Some patients appear to get prophylactic aspirin treatment inappropriately

by Bruce Sylvester: About 12 percent of patients treated with aspirin for cardiovascular disease prevention are receiving aspirin inappropriately, researchers reported on Jan, 12, 2015 in the Journal of the American College of Cardiology.

Providers should consider whether the potential for bleeding outweigh the potential benefits of aspirin therapy in patients who don’t yet meet guidelines for aspirin therapy, said lead investigator Ravi S. Hira, M.D., of the Baylor College of Medicine in Houston, Texas. “Since aspirin is available over the counter, patient and public education against using aspirin without a medical provider’s recommendation will also play a key role in avoiding inappropriate use,” he added.

As background, the authors noted that the American Heart Association, the U.S. Preventative Services Task Force, and other organizations, have said that prophylactic aspirin use is inappropriate in patients with a 10 year cardiovascular disease risk of less than 6 percent.

The investigators analyzed data from the (US) National Cardiovascular Disease Registry Practice Innovation and Clinical Excellence (PINNACLE) Registry, a US national sample of 68,808 patients prescribed aspirin to prevent primary cardiovascular disease.

The investigators identified patients from 119 practices who were treated with aspirin between January 2008 and June 2013. They excluded patients using aspirin for secondary prevention due to a history of cardiovascular disease.

They found that about 12 percent of the subjects prescribed aspirin for primary prevention were treated with it inappropriately.

The rate of inappropriate aspirin use was higher among women (17 percent) than men (5 percent). Inappropriately treated subjects were an average of 16 years younger than appropriately treated subjects.

Notably, inappropriate aspirin use decreased from 14 percent in 2008 to 9 percent in 2013.

A comparison of medical practices led to the discovery of wide variation in the prophylactic use of aspirin. The investigators used a median rate ratio analysis, and they determined that between two similar patients treated at two random practices, one patient was 63 percent more likely to be prescribed aspirin inappropriately, depending on location of medical care.

In an accompanying editorial, Freek W.A. Verheugt, M.D., of Onza Lieve Vrouwe Gasthuis Radboud University Nijmegen Medical Centre in Amsterdam, The Netherlands  said, “Major coronary events are reduced 18 percent by aspirin, but at the cost of an increase of 54 percent of major extracranial bleeding. Each two major coronary events have shown to be prevented by prophylactic aspirin at the cost of one major extracranial bleed. Yet, primary prevention with aspirin is widely applied.”