AHA Recommendation
Aspirin in secondary prevention
The American Heart Association recommends the use of aspirin in patients who have experienced a myocardial infarction (heart attack), unstable angina , ischemic stroke, or transient ischemic attacks (TIAs or "little strokes"). This recommendation is based on sound clinical trial evidence showing that aspirin prevents clinical events such as heart attack, hospitalization for recurrent angina, second strokes, etc.
The use of aspirin after the onset of known heart or blood vessel disease is commonly referred to as "secondary prevention." Clinical trial evidence is not available to demonstrate similar benefits in patients with other forms of diagnosed vascular disease, such as
+ peripheral vascular blockage
+ carotid artery narrowing
+ aortic atherosclerosis
However, the AHA’s secondary prevention panel believes that such benefits are likely, and that aspirin should be considered for use in all such patients. Since aspirin is not without risk in certain people, the decision for its use should be made by the patient and physician. Together they should evaluate that patient’s risk and likelihood of benefit. The principle factors to consider are the presence of
+ liver or kidney disease
+ peptic ulcer
+ other gastrointestinal disease or bleeding
+ other bleeding problems
+ allergy to aspirin
+ use of alcohol
Aspirin in primary prevention
The use of aspirin to prevent a first heart attack, stroke or other vascular event in healthy people is referred to as "primary prevention." In its 1993 scientific statement, entitled "Aspirin as a Therapeutic Agent in Cardiovascular Disease," the AHA concluded that the clinical decision to use aspirin in primary prevention should be made on an individual basis by a physician.
The American Heart Association cautions people not to begin taking aspirin on a long-term basis without first consulting their doctors. When more data have been analyzed and published, these decisions may be made more objectively. Physicians will need to evaluate each candidate individually. In particular they will have to weigh a person's risk of myocardial infarction and coronary heart disease and death against the potential for adverse reactions to prolonged aspirin therapy. Some of these possible side
effects are now being explored.
Cautions
Overall, there are a number of cautions to exercise before one launches into a lifetime of taking aspirin. These include risk of abnormal bleeding in the gastrointestinal tract.
AHA Recommendation
The American Heart Association therefore makes the following recommendations for aspirin use in primary prevention:
1. All other major risk factors for coronary heart disease and stroke should be determined and a concerted program begun to reduce or modify those risk factors, which include smoking, high blood cholesterol, high blood pressure, physical inactivity, obesity and diabetes.
2. The decision to start taking aspirin every other day should be made only after each person consults with his or her physician. Among the contraindications to regular aspirin therapy are liver or kidney disease, peptic ulcer, gastrointestinal bleeding or other bleeding problems, and allergy to aspirin. These must be ruled out by the physician to protect the individual.
3. A person who chooses to start a regular aspirin regimen should be aware of the side effects of the drug. If they occur, they should be reported to his or her physician. If a person taking aspirin must undergo even a simple surgical procedure or dental extraction, the surgeon or dentist must be told of the aspirin dosage. That’s because the tendency to bleed persists for up to 10 days after the drug is stopped.
What about aspirin and alcohol?
The U.S. Food and Drug Administration warns against drinking alcohol for people who take aspirin on a regular basis. Patients who have heart disease should stop drinking and continue taking aspirin if their doctor prescribed aspirin as part of the treatment plan for their heart condition. Patients should not discontinue taking aspirin without talking to their doctor first.
