PPRNet Practice Guidelines
Aspirin
Chemoprevention
Practice guidelines:
· Aspirin or anti-platelet agent prescribed for men >=45 years of age and women >=55 years of age, and in patients with diabetes, coronary heart disease, other atherosclerotic disease, hypertension or hyperlipidemia
The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians
assess both the benefits and risks of aspirin chemoprevention with adult
patients at increased risk of coronary heart disease.
The USPSTF found good evidence that aspirin decreases the
incidence of myocardial infarction in men 45 years of age or older and ischemic
stroke in women 55 years of age or older. They also found good evidence
that aspirin increases the incidence of gastrointestinal bleeding and fair
evidence that aspirin increases the incidence of hemorrhagic stroke. Calculators
have been developed to assess patients’ initial risk of coronary heart disease (http://www.mcw.edu/calculators.htm)
or ischemic stroke (http://www.westernstroke.org/PersonalStrokeRisk1.xls).
Age and sex are the most important risk factors for gastrointestinal bleeding
and other risks include upper gastrointestinal tract pain,
gastrointestinal ulcers, and non-steroidal anti-inflammatory drug (NSAID) use.
While patients 80 years of age or older carry significant cardiovascular risk,
they are also in the highest risk group for gastrointestinal bleeding.
Therefore the USPSTF also concluded that the current evidence is insufficient to
assess benefits and harms for this group of patients.
Additional resources:
USPSTF Recommendation: Aspirin for the Prevention of Cardiovascular Disease (updated March 2009)
