PPRNet Practice Guidelines

 

Aspirin Chemoprevention  

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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)