November 4th, 2009
Forget aspirin in primary prevention?
JoAnne M. Foody, MD
Recent studies (e.g., Drug and Therapeutics Bulletin 2009;47:122; Lancet 2009; 373:1849; BMJ 2008; 347:a1840) suggest that aspirin confers no benefit whatsoever in primary prevention of cardiovascular disease. The more we explore this issue, the more it appears that only individuals at intermediate or high risk are likely to benefit. We know that data in women are weak. Some evidence suggests that only those individuals with high hs-CRP levels benefit from aspirin.
How are you making decisions regarding aspirin in primary prevention?
One Response to “Forget aspirin in primary prevention?”
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I avoid giving asprin to low risk individuals and those with poorly controlled severe hypertension….for example, the patient who is noncompliant with medications and typically has systolic BP > 180 mm Hg. These individuals often present to the ED with mildly elevated troponin levels (so called, “troponosis”) and are immediately put on aspirin. Personally, I don’t think that’s wise, as the increased risk of ICH with aspirin therapy outweighs any benefits of aspirin in these patients.