Aspirin therapy

This was largely influenced by the high-dose UFH group in 1ST (OR 1.38, 95% Cl 1.05-1.82). An interaction by UFH dose (p = 0.01) on recurrent stroke risk with combination UFH-aspirin therapy compared to aspirin monotherapy was observed, with a trend toward increased risk of recurrent stroke with high-dose UFH + aspirin (OR 1.22, 95% Cl 0.92-1.62) and a trend toward reduced risk with low-dose UFH + aspirin (OR 0.75, 95% Cl 0.56-1.03), equivalent to 10 fewer (95% Cl 0-20 fewer) recurrent strokes per 1000 patients treated. They found a small, but significant beneht of LMWH over aspirin in the prevention of symptomatic DVT, equivalent to 10 (95% Cl 0-30) fewer DVTs per 1000 patients treated. Compared with aspirin, anticoagulants were associated with nonsignificantly fewer symptomatic PEs (OR 0.85, 95% Cl 0.55-1.32). There were fewer PEs with the combination of UEH and aspirin (OR 0.58, 95% Cl 0.34—1.00), equivalent to 5 fewer (Cl 0-10) PEs per 1000 patients treated. However, the overall incidence of symptomatic DVT and PE was low (1.1% and 0.7%). 

Overall no evidence was found to support the claim that anticoagulants offer a net advantage over aspirin in patients with acute ischemic stroke. There was evidence, however, to suggest that combination anticoagulant and aspirin therapy was associated with a small increase in the number of deaths at the end of follow-up, equivalent to 20 more deaths per 1000 patients treated. This adverse effect can probably be attributed partly to the 10 extra sICHs, and the 5 extra major extracranial hemorrhages per 1000 patients treated with combination anticoagulant/ aspirin therapy. 

When the CAST collaborative group performed a meta-analysis of 1ST, CAST, and MAST-I, the trend seen in CAST and 1ST toward a beneficial effect of aspirin on the rate of death or dependency reached the threshold for statistical significance. Early aspirin therapy (160-300 mg/day) conferred an absolute reduction in the rate of recurrent ischemic stroke by 0.7% (7 per 1000 patients treated) (p < 0.001) and reduced the rate of death or dependency by 1.3% (13 per 1000 patients treated) (2p = 0.007). Aspirin caused about 2 hemorrhagic strokes among every 1000 patients treated, but prevented about 11 other strokes or deaths in hospital. 

PROFESS is an ongoing large randomized trial examining combination ER-DP plus aspirin therapy compared with clopidogrel (each group also with or without telmisartan, an angiotensin receptor antagonist) for the secondary prevention of early and late recurrent stroke, and other vascular events. 

Acute Aspirin Therapy for AF-associated Stroke A combined analysis of the 1ST and CAST trials indicated a 21% RRR (95% Cl —5 to 41) in the frequency of early recurrent stroke associated with acute aspirin therapy compared to placebo in patients with AF. No difference in early mortality or sICH was found. This finding was largely driven by the relatively large (about 25% RRR) benefit observed in the unblinded 1ST, compared to the smaller benefit (5% RRR) observed in the double-blinded CAST. 

For patients with ischemic stroke who are not receiving thrombolysis, they recommend early aspirin therapy, 160-325 mg/day grade lA evidence). 

Note patients on aspirin therapy before CVA onset can still receive tPA. No recommendations are made regarding other antiplatelet agents. 

Other gastrointestinal disturbances, including dyspepsia and nausea, are infrequent when low-dose aspirin is used. Aspirin therapy should be continued indefinitely. 

The risk of major bleeding from chronic aspirin therapy is approximately 2% and is dose-related. Aspirin doses higher than 75 to 81 mg are no less effective than doses of 160 to 325 mg, but do have lower rates of bleeding. Therefore, chronic doses of aspirin should not exceed 81 mg. 

Early aspirin therapy is recommended in most patients with acute ischemic stroke within the first 24 to 48 hours after stroke onset and should be continued for at least 2 weeks. 

The most recent CHEST guidelines continue to recommend aspirin therapy for the secondary prevention of stroke.12 The... 

Prophylactic regimens against PUD are often required in patients who require long-term NSAID or aspirin therapy for... 

In patients who experience a PUD-related bleeding event while taking aspirin but who require continued aspirin therapy, the addition of a PPI reduces the incidence of recurrent GI bleeding.27... 

IgE -mediated urticarial/angioedema reactions and anaphylaxis are associated with aspirin and NSAIDs. Urticaria is the most common form of IgE-mediated reaction. This class is second only to fi-lactams in causing anaphylaxis. The potential for cross-reactivity between agents in IgE-mediated reactions appears small, but caution is advised. Because aspirin therapy is highly beneficial in primary and secondary prevention in... 

Based on RM s history, is he a candidate for daily aspirin therapy ... 

Children 6 months to 18 years of age who are on longterm aspirin therapy... 

Children between 6 months and 18 years old who are receiving longterm aspirin therapy, placing them at risk for Reye s syndrome following influenza. 

Children and teenagers receiving chronic aspirin therapy... 

Because ticlopidine is associated with a risk of life-threatening blood dyscrasias including TTP and neutropenia/agranulocytosis (see Warnings), reserve for patients who are intolerant or allergic to aspirin therapy or who have failed aspirin therapy. 

Unstable angina/Non-Q-wave Ml - The recommended dose is 120 units/kg of body weight (but not more than 10,000 units) subcutaneously every 12 hours with concurrent oral aspirin (75 to 165 mg/day) therapy. Concurrent aspirin therapy is recommended except when contraindicated. Continue treatment until the patient is clinically stabilized. The usual duration of treatment is 5 to 8 days. 

Concomitant aspirin therapy Bivalirudin is intended for use with aspirin and has been studied only in patients receiving concomitant aspirin. 

Drug therapy of acute coronary syndromes including unstable angina and non-Q-wave myocardial infarction includes use of aspirin, heparin and anti-ischaemic drugs and is similar in older patients to other age groups. Activation of platelet thromboxane production in the coronary circulation has been demonstrated in unstable angina. The risk of myocardial infarction or death is reduced by approximately 50% by early aspirin therapy in recommended doses of 160-325 mg per day and continued... 

Prevention of ischemic complications of unstable angina and non-Q-wave MI (with oral aspirin therapy) Subcutaneous lmg/kgql2h. 

Contraindications Blood dyscrasias, concurrent high-dose aspirin therapy, severe renal impairment, uric acid calculi... 

Clinical use Acetylsalicylic acid is the prototype of a nonsteroidal anti-inflammatory drug and is used in a large number of inflammatory and pain indications including musculoskeletal, soft tissue and joint disorders, headache, dysmenorrhoea and fever (Symposium on new perspectives on aspirin therapy 1983, various authors). Furthermore, acetylsalicylic acid is used as an antiplatelet drug in the acute treatment of myocardial infarction in combination with thrombolytics and for the prevention of myocardial infarction and stroke (Patrono, 1994). 

Bashein. G., et al, Preoperative Aspirin Therapy and Reoperation for Bleeding After Coronary Artery Bypass Surgery, Arch. Intern. Med., 114, 835-9 (J991). Dutch TIA Trial Study Group A Comparison of Two Doses of Aspirin (30 mg vs. 283 mg a day) in Patients. After a Transient Ischemic Attack or Minor Ischemic Stroke, N. Eng. J. Med., 1261 (May 1, 1992). 

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