Prescribing Aspirin Based on the Benefit-to-Risk Ratio - European Medical Journal
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Prescribing Aspirin Based on the Benefit-to-Risk Ratio

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Cardiology
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GUIDELINES issued by the American Heart Association (AHA) and American College of Cardiology (ACC) have restricted the use of aspirin in the primary prevention of cardiovascular disease (CVD) to people under the age of 70 years. Further, the U.S. Preventive Services Task Force will now recommend against prescribing low-dose aspirin for the primary prevention of CVD in adults aged 60 years and older. Confusion about whether to prescribe aspirin arose following the results of four recent large-scale randomised trials, which investigated the role of this medication in high-risk primary prevention subjects. While two of the studies showed significant benefits of aspirin, the other two, perhaps as a consequence of poor adherence, did not.  

Despite the recommendations restricting aspirin usage, the risk of heart attack and stroke increases drastically with age. For this reason, researchers from the Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA, and collaborators published a perspective document that provides guidance to both primary care providers and their patients.  

Previously, the most comprehensive meta-analysis, which was published by the Antithrombotic Trialists’ (ATT) Collaboration, encompassed six major studies. In this instance, aspirin produced a significant 12% reduction in CVD, with similar risk–benefit ratios at older ages. In order to conduct an updated meta-analysis, the authors added the four latest trials to the six from the ATT.  

The new meta-analysis revealed that aspirin significantly reduced CVD by 13%, with similar benefits at older ages in each of the trials. Therefore, the authors stressed that health practitioners should make individual judgements about initiating aspirin on a case-by-case basis and based on the benefit-to-risk ratio rather than age 

Sarah K. Wood, senior author of the paper and Interim Dean at Charles E. Schmidt College of Medicine, noted: “Any judgements about prescribing long-term aspirin therapy for apparently healthy individuals should be based on individual clinical judgements between the health care provider and each of his or her patients that weighs the absolute benefit of clotting against the absolute risk of bleeding.” Wood added: “For long-term use of aspirin or any over-the-counter drug, patients should consult their primary care provider.”