induction in anovulatory PCOS women. To evaluate the efficacy of co-administration of low-dose aspirin (LDA) and tamoxifen on ovulation rates, endometrial thickness and clinical pregnancy rates in anovulatory PCOS women.A randomized clinical trial was conducted among 188 anovulatory PCOS women at Suez Canal University Hospitals, Ismailia - Egypt. Patients were divided into 2 groups. The study group received a daily
Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials The role of aspirin in the primary prevention setting is continuously evolving. Recent randomized trials have challenged the role of aspirin in the primary prevention setting.Electronic databases were searched for randomized trials that compared aspirin vs. placebo (or control) in subjects without established atherosclerotic disease (...) . The primary efficacy outcome was all-cause mortality, while the primary safety outcome was major bleeding. Summary estimates were reported using a DerSimonian and Laird random effects model. A total of 11 trials with 157 248 subjects were included. At a mean follow-up of 6.6 years, aspirin was not associated with a lower incidence of all-cause mortality [risk ratio (RR) 0.98, 95% confidence interval (CI) 0.93-1.02; P = 0.30]; however, aspirin was associated with an increased incidence of major bleeding
Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis. To assess the effectiveness and safety of dual agent antiplatelet therapy combining clopidogrel and aspirin to prevent recurrent thrombotic and bleeding events compared with aspirin alone in patients with acute minor ischaemic stroke or transient ischaemic attack (TIA).Systematic review and meta-analysis of randomised, placebo controlled (...) considered important, clarification and additional information was sought from the authors. The analysis was conducted in RevMan 5.3 and MAGICapp based on GRADE methodology.Three eligible trials involving 10 447 participants were identified. Compared with aspirin alone, dual antiplatelet therapy with clopidogrel and aspirin that was started within 24 hours of symptom onset reduced the risk of non-fatal recurrent stroke (relative risk 0.70, 95% confidence interval 0.61 to 0.80, I2=0%, absolute risk
Aspirin in coronary artery surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival.Using a factorial design, we randomly assigned patients undergoing coronary artery (...) surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score < 8. Secondary outcomes included a composite of myocardial infarction, stroke and death from any cause through to 1 year after surgery.Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate
Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes.Using a factorial design, we randomly assigned patients undergoing (...) coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery.The rate of death or disability at 1 year was 3.8
Eicosapentaenoic acid and aspirin, alone and in combination, for the prevention of colorectal adenomas (seAFOod Polyp Prevention trial): a multicentre, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial. The omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) and aspirin both have proof of concept for colorectal cancer chemoprevention, aligned with an excellent safety profile. Therefore, we aimed to test the efficacy of EPA and aspirin, alone and in combination (...) randomly allocated (1:1:1:1) using a secure web-based server to receive 2 g EPA-free fatty acid (FFA) per day (either as the FFA or triglyceride), 300 mg aspirin per day, both treatments in combination, or placebo for 12 months using random permuted blocks of randomly varying size, and stratified by BCSP site. Research staff and participants were masked to group assignment. The primary endpoint was the adenoma detection rate (ADR; the proportion of participants with any adenoma) at 1 year surveillance
2018LancetControlled trial quality: predicted high
Misoprostol Heals Small Bowel Ulcers in Aspirin Users With Small Bowel Bleeding There is no effective treatment for aspirin-induced small bowel ulcer bleeding. We performed a double-blind, randomized, placebo-controlled trial to determine whether misoprostol can heal small bowel ulcers in patients with small bowel bleeding who require continuous aspirin therapy.We performed a prospective study of 84 aspirin users with small bowel bleeding who required continued aspirin therapy in Hong Kong (...) and Japan. Patients with small bowel ulcers or multiple erosions, detected by capsule endoscopy, were randomly assigned to groups that received either misoprostol (200 μg, 4 times daily; n = 42) or placebo (n = 42) for 8 weeks. All patients continued taking aspirin (100 mg, once daily). The primary end point was complete ulcer healing at follow-up capsule endoscopy. Secondary end points included changes in hemoglobin level and number of ulcer/erosions from baseline.Complete healing of small bowel ulcers
Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial Patent foramen ovale (PFO) is a contributor to embolic stroke of undetermined source (ESUS). Subgroup analyses from previous studies suggest that anticoagulation could reduce recurrent stroke compared with antiplatelet therapy. We hypothesised that anticoagulant treatment with rivaroxaban, an oral factor Xa inhibitor, would reduce the risk (...) of recurrent ischaemic stroke compared with aspirin among patients with PFO enrolled in the NAVIGATE ESUS trial.NAVIGATE ESUS was a double-blinded, randomised, phase 3 trial done at 459 centres in 31 countries that assessed the efficacy and safety of rivaroxaban versus aspirin for secondary stroke prevention in patients with ESUS. For this prespecified subgroup analysis, cohorts with and without PFO were defined on the basis of transthoracic echocardiography (TTE) and transoesophageal echocardiography (TOE
Hydroxycarbamide Plus Aspirin Versus Aspirin Alone in Patients With Essential Thrombocythemia Age 40 to 59 Years Without High-Risk Features Purpose Cytoreductive therapy is beneficial in patients with essential thrombocythemia (ET) at high risk of thrombosis. However, its value in those lacking high-risk features remains unknown. This open-label, randomized trial compared hydroxycarbamide plus aspirin with aspirin alone in patients with ET age 40 to 59 years and without high-risk factors (...) or extreme thrombocytosis. Patients and Methods Patients were age 40 to 59 years and lacked a history of ischemia, thrombosis, embolism, hemorrhage, extreme thrombocytosis (platelet count ≥ 1,500 × 109/L), hypertension, or diabetes requiring therapy. In all, 382 patients were randomly assigned 1:1 to hydroxycarbamide plus aspirin or aspirin alone. The composite primary end point was time to arterial or venous thrombosis, serious hemorrhage, or death from vascular causes. Secondary end points were time