Volume 180 - Issue 2
Aspirin for cardiovascular disease prevention
Authors: Johan H A Janssen and David Henshaw
Med J Aust 2004; 180 (2): 94. || doi: 10.5694/j.1326-5377.2004.tb05814.x
Published online: 19 January 2004
Published online: 19 January 2004
Johan H A Janssen,* David Henshaw†
* Cardiologist, † General Physician, Kalgoorlie Regional Hospital, PO Box 8035, Hannans, Kalgoorlie, WA 6433. Johan.JanssenAThealth.wa.gov.au
To the Editor: We read with interest the article by Hung on aspirin for cardiovascular disease prevention,1 and would like to alert readers to the fact that, from the same studies Hung discussed, it is clear aspirin fails to prevent 80% of recurrent serious vascular events, and that one in eight high-risk patients will suffer from another “event” in the next 2 years while taking aspirin.2
Recent studies have triggered discussion about the concept of aspirin resistance and competitive binding issues as possible causes for the observed failure of aspirin, or indeed the increased risk of all-cause mortality when aspirin is used in combination with ibuprofen.3,4 Although it may still be premature to recommend routine testing for aspirin resistance, the possibility that testing might lead to improved strategies for reducing the risk of thrombotic complications means that it should be considered. Another point for consideration is whether primary prophylaxis with aspirin might induce aspirin resistance, thereby nullifying the effect of taking it in the first place.
We agree with Hung that the current main alternative to aspirin is clopidogrel, and that this agent could be used in cases in which there is any doubt about the efficacy of aspirin.
References
- Hung J, for the Medical Issues Committee of the National Heart Foundation of Australia. Aspirin for cardiovascular disease prevention. Med J Aust 2003; 179: 147-152. <eMJA full text>
- Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. Antithrombotic Trialists’ Collaboration. BMJ 2002; 324: 71-86. i1082886
- Gum PA, Kottke-Marchant K, Welsh PA, et al. A prospective, blinded determination of the natural history of aspirin resistance among stable patients with cardiovascular disease. J Am Coll Cardiol 2003; 41: 961-965. i1082889
- MacDonald TM, Wei L. Effect of ibuprofen on cardioprotective effect of aspirin. Lancet 2003; 361: 573-574. i1082891