On the one hand, a lot of people who should be taking aspirin aren’t doing so. On the other hand, a lot of people who are taking aspirin shouldn’t be doing so. Those are the dual conclusions of a new report and accompanying editorial from the REACH Registry appearing in the American Journal of Cardiology.
Chris Cannon and fellow REACH registry investigators analyzed data from more than 25,000 US patients with vascular disease or multiple risk factors and found that only 70% were taking aspirin. Approximately half of these were taking other antithrombotic agents, but the other half– 15% of the study population– were not receiving any antithrombotic therapy.
The REACH investigators note that current guidelines recommend that patients like those in the study should receive aspirin or other antiplatelet therapy, though they acknowledge that “recent data have suggested that aspirin might not be as effective in preventing ischemic events, suggesting future evidence-based guidelines might not be as liberal in their recommendations for aspirin use, particularly for primary prevention.”
Following up on this point, the editorialists, Luke Tapp, Eduard Shansila, and Gregory YH Lip, ask whether aspirin is “a drug whose time has gone?” They write that “efforts should undoubtedly be made to reinforce aspirin use” in those groups where it is appropriate, but, they write, “we must be vigilant to the phenomenon of ‘indication creep,’ whereby aspirin use spreads beyond the boundaries of evidence if the data are inappropriately extrapolated.” They call for a reconsideration of international guidelines regarding aspirin in primary prevention and suggest that “perhaps aspirin may be reserved for those at highest cardiovascular risk.”
Readers may remember that last May the Antithrombotic Trialists’ Collaboration raised questions regarding the value of aspirin in primary prevention.
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