Significant inappropriate aspirin use seen among cardiology patients

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More than one in 10 patients enrolled in a cardiovascular registry take aspirin inappropriately, according to a study published in the Jan. 20 issue of the Journal of the American College of Cardiology.

According to guidelines developed by the U.S. Preventive Services Task Force, American Heart Association (AHA) and American Stroke Association on aspirin use for preventing cardiovascular or coronary heart disease, 10-year disease risks for patients taking aspirin should be more than 6 percent.

When researching aspirin use among patients enrolled in National Cardiovascular Disease Registry’s Practice Innovation and Clinical Excellence (PINNACLE) registry, Ravi S. Hira, MD, from Baylor College of Medicine in Houston, and colleagues found a wide variation in the percentage of inappropriate use by cardiology practice. While some practices had no inappropriate use, in others, inappropriate use was as much as 71.8 percent. More women were taking aspirin inappropriately (16.6 percent). Regionally, the proportion of inappropriate aspirin therapy was 11.4 percent, 12.2 percent, 11.3 percent and 10.6 percent for the Northeast, Midwest, South and West, respectively.

They found inappropriate aspirin use decreased overtime. In 2008, the rate of inappropriate use was 14.5 percent and dropped to 9.1 percent in 2013. 

Hira et al noted that the percentages of patients inappropriately taking aspirin may be higher. Aspirin use was self-reported. Further, of patients in PINNACLE reportedly taking aspirin, 72.9 percent lacked variables to calculate 10-year cardiovascular disease risk. Also, aspirin usage was reported as yes/no; dosage information was not available. 

As noted in an editorial by Freek W.A. Verheugt, MD, of Nijmegen Medical Centre in Amsterdam, aspirin’s ability to reduce coronary events has a risk: bleeding. “For every 2 major coronary events shown to be prevented by prophylactic aspirin, they occur at the cost of 1 major extracranial bleed. Primary prevention with aspirin is widely applied, however. This regimen is not only used because of its cardioprotection but also because there is increasing evidence of chemoprotection of aspirin against cancer,” Verheugt wrote.

"Medical providers must consider whether the potential for bleeding outweighing the potential benefits of aspirin therapy in patients who don't yet meet the guidelines for prescribing aspirin therapy," said Hira in a press release. "Since aspirin is available over the counter, patient and public education against using aspirin without a medical provider's recommendation will also play a key role in avoiding inappropriate use."