One study found that stopping aspirin may increase the risk of cardiovascular events in certain patients who previously took it to prevent heart disease. This challenges current guidelines and suggests an individualized approach to aspirin use.

Analysis of the results of international trials calls into question whether current aspirin recommendations apply to all patients.

In a study published in a prestigious medical journal Circulationa review of data from three clinical trials, calls into question current best practices for the use of drugs for the primary prevention of stroke and the heart disease known as atherosclerosis. cardiovascular disease.

The study examined the results of a clinical trial published in 2018 that included more than 47,000 patients in 10 countries, including the United States, United Kingdom, and Australia.

Subgroup analysis reveals new insights

The analysis focused on results for a subgroup of 7,222 patients who were already taking aspirin before the three trials began. The people in the study were at high risk for cardiovascular disease and were taking aspirin to prevent their first heart attack or stroke.

According to the data, patients who took aspirin before the trial and then stopped had a 12.5% ​​versus 10.4% higher risk of heart disease or stroke compared to those who continued taking it.

The analysis also found no significant statistical difference in the risk of major bleeding between the two patient groups.

Changing expert perspectives and guidelines

The study was conducted by Professor J. William McEvoy, an established professor of preventive cardiology at the University of Galway and consultant cardiologist at Saolta University Healthcare Group, in collaboration with researchers from the University of Tasmania and Monash University in Melbourne. I took the lead.

Professor McEvoy said: “We challenged the idea that aspirin withdrawal is a one-size-fits-all approach.”

The research team found that adults who were first prescribed aspirin to reduce their risk of heart attack or stroke, but then chose to stop taking it without being told, had a 28% lower risk of heart disease and stroke. We focused on the results of observational studies that suggest a higher percentage. Doctors do that.

Based largely on three major clinical trials published in 2018, international guidelines no longer recommend the routine use of aspirin to prevent first heart attacks and strokes.

Importantly, aspirin is still recommended for high-risk adults who have already had heart disease or stroke to reduce the risk of secondary events.

The shift away from primary prevention aspirin in recent guidelines was motivated by the increased risk of major bleeding seen with this common drug in three trials, but major bleeding is relatively rare with aspirin and It was most evident only among trial participants who started, but not among those who had previously taken aspirin safely, during the trial.

Continuation of aspirin: A balanced approach

These trials primarily tested the effects of starting aspirin in adults who had not previously been treated with aspirin to reduce the risk of atherosclerotic cardiovascular disease. Less is known about what to do in the common scenario of adults who are already safely taking aspirin for primary prevention.

Professor McEvoy said: “Our findings about the benefits of aspirin in reducing heart disease and stroke without the risk of excessive bleeding in some patients who already take aspirin without having bleeding problems. “This may be due to the fact that adults inherently have lower future risk.” Bleeding problems caused by drugs. Therefore, they appear to be getting more of the benefits of aspirin with less risk.

“While these results are hypothesis-generating, they are the best data available at this time. Until further evidence is available, aspirin-related bleeding is already safe as a primary preventive measure, unless new risk factors emerge. People currently receiving low-dose aspirin treatment may be able to continue it.

Reference: “Outcomes after Aspirin Discontinuation for Baseline Users in Modern Primary Prevention Aspirin Trials: A Meta-Analysis” by Ruth Campbell, Mark R. Nelson, John J. McNeil, and John W. McEvoy, 2024. February 26th, Circulation.
DOI: 10.1161/circulationAHA.123.065420