Q&A
Q
Regarding the three back to back NEJM publications regarding use and safety of Aspirin, which publication is the most relevant?
A.
All 3 publications showing no overall benefit of aspirin despite slight decrease in cV events in various primary prevention settings are important as they also showed slight increase in GI hemorrhage and cancer. Hence be away from aspirin unless you had CAD symptoms or ACS.
Q
What is its unambiguous take home message?
A.
The aspirin message is clear that aspirin should not be routinely prescribed for primary prevention even in diabetics.
Q
What could be the reason of higher cancers?
A.
The reasons for higher cancer in aspirin group is not clear and is being intensely studied currently.
Q
Have you begun to act regarding your patients following this unprecedented press?
A.
Yes, I am asking pts not to take aspirin for the indication of primary prevention.
Q
Have you already begun changing your recommendations for the healthy elderly?
A.
Yes. No need to take aspirin unless you have ACS or CAD or had a procedure.
Q
So, for which patient is Aspirin recommended now?
A.
Aspirin is indicated in ACS & CAD pts, post PCI pts and post CABG pts.
Q
The dose?
A.
Aspirin 75-100mg daily. In pts weighing >80kg, I will recommend 162mg daily.
Q
And for which patients is Aspirin not recommended now?
A.
Aspirin is not recommended in the primary prevention and diabetic setting.
Q
Are we looking at complete elimination of Aspirin and COX 2 inhibitors in the future from Interventional Cardiology?
A.
Only future trials will show the final role of aspirin in the CAD pts and may very well be eliminated from the therapeutic armamentarium.
Q
Based upon these three publications, can one expect guidelines modifications?
A.
Yes, upcoming guideline will incorporate these updated recommendations.
