Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Low-Dose Aspirin Discontinuation & CV Risk

Circulation; ePub 2017 Sep 25; Sundström, et al

Discontinuation of low-dose aspirin in the absence of major surgery or bleeding in long-term users was associated with a >30% risk of cardiovascular (CV) events, a recent study found. The population-based cohort included 601,527 users (aged >40 years) of low-dose aspirin for primary or secondary prevention between 2005 and 2009 who were free from previous cancer, and had ≥80% adherence during the first observed year of treatment. Researchers found:

  • 62,690 CV events occurred during a median follow-up of 3 years.
  • Patients who discontinued aspirin had a 37% higher rate of CV events vs those who continued (adjusted HR, 1.37).
  • This risk increased shortly after discontinuation and did not diminish over time.
Citation:

Sundström J, Hedberg J, Thuresson M, Aarskog P, Johannesen KM, Oldgren J. Low-dose aspirin discontinuation and risk of cardiovascular events. [Published online ahead of print September 25, 2017]. Circulation. doi:10.1161/CIRCULATIONAHA.117.028321.

Commentary:

There are 2 different groups of patients in this study—those for whom aspirin is being used for primary prevention and those for whom aspirin is being used for secondary prevention. It is clear that for secondary prevention, regular aspirin use reduces recurrent CV disease. For primary prevention, the data is not as strong, though it remains a recommendation for those at higher risk. The US Preventive Services Task Force (USPSTF) recommends, “Low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years, and are willing to take low-dose aspirin daily for at least 10 years. (Grade B recommendation)." The recommendation for adults aged 60 to 69 years is similar, with a grade C level of recommendation.1 We also know that adherence to taking any chronic medication is inconsistent, and many patients miss 30-50% of doses. This study shows that for both primary and secondary prevention, it is important for patients who take aspirin to use it on a daily basis as prescribed. —Neil Skolnik, MD

  1. US Preventive Services Task Force. Aspirin use to prevent cardiovascular disease and colorectal cancer: Preventive Medication. https://www.uspreventiveservicestaskforce.org/Page/Document/Recommendati.... Accessed October 2017.

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