February 12th, 2015

Discontinuing Aspirin for Primary Prevention: What Do You Say to Your Patient?

This post continues our series “What Do You Say to Your Patient?” In this series, we ask members to share how they interpret a complex or controversial issue for patients. To review earlier posts, click here.

The following scenario stems from a recent Japanese Primary Prevention Project study, published in JAMA, which found that once-daily, low-dose aspirin did not significantly reduce the risk for cardiovascular events among patients age 60 older with atherosclerotic risk factors.

A 60-year-old man walks into your office. He has mild hypertension treated by diet and exercise and his LDL is 120 mg/dl. He has no personal or family history of heart disease and does not have diabetes. Physically active, he is keen to find ways to reduce his cardiovascular risk.

Having taken an aspirin a day since he turned 50, your patient says he’s learned of several recent studies that indicate he should not be taking it.

He does not know what to do, and wonders if another study will be published next year that says he should take aspirin. He asks you for guidance – and for help understanding what he is reading in the news.

What do you say?

Do you advise him to stop taking aspirin?

How do you put the news media coverage in perspective for him?


2 Responses to “Discontinuing Aspirin for Primary Prevention: What Do You Say to Your Patient?”

  1. Jean-Pierre Usdin, MD says:

    I will say to him “continue with aspirin”.
    Considering the recent british history of endocarditis prophylaxy i.e. significant recurrence of endocarditis after stopping dental antibioprophylaxy in native aortic and mitral valve incompetence.
    So “you have no contra indication, no bleeding event with small dose of aspirin, you are ten-year older, you are a male so go on for the next 10 years…

  2. Joel Wolkowicz, MDCM says:

    You can say: Everyday we learn new things. I don’t know what we will learn next year. I can only tell you what I know today. And today, I can tell you that you have little to gain from taking aspirin, and you are at risk of side effects.