Healthcare professionals reminded to promote the use of Low Dose Aspirin therapy in its well established indications

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 Panel discussion on use of Aspirin at Gujranwala and Sialkot

Healthcare professionals reminded to promote
the use of Low Dose Aspirin therapy in
its well established indications

Guidelines prepared by Pakistan Aspirin Foundation
gives comprehensive details about indications, dosage,
contra-indications as well as emerging uses of Aspirin

GUJRANWALA & SIALKOT: Pakistan Aspirin Foundation as a part of its Continuing Medical Education programme for healthcare professionals organized panel discussion on Medical Uses of Aspirin at Gujranwala and Sialkot on March 8th and 9th respectively. A select group of cardiologists, physicians, obstetricians &gynecologists and Surgeons besides leading Family Physicians were invited to have their feedback on these Guidelines which were distributed among the participants along with an informative booklet in Urdu on Aspirin- a lifesaving miracle drug authored by late Dr. Maqbool H. Jafary and Mr. Shaukat Ali Jawaid Chief Editor of Pulse International who is also Secretary of the Foundation.

It may be mentioned here that despite lot of studies and literature proving the safety and efficacy of low dose aspirin therapy in a wide range of medical disorders, cardiovascular diseases in particular, aspirin is still under used in Pakistan and the situation is not different in many other countries as well. That is why Pakistan Aspirin Foundation has started this campaign of creating awareness about the use of Low Dose Aspirin therapy among the healthcare professionals.


Pakistan Aspirin Foundation organized a panel discussion on Medical Uses of Aspirin in its
well established indications at Gujranwala on March 8th2016. Picture taken on this occasion
shows Dr. Ikram Warraich and Mr. Shaukat Ali Jawaid (in the center) speaking on this
occasion along with the participants.

Some of the well-establishedindications for regular use of low dose aspirin therapy are as under:

  1. Acute Myocardial Infarction(AMI)
  2. Acute Coronary Syndrome
  3. Secondary prevention of AMI
  4. Primary prevention of CAD
  5. Acute Ischemic strokes
  6. Transient Ischemic Attacks(TIAs)
  7. Primary and Secondary prevention of strokes
  8. Hypertension
  9. Diabetes Mellitus
  10. Acute Rheumatic Fever
  11. Prophylaxis against DVT and Pulmonary Embolism

In addition to the above there are some emerging indications for the use of Aspirin therapy which includes colorectal cancer, pregnancy induced hypertension, Eclampsia, Phospholipid Antibody Syndrome, Dementia and Alzheimer’s Disease etc.


At the Gujranwala meeting after brief introduction of the Pakistan Aspirin Foundation and the Guidelines by Mr. Shaukat Ali Jawaid, Dr. IkramWarraich moderated the session and asked for input from the participants who actively participated in the discussion and put forward their views. Dr. Ikram Warraich remarked that Aspirin is also called as poor man’s Streptokinase and poor man’s Statin as it reduces mortality after acute myocardial infarction by 23% if one soluble tablet of Aspirin is taken immediately while the streptokinase injection which costs about five thousand rupees achieves similar mortalityreduction. However, if both are combined the mortality reduction is further increased. He also pointed out that even in impending cases of myocardial infarction, Aspirin is highly effective and proves lifesaving. Hence in case of chest pain, cardiac or non-cardiac in nature, one tablet of Aspirin 325mg should be give immediately. In acute conditions soluble aspirin should be preferred while for longer use low dose Aspirin enteric coated tablets are preferred because of safety.


Dr. Zeeshan and Mr. Kashif Riaz speaking at the Panel Discussion on Medical Uses of Aspirin
organized by Pakistan Aspirin Foundation at Sialkot on March 9th 2016. Prof. Eice Mohammad
Prof. of Medicine at Islam Medical College presided who is also seen in the picture along
with Mr. Shaukat Ali Jawaid. On extreme right is a view of the participants.

During the discussion it was also highlighted that first the patients should be advised to change their life style and reduce the known risk factors before starting any therapeutic intervention. Elderly patients who are already taking too many medications should avoid the use of Aspirin or use it very carefully. Replying to a questions regarding the use of Aspirin in Gout and Hyperuricemia, it was pointed out that in order to provide protection against cardiovascular disease to these elderly patients who are also suffering from Gout, low dose aspirin therapy is quite safe and can be given. However, it was emphasized that for long term use, lose dose of 75mg, 81mg or 100mg was recommended but for stroke the recommended dosage of Aspirin was 150mg daily. One of the participants suggested that in case of chest pain radiating to left side, one should first take an ECG. However, it was pointed out that it is neither feasible nor practical and ECG facilities may not be available at that time. It was also highlighted that the toxicity score of NSAIDs which are being extensively used was much higher as compared to Aspirin.


An obstetrician and Gynaecologist remarked that Aspirin therapy is indicated in patients with bad obstetric history, frequent miscarriages, secondary infertility besides pregnancy induced hypertension and we use it regularly. The panel discussion at Sialkot was chaired by Prof. Eice Mohammad and it was also attended by  cardiologists, physicians, surgeons, nephrologists, postgraduate students and leading family physicians. Consultant cardiologist Dr. Zeeshan speaking at the occasion said that without cardiology there is no Medicine and without Aspirin there is no Cardiology which highlights the importance of Aspirin in management of cardiovascular diseases. He reiterated its use in well-establishedindications like AMI, CAD, primary and secondary prevention of AMI, stroke, IHD, TIAs, Acute Coronary Syndrome after PCI, angioplasty and Stenting besides numerous emerging indications for the regular use of low dose aspirin therapy. 

All individuals after the age of forty years with more than two risk factors like hypertension, obesity, overweight, family history of heart disease etc., should be put on regular low dose aspirin therapy.  One of the participants remarked that most of the doctors have a sedentary life style, hence they should also take low dose aspirin regularly. Dr. Zeeshan further stated that one can also use combination therapy of Aspirin with clopidogril which further enhances its efficacy. If it cannot be taken orally, one can administer aspirin through rectal route in emergency in acute conditions.

 

Some of the participants at the Panel Discussion on Medical Uses of Aspirin organized
by Pakistan Aspirin
Foundation at Sialkot on March 9th 2016.

Dr. Khawar Qureshi participating in the discussion endorsed the use of low dose aspirin therapy in its well established indications which he said, have been discussed in detail. Aspirin is being used now for more than one hundred years and its safety and efficacy in a wide range of medical disorders has been well established. For the first time it was also used for the treatment of arthritis. Dr. Mrs. Khawar Qureshi consultant obstetrician and Gynaecologist referred to the use of Aspirin therapy in PIH, cases of secondary infertility, repeatedmiscarriages, Eclampsia where Aspirin was being used regularly. Dr. Khawar Qureshi was of the view that while using Aspirin therapy one should always calculate the risk benefit ratio which is quite easy to calculate and then prescribe aspirin therapy. Responding to a question Mr.Shaukat Ali Jawaid said that there was no difference in efficacy hence one can use either 75mg, 81mg or 100mg enteric coated Aspirin tablets for long term use.  He also informed that recent studies suggest that low dose Aspirin therapy should be taken at night which will take care of the early morning spike in blood pressure as most of the heart attacks occur early in the morning.

Prof. Eice Mohammad in his remarks thanked Pakistan Aspirin Foundation for promoting the medical uses of Aspirin. However, he cautioned that in case of combination of Aspirin and Clopidogril, the risk of bleeding also increases and one has to be careful in such conditions.


Earlier in his introductory remarks Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation pointed out that the Foundation has no company bias. We strictly uphold professional ethics and do not support or promote any company or brand name. It is up to the healthcare professionals to use any Aspirin they like. However, he thanked Atco Laboratorieswhich has been sponsoring these CME programmes for the last many years. We are extremely thankful to them for this generosity and extending us their valuable help and assistance in this noble cause. These Guidelines, he further stated, have been prepared by an Experts Panel of Pakistan Aspirin Foundation headed by Prof. Abdus Samad an eminent cardiologists of Pakistan. Other members of the group included Prof. Ejaz Ahmad Vohra another distinguished physician from Ziauddin Medical University, Prof. M. Akbar Chaudhry presently Principal of Azra Naheed Medical College and all of them have served as Presidents of Pakistan Aspirin Foundation.  We reviewed the literature on Aspirin until 2014 before finalizing these guidelines and it was shared with a large number of eminent cardiologists to have their input before its final publication. He also thanked the participants for joining in the panel discussion and specially thanked Prof. Eice Mohammad who was kind enough to have graced the occasion with his presence and share his views on use of low dose aspirin therapy. Both these meetings were sponsored by Atco Laboratories.

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