Aspirin Inappropriately Prescribed in 10% of Patients

More than 10% of patients given preventive aspirin treated for treating primary cardiovascular disease were probably inappropriately prescribed, according to a new study.

Researchers at Baylor College of Medicine (Houston, TX, USA), Saint Luke's Hospital (Kansas City, MO, USA), and other institutions assessed 68,808 unique patients receiving aspirin for primary prevention from 119 practices in the United States. The researchers then reviewed guidelines recommended by the American Heart Association (AHA), the US Preventative Services Task Force (Rockville, MD, USA), and other organizations, to determine inappropriate aspirin use in patients with a 10 year cardiovascular disease risk of less than six percent.

The researchers found that 11.6% of the patients receiving aspirin for primary prevention were receiving it inappropriately. The frequency of inappropriate aspirin use was higher among women (17%) than men (5%). Patients inappropriately receiving aspirin were also, on average, 16 years younger than those receiving aspirin appropriately. On the other hand, inappropriate aspirin use decreased from 14% in 2008 to 9% in 2013. The study was published on January 20, 2015, in the Journal of the American College of Cardiology (JACC).

“Medical providers must consider whether the potential for bleeding outweighs the potential benefits of aspirin therapy in patients who don't yet meet the guidelines for prescribing aspirin therapy,” said lead author Ravi Hira, MD, of Baylor College of Medicine. “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.”

“In patients with low cardiovascular disease risk and no prior events, aspirin use has not been associated with reduced cardiovascular events,” commented JACC editor Valentin Fuster, MD. “In fact, in this primary prevention population, the increased risk of gastrointestinal bleeding and hemorrhagic stroke associated with aspirin use outweighs any potential benefit in cardiovascular risk reduction.”

The US Food and Drug Administration (FDA) issued an advisory in 2014 warning that its review of the evidence did not support use of aspirin for primary prevention of heart attack and stroke.

Related Links:
Baylor College of Medicine
Saint Luke's Hospital
US Preventative Services Task Force