Revised Aspirin Therapy Guidelines

Mar. 18, 2009 — US experts have revised aspirin guidelines, stating that lower doses appear to be at least as effective as higher doses and safer at preventing heart attack in men and stroke in women.

Whether to take daily aspirin to fight heart disease has been a long-standing debate. In light of the increased risks for gastrointestinal bleeding in some, the debate questions who should take aspirin and at what dose

People taking the clot-dissolving drug clopidogrel (Plavix^®) are of particular concern.

New Aspirin Guidelines
The new US Preventive Services Task Force guidelines are tailored to match age and gender. Among the recommendations: Men aged 45 to 79 should take aspirin if the chances of preventing a heart attack outweigh the chances of gastrointestinal bleeding (GI). Women aged 55 to 79 should take the drug if the chances of reducing ischemic stroke outweigh the risks of GI bleeding.

"Subsequent to the 2002 recommendations, there was more information that came out of the Women's Health Initiative, specifically, that enabled us to look at this recommendation by gender," says Dr. Michael LeFevre, a task force member and professor of family and community medicine at the University of Missouri, Columbia. As a result, "We have a recommendation for men and a recommendation for women. We did not have that before."

Dr. LeFevre, adds that aspirin seems to be more effective in men for preventing heart attack but, in women, better at preventing stroke.

Balancing the Benefits and Risks
In addition, Dr. Carl J. Lavie, medical director of cardiac rehabilitation at the Ochsner Heart and Vascular Institute in New Orleans, says, "The benefits of aspirin use always have to be balanced against the risks. If a patient has low risk of events in the near future, aspirin should not be prescribed. If the risk is very high, clearly aspirin is needed."

The recommendations, published in the March issue of the Annals of Internal Medicine, state:

• Men aged 45 to 79 with heart risk factors should take aspirin if the preventive benefits outweigh the risk of bleeding.



• At-risk women aged 55 to 79 should take aspirin if the odds of reducing a first ischemic stroke outweigh the chance of bleeding.



• Men under the age of 45 and women under 55 who have never had a heart attack or stroke should not take aspirin for prevention.



• At this time, it is not clear whether patients aged 80 and older should take aspirin.

Dose Recommendations Reaffirmed
The task force emphasized that the recommendations only apply to people who have never had a heart attack or stroke. The last task force recommendations came out in 2002. At the time, the panel acknowledged that the evidence for the use of aspirin in preventing heart problems was still evolving.

A second paper in the same issue of the journal reaffirms the task force guidelines. Lower doses of daily aspirin (75 milligrams to 81 milligrams) are equally, if not more effective, than higher doses (100 mg or more) in preventing heart attack and stroke in at-risk individuals.

The paper also found that high doses may actually do more harm, especially in people taking Plavix.

Aspirin is the most used drug worldwide to prevent heart attack and stroke, according to background information in the study. More than one-third of US adults are believed to take aspirin each day.

Dr. Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York City says, "All these trials put together really favor taking lower doses of aspirin."

Always consult your physician for more information.

Online Resources

(Our Organization is not responsible for the content of Internet sites.)

American Academy of Family Physicians

American College of Cardiology

American Heart Association

American Stroke Association

Annals of Internal Medicine - Aspirin to Prevent Cardiovascular Disease: The Association of Aspirin Dose and Clopidogrel With Thrombosis and Bleeding

National Institute of Neurological Disorders and Stroke