Some issues of administering acetylsalicylic acid in clinical practice
https://doi.org/10.18705/1607-419X-2015-21-5-536-544
Abstract
This article reviews some issues related to the long-term administration of antithrombotic drugs for primary and secondary cardiovascular prevention. It does not address initial management of acute coronary syndromes or periprocedural use of antithrombotic therapies. We review the pros and cons regarding acetylsalicylic acid (ASA) therapy in primary prevention based on the available evidence, including recent data linking ASA with cancer protection. We do not include other antiplatelet therapies (e. g., clopidogrel alone or in combination with aspirin) or oral anticoagulation (e. g., warfarin), because they are not likely to be used in primary prevention setting. Recent guidelines depend on the accurate assessment of cardiovascular risk as part of decision-making process. While awaiting the results of several ongoing studies, we argue for a pragmatic approach to use low-dose ASAin primary cardiovascular prevention and discussits use in patients at high cardiovascular risk. Patients with diabetes mellitus are known to have an increased risk of cardiovascular events. Low dose ASA is recommended for secondary prevention, as for primary prevention it can be prescribed in patients with diabetes mellitus and at high cardiovascular risk. Antiplatelet therapy is the standard of care for the secondary prevention of coronary artery disease and ischemic stroke. However, it is associated with increased risk of bleeding, first of all gastrointestinal bleeding. Prescription of proton pump inhibitors along with antiplatelet therapy reduces the risk of upper gastro-intestinal bleeding.
About the Author
Ya. A. Orlova
Clinic of M.V. Lomonosov Moscow State University
Russian Federation
Russian Federation
MD, PhD, Deputy Director,
27/10 Lomonosovsky avenue, Moscow, 119192, 5163002@bk.ru
References
1. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R et al. Antithrombotic Trialists’ (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373(9678):1849–1860.
2. 2013 ESH/ESC Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J. 2013;34 (28):2159–2219.
3. ВНОК. Диагностика и лечение стабильной стенокардии. Российские рекомендации (2‑й пересмотр). Кардиоваскулярная терапия и профилактика. 2008;7(6), прил. 4: 37 c. [Russian Cardiological Society. Guidelines on management of stable angina. Kardiovaskulyarnaya Terapiya i Profilaktika = Cardiovascular Therapy and Prevention. 2008;7(6), Suppl. 4: 37 p. In Russian].
4. Bhatt D, Eagle K, Ohman E, Hirsch A, Goto S, Mahoney E et al. REACH Registry Investigators. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. J Am Med Assoc. 2010;304(12):1350–1357.
5. Kolber M, Sharif N, Marceau R, Szafran O. Family practice patients’ use of acetylsalicylic acid for CVD prevention. Can Fam Physician. 2013;59(1):55–61.
6. Fiscella K, Winters P, Mendoza M, Noronha G, Swanger C, Bisognano J et al. Do clinicians recommend aspirin to patients for primary prevention of cardiovascular disease? J Gen Intern Med. 2015;30(2):155–160.
7. Biondi-Zoccai G, Wu Y, Serrano C, Frati G, Agostoni P, Abbate A. Aspirin underuse, non-compliance or cessation: definition, extent, impact and potential solutions in the primary and secondary prevention of cardiovascular disease. Int J Cardiol. 2015;182:148–154.
8. Final report on the aspirin component of the ongoing Physicians’ Health Study. Steering Committee of the Physicians’ Health Study Research Group. N Engl J Med. 1989;321(3):129–135.
9. Ridker P, Cook N, Lee I, Gordon D, Gaziano J, Manson J et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med. 2005;352(13):1293–1304.
10. US Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;150 (6):396–404.
11. Seshasai S, Wijesuriya S, Sivakumaran R, Nethercott S, Erqou S, Sattar N et al. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med. 2012;172(3):209–216.
12. Ikeda Y, Shimada K, Teramoto T, Uchiyama S, Yamazaki T, Oikawa S et al. Low-dose aspirin for primary prevention of cardiovascular events in japanese patients 60 years or older with atherosclerotic risk factors a randomized clinical trial. J Am Med Assoc. 2014;312(23):2510–2520.
13. Zanchetti A, Hansson L, Dahlöf B, Julius S, Ménard J, Warnold I et al. Benefit and harm of low-dose aspirin in well-treated hypertensives at different baseline cardiovascular risk. J Hypertens. 2002;20(11):2301–2307.
14. Available from: http://www.fda.gov/Drugs/ResourcesforYou/Consumers/ucm390574.htm
15. Halvorsen S, Andreotti F, ten Berg J, Cattaneo M, Coccheri S, Marchioli R et al. Aspirin therapy in primary cardiovascular disease prevention: a position paper of the European Society of Cardiology working group on thrombosis. J Am Coll Cardiol. 2014;64(3):319–327.
16. Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren M et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J. 2012;33(13):1635–1701.
17. De Berardis G, Lucisano G, D’Ettorre A, Pellegrini F, Lepore V, Tognoni G et al. Association of aspirin use with major bleeding in patients with and without diabetes. J Am Med Assoc. 307(21):2286–2294.
18. ClinicalTrials.gov. ASCEND: A Study of Cardiovascular Eventsin Diabetes. NCT00135226. Available from: http://clinicaltrials.gov/show/NCT00135226
19. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J. 2013;34(39):3035–3087.
20. Available from: http://www.mdcalc.com/has-bled-scorefor-major-bleeding-risk/
21. Российское медицинское общество по артериальной гипертонии (РМОАГ), Всероссийское научное общество кардиологов (ВНОК). Диагностика и лечение артериальной гипертензии. Российские рекомендации (четвертый пересмотр). Системные гипертензии 2010;3:5–26. [Russian Society of HTN. Russian Cardiological Society. Guidelines on management of HTN. Systemnye Gipertenzii = System Hypertensions. 2010;3:5–26. In Russian].
22. Antithrombotic Trialists’ (ATT) Collaboration: Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373(9678):1849–1860.
23. Antiplatelet Trialist’ Collaboration metaanalyse of randomized trials of antiplatelet therapy: prevention of myocardial infarction and stroke by prolonged antiplatelet therapy in high risk patients. Br Med J. 2002;324(6921):76–81.
24. Mehta S, Tanguay J, Eikelboom J, Jolly S, Joyner C, Granger C et al. CURRENT-OASIS 7 trial investigators. Doubledose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet. 2010;376 (6948):1233–1243.
25. Fang J, George M, Gindi R, Hong Y, Yang Q, Ayala C et al. Use of low-dose aspirin as secondary prevention of atherosclerotic cardiovascular disease in US adults (from the National Health Interview Survey, 2012). Am J Cardiol. 2015;115 (7):895–900.
26. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J. 2013;34(38):2949–3003.
27. Peters R, Mehta S, Fox K, Zhao F, Lewis B, Kopecky S et al. Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) Trial Investigators. Effects of aspirin dose when used alone or in combination with clopidogrel in patients with acute coronary syndromes: observations from the Clopidogrel in Unstable angina to prevent Recurrent Events (CURE) study. Circulation. 2003;108 (14):1682–1687.
28. Steinhubl S, Bhatt D, Brennan D, Montalescot G, Hankey G, Eikelboom J et al. Aspirin to prevent cardiovascular disease: the association of aspirin dose and clopidogrel with thrombosis and bleeding. Ann Intern Med. 2009;150(6):379–386.
29. Баркаган З. С., Котовщикова Е. Ф. Сравнительный анализ основных и побочных эффектов различных форм ацетилсалициловой кислоты. Клин. фармакол. тер., 2004;13 (3):1–4 [Barkagan ZS, Kotovshchikova EF. Comparative analysis of main and adverse effects of different acetylsalicylic acid formulations. Klinicheskaya Farmakologiya i Terapiya = Clinical Pharmacology and Therapy. 2004;13(3):1–4. In Russian].
30. Яковенко Э. П., Краснолобова Л. П., Яковенко А.В., Агафонова Н. А., Иванов А. Н., Богомолова Е. А. и соавт. Влияние препаратов ацетилсалициловой кислоты на морфо-функциональное состояние слизистой оболочки желудка у кардиологических пациентов пожилого возраста. Сердце: журнал для практикующих врачей. 2013; (71):145–150. [Yakovenko EP, Krasnolobova LP, Yakovenko AV, Agafonova NA, Ivanov AN, Bogomolova EA. Effects of acetylsalicylic acid formulations on morphological and functional state of gastric mucosa among older cardiological patients. Serdtse = Heart. 2013;(71):145–150. In Russian].
31. Takada M, Fujimoto M, Hosomi K. Difference in risk of gastrointestinal complications between users of enteric-coated and buffered low-dose aspirin. Int J Clin Pharmacol Therap. 2014;52 (3):181–191.
32. Abraham N, Hartman C, Castillo D, Richardson P, Smalley W. Effectiveness of national provider prescription of PPI gastroprotection among elderly NSAID users. Am J Gastroenterol. 2008;103(2):323–332.
33. Moore N, Pollack C, Butkerait P. Adverse drug reactions and drug-drug interactions with over-the-counter NSAIDs. Ther Clin Risk Manag. 2015;11:1061–1075.
34. Bhatt D, Scheiman J, Abraham N, Antman E, Chan F, Furberg C et al. ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol. 2008;52(18):1502–1517.
35. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet. 1996;348(9038):1329–1339.
Review
For citations:
Orlova Ya.A. Some issues of administering acetylsalicylic acid in clinical practice. "Arterial’naya Gipertenziya" ("Arterial Hypertension"). 2015;21(5):536-544. (In Russ.) https://doi.org/10.18705/1607-419X-2015-21-5-536-544
Views:
1452
Email this article 