Tag Archives: aspirin

Background, epidemiology and rationale for the COMPASS study One quarter of all deaths in the UK in 2017 occurred as a result of diseases of the heart and circulation.1 One in seven men and one in twelve women died from coronary heart disease (CHD).1 The presence of CHD doubles the risk of stroke,2 and more than 100,000 strokes occur in the UK each year.1 Although the mortality rate from circulatory diseases is declining due to advances in treatment,1,3 more than 100,000 deaths resulted from CHD or stroke combined in the UK each year.1 CHD and stroke are the two leading causes of death worldwide.4 Circulatory disease is also associated with a

Introduction The ASPirin in Reducing Events in the Elderly trial (ASPREE), published in 2018, was a landmark randomised-controlled trial (RCT) that contributed important knowledge about primary cardiovascular disease (CVD) prevention among healthy older adults.1 ASPREE found that daily low-dose aspirin (LDA) does not statistically prevent disability or CVD among adults aged over 70 years when compared with placebo, but does significantly increase risk of haemorrhage; findings that immediately influenced clinical practice guidelines.2 When used as a case study of large RCTs, ASPREE provides further, more existential, lessons for both researche

Over a mean follow-up of 23 months, there was a marked decrease in the primary composite end point of cardiovascular death, stroke, or myocardial infarction in the combination therapy group by 24% (hazard ration [HR] 0.76; 95% CI 0.66-0.86; p<0.001) over aspirin monotherapy, and improved survival by 18%. The trial terminated prematurely by the data monitoring committee due to due to overwhelming efficacy. Rivaroxaban monotherapy showed no efficacy benefit. The anticipated trade-off was apparent with increased major bleeding in the combination therapy arm (HR 1.70, 95% CI 1.40–2.05; p<0.001), although fatal and intracranial bleeds wer

Approximately 20–30% of patients with AF, who are continuously taking an oral anticoagulant to reduce their risk of AF-related stroke, have coexisting coronary artery disease and may require PCI. The current practice of administering triple therapy with warfarin and two antiplatelet agents in patients with AF after a PCI is associated with high rates of major bleeding. RE-DUAL PCI tested an alternative treatment strategy: dual therapy with dabigatran and a single antiplatelet agent (P2Y12 inhibitor). Selected for one of the meeting’s hotline sessions and simultaneously published in the New England Journal of Medicine (https://doi.org/10.

A new gene therapy that targets the heart and requires only one treatment session, has been found safe for patients with coronary artery disease, according to a successful trial carried out in Finland (doi: 10.1093/eurheartj/ehx352). The treatment enhances circulation in ischaemic heart muscle and the effects were still visible one year after treatment. The randomised, blinded, placebo-controlled phase 1/2a trial was carried out in collaboration between the University of Eastern Finland, Kuopio University Hospital and Turku PET Centre. The biological bypass is based on gene transfer in which a natural human growth factor, AdVEGF-DΔNΔC, a ne

WOEST: aspirin not required for stent patients on oral anticoagulants  A strategy of using clopidogrel as a single antiplatelet drug for patients receiving a drug-eluting stent who are also taking an oral anticoagulant appears safe and can reduce bleeding, the results of the WOEST study suggest. How to treat patients on anticoagulation when they receive a stent is fraught with difficulty as giving the normal dual antiplatelet therapy with aspirin and clopidogrel means they will be taking three anti-clotting agents which could increase bleeding complications to a dangerous level. But no randomised clinical trials have ever investigated whethe

The authors, led by Professor Kausik Ray (St George’s University of London) conclude that the modest benefits and the significant increase in risk of bleeding do not justify routine use of aspirin in primary prevention, but that aspirin may be considered in certain higher-risk groups. The recently published meta-analysis (Arch Intern Med 2012;172:209–16), included nine randomised placebo-controlled trials with a total of 100,000 participants. Results (table 1) showed that during a mean follow-up of six years, aspirin treatment reduced total cardiovascular events by 10%, driven primarily by a reduction in non-fatal myocardial infarction (M

Introduction Daily low-dose aspirin (75–100 mg per day) substantially reduces the risk of subsequent vascular events, such as myocardial infarction and ischaemic stroke.1 Evidence from primary prevention trials has indicated a reduction in the risk of a first vascular event,2 but the benefit–risk balance for this is open to debate.3 The prevalence of aspirin taking by patients at increased vascular risk and by the general population is unknown in the UK. The following reports a survey to determine the taking of regular aspirin within a representative community sample of adult individuals in the south Wales county of Caerphilly. Methods T

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Introduction Aspirin, used in vascular disease prophylaxis, is probably the most cost-effective drug available in clinical practice and daily low-dose aspirin is now a standard item in the long-term management of vascular disease. Within a public health context, the provision of aspirin to individuals at increased vascular risk has been judged to be the preventive activity of greatest benefit and at the lowest cost (by far), apart from smoking cessation.1 Patients with known vascular disease are clearly at increased vascular risk, and a recent US Task Force judged that ‘individuals at increased risk’ includes males aged over about 45 and