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The Consequences of Stopping Low-Dose Aspirin
10/16/2016 11:35:00 AM
Information sourced from NEJM Journal Watch:
The Consequences of Stopping Low-Dose Aspirin
The risk for cardiovascular events rises soon after discontinuation, according to this large-scale, observational study.
Aspirin is a mainstay in the treatment of patients with coronary artery disease and has been used for primary prevention. To learn about the effect of discontinuing aspirin, investigators examined Swedish national databases to conduct a partially industry-funded, cohort study of approximately 600,000 users of low-dose aspirin for primary or secondary prevention between 2005 and 2009.
Included were people aged >40, without cancer histories, and with an 80% adherence during the first year of aspirin use (mean age, 73; 52% women; diabetes, 16%); 54% used aspirin for secondary prevention, whereas the others likely used aspirin as primary prevention. Almost 63,000 cardiovascular events occurred during a median follow-up of 3 years (incidence rate, 42/1000 person-years at risk).
In adjusted analyses, persistent aspirin treatment was associated with the lowest cumulative incidence of cardiovascular events. Patients who discontinued aspirin had a 37% higher rate of cardiovascular events (13.5 events/1000 person-years at risk). In subgroup analyses, older individuals and those with prior cardiovascular disease faced even higher risks for events off aspirin. Treatment with oral anticoagulants or other antiplatelet drugs, however, was not associated with risk for cardiovascular events off aspirin.
COMMENT
One of every 74 Swedes who discontinued aspirin experienced an additional cardiovascular event within 1 year. The risk for cardiovascular events increased soon after the discontinuation of aspirin therapy and did not wane over time. This study provides strong evidence for the continuation of aspirin indefinitely in patients with known cardiovascular disease.
Joel M. Gore, MD reviewing Sundström J et al. Circulation 2017 Sep 26.
CITATION(S):
Sundström J et al. Low-dose aspirin discontinuation and risk of cardiovascular events. Circulation 2017 Sep 26; 136:1183.
[Free full-text Circulation article]
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