Low-dose aspirin in primary prevention
Модератор: Pyankov Vasily
-
- Сообщения: 5567
- Зарегистрирован: Пн ноя 24, 2008 12:59 am
- Откуда: Киров
Low-dose aspirin in primary prevention
Low-dose aspirin in primary prevention: cardioprotection, chemoprevention, both, or neither?
Low-dose aspirin has been shown to be effective in preventing about one-fifth of atherothrombotic vascular complications (non-fatal myocardialinfarction, non-fatal stroke, or vascular death) in a meta-analysis of 16 secondary prevention trials in patients with previous myocardial infarction, stroke, or transient cerebral ischaemia. This corresponds to an absolute reduction of about 10–20 per 1000 patients in the yearly incidence of non-fatal events, and to a smaller, but still definite, reduction in vascular death. Against this benefit, the absolute increase in major extracranial bleeding complications [mostly, gastrointestinal (GI)] is 20- to 50-fold smaller, depending on age and sex. Hence, for secondary prevention, the benefits of antiplatelet therapy substantially exceed the risks. For primary prevention, the balance between vascular events avoided and major bleeds caused by aspirin is substantially uncertain because the risks without aspirin, and hence the absolute benefits of antiplatelet prophylaxis, are at least an order of magnitude lower than in secondary prevention. The aim of this article is to review the
updated evidence for the efficacy and safety of low-dose aspirin in primary prevention and to discuss additional health benefits resulting from prolonged antiplatelet therapy in apparently healthy people at low average risk of vascular events.
European Heart Journal (2013) 34, 3403–3411
Low-dose aspirin has been shown to be effective in preventing about one-fifth of atherothrombotic vascular complications (non-fatal myocardialinfarction, non-fatal stroke, or vascular death) in a meta-analysis of 16 secondary prevention trials in patients with previous myocardial infarction, stroke, or transient cerebral ischaemia. This corresponds to an absolute reduction of about 10–20 per 1000 patients in the yearly incidence of non-fatal events, and to a smaller, but still definite, reduction in vascular death. Against this benefit, the absolute increase in major extracranial bleeding complications [mostly, gastrointestinal (GI)] is 20- to 50-fold smaller, depending on age and sex. Hence, for secondary prevention, the benefits of antiplatelet therapy substantially exceed the risks. For primary prevention, the balance between vascular events avoided and major bleeds caused by aspirin is substantially uncertain because the risks without aspirin, and hence the absolute benefits of antiplatelet prophylaxis, are at least an order of magnitude lower than in secondary prevention. The aim of this article is to review the
updated evidence for the efficacy and safety of low-dose aspirin in primary prevention and to discuss additional health benefits resulting from prolonged antiplatelet therapy in apparently healthy people at low average risk of vascular events.
European Heart Journal (2013) 34, 3403–3411
- Вложения
-
- Low-dose aspirin in primary prevention.pdf
- Оригинал статьи
- (488.97 КБ) 236 скачиваний
Пьянков Василий Алексеевич
-
- Сообщения: 5567
- Зарегистрирован: Пн ноя 24, 2008 12:59 am
- Откуда: Киров
Спасибо Артемий! У нас похоже никто не читал последний европейский гайд по сердечно-сосудистой профилактике. Назначают аспирин всем подряд, без разбора. По телевизору идет активная реклама низкодозовых препаратов аспирина известных западных брендов.AOkhotin писал(а):Для первичной профилактики почти не назначаю, только при очень высоком риске, в основном при сахарном диабете. И всегда предупреждаю больных, что польза очень мала. Но они все ссылаются на Бокерию, который где-то по телевизору рекомендует всем.
P.S. Впрочем у американцев пока действуют старые рекомендации по применению аспирина при первичной профилактие.
- Вложения
-
- 666.jpg (98.02 КБ) 5137 просмотров
-
- 555.jpg (47.99 КБ) 5137 просмотров
-
- 444.jpg (38.97 КБ) 5137 просмотров
-
- Европейский гайд 2012г.
- .jpg (245.1 КБ) 5137 просмотров
Пьянков Василий Алексеевич
-
- Сообщения: 139
- Зарегистрирован: Чт май 05, 2011 4:22 pm
- Откуда: Киров
Аспирин принимается для разжижения крови. Чтобы не передозировать - нужно контролировать МНО ((С) Пациенты). Шутки шутками, но про необходимость контроля свертываемости (в виде протромбина/ МНО) очень многие "знают".
А назначение аспирина при гемодинамически незначимых (и неосложненных) стенозах БЦА- это первичная или вторичная прифилактика?
А назначение аспирина при гемодинамически незначимых (и неосложненных) стенозах БЦА- это первичная или вторичная прифилактика?
-
- Сообщения: 5567
- Зарегистрирован: Пн ноя 24, 2008 12:59 am
- Откуда: Киров
-
- Сообщения: 5567
- Зарегистрирован: Пн ноя 24, 2008 12:59 am
- Откуда: Киров
Самые новые рекомендации AHA/ASA по применению аспирина у женщин для первичной профилактики инсульта.
Aspirin therapy (75–325 mg/d) is reasonable in women with diabetes mellitus unless contraindicated.
(Class IIa; Level of Evidence B)
Aspirin therapy can be useful in women ≥65 years of age (81 mg/d or 100 mg every other day) if BP is controlled and the benefit for IS and MI prevention is likely to outweigh the risk of gastrointestinal bleeding and hemorrhagic stroke (Class IIa; Level of Evidence B) and may be reasonable for women <65 years of age for IS prevention (Class IIb; Level of Evidence B).
Aspirin therapy (75–325 mg/d) is reasonable in women with diabetes mellitus unless contraindicated.
(Class IIa; Level of Evidence B)
Aspirin therapy can be useful in women ≥65 years of age (81 mg/d or 100 mg every other day) if BP is controlled and the benefit for IS and MI prevention is likely to outweigh the risk of gastrointestinal bleeding and hemorrhagic stroke (Class IIa; Level of Evidence B) and may be reasonable for women <65 years of age for IS prevention (Class IIb; Level of Evidence B).
Пьянков Василий Алексеевич
-
- Site Admin
- Сообщения: 3780
- Зарегистрирован: Пн мар 19, 2007 10:40 am
- Откуда: Таруса
- Контактная информация:
Первичная.Alexey Gritchin писал(а):А назначение аспирина при гемодинамически незначимых (и неосложненных) стенозах БЦА- это первичная или вторичная прифилактика?
Но вообще, по-видимому, выявление таких стенозов приносит больше вреда, чем пользы:
http://www.medpagetoday.com/Cardiology/Strokes/44344
-
- Сообщения: 5567
- Зарегистрирован: Пн ноя 24, 2008 12:59 am
- Откуда: Киров
The U.S. Preventive Services Task Force (USPSTF) recommends against screening for asymptomatic carotid artery stenosis (CAS) in the general adult population.
http://www.uspreventiveservicestaskforc ... ftrec3.htm
http://www.uspreventiveservicestaskforc ... ftrec3.htm
Пьянков Василий Алексеевич
-
- Сообщения: 5567
- Зарегистрирован: Пн ноя 24, 2008 12:59 am
- Откуда: Киров
Effects of Changing Guidelines on Prescribing Aspirin for Primary Prevention of Cardiovascular Events
Objective:
The use of low-dose aspirin for primary prevention of cardiovascular events in patients at elevated risk for cardiovascular disease (CVD) is increasingly being questioned. Aspirin may not benefit this population and may increase the risk of major bleeding events. Data support aspirin use in patients with known CVD.
Methods:
This is a secondary analysis of de-identified electronic health record (EHR) data from 131,050 individuals with known CVD or elevated risk for CVD as determined by diagnostic, demographic, and clinical data collected from 33 primary care practices in 11 different clinical organizations across 6 states. The percentage of the population of each cohort with aspirin recorded on their medication list, created through risk base analysis, was observed across 4 time periods.
Results:
From 2007 to 2011, aspirin usage reflected in the EHR increased for the entire population and for each individual high-risk diagnosis. The percentage of the population initiating aspirin therapy for primary prevention within a year of diagnosis of CVD risk factors or CVD "equivalency" increased between 2007 and 2011. Among those with a new diagnosis of CVD, aspirin usage also steadily increased over the 4-year period, indicating no negative impact from new negative primary prevention studies.
Conclusions:
Primary care clinicians have a central role in providing evidence-based preventive services and should integrate revised information into their practice to improve outcomes. Even with new evidence against the use of aspirin for primary prevention, it is difficult to change beliefs about the effectiveness and safety of aspirin, as reflected in the behavior of physicians and patients.
J Am Board Fam Med. 2014;27(1):78-86.
Objective:
The use of low-dose aspirin for primary prevention of cardiovascular events in patients at elevated risk for cardiovascular disease (CVD) is increasingly being questioned. Aspirin may not benefit this population and may increase the risk of major bleeding events. Data support aspirin use in patients with known CVD.
Methods:
This is a secondary analysis of de-identified electronic health record (EHR) data from 131,050 individuals with known CVD or elevated risk for CVD as determined by diagnostic, demographic, and clinical data collected from 33 primary care practices in 11 different clinical organizations across 6 states. The percentage of the population of each cohort with aspirin recorded on their medication list, created through risk base analysis, was observed across 4 time periods.
Results:
From 2007 to 2011, aspirin usage reflected in the EHR increased for the entire population and for each individual high-risk diagnosis. The percentage of the population initiating aspirin therapy for primary prevention within a year of diagnosis of CVD risk factors or CVD "equivalency" increased between 2007 and 2011. Among those with a new diagnosis of CVD, aspirin usage also steadily increased over the 4-year period, indicating no negative impact from new negative primary prevention studies.
Conclusions:
Primary care clinicians have a central role in providing evidence-based preventive services and should integrate revised information into their practice to improve outcomes. Even with new evidence against the use of aspirin for primary prevention, it is difficult to change beliefs about the effectiveness and safety of aspirin, as reflected in the behavior of physicians and patients.
J Am Board Fam Med. 2014;27(1):78-86.
Пьянков Василий Алексеевич