Aspirin is an essential part of antiplatelet therapy in secondary prevention of cardiovascular diseases- Shahbaz Kureshi


 Aspirin Session at CARDIOCON 2018

Aspirin is an essential part of antiplatelet
therapy in secondary prevention of
cardiovascular diseases- Shahbaz Kureshi

It can also be used for primary prevention in selected patients

MULTAN: Aspirin is an essential part of dual antiplatelet therapy in and it is strongly indicated in secondary prevention of cardiovascular diseases. It can also be used for primary prevention in carefully selected cases. However, for those who have a high risk of bleeding, it should not be used for primary prevention in adults with diabetes and low atherosclerotic risk. Currently numerous trials are ongoing to find out and one should calculate the risk before prescribing Aspirin. This was stated by Prof. Shahbaz A. Kureshi consultant cardiologist and President-elect of Pakistan Aspirin Foundation. He was making a presentation on “Aspirin for Life” at the breakfast session on Aspirin during the recently held CARDIOCON 2018 at Nishter Medical University Multan on November 24th 2018.

Prof. Shahbaz A. Kureshi 

Prof. Shahbaz Kureshi further stated that for secondary prevention in patients with diabetes, there is no controversy regarding the use of anti-platelet therapy. However, one has to keep in mind that platelet aggregation is higher on aspirin treatment in patients with diabetes than non-diabetics. Hence, in these patients dosing twice daily may be more useful. As regards aspirin resistance, it seems to be over-stated. It more importantly appears to be lack of adherence to therapy or they may be non-responders, he remarked.

Speaking about the use of aspirin for primary prevention, Prof. Shahbaz Kureshi said at present it is controversial. “Aspirin-guide” apps have been developed which can help the physicians decide whether or not a person is a candidate and should be prescribed Low-Dose Aspirin for primary prevention by balancing the benefits of preventing atherosclerotic cardiovascular disease against the risk of developing gastrointestinal bleeding. The use of a proton pump inhibitor (PPI) may be considered in these cases, he added. New and emerging indications of Aspirin shows that it is very useful in colorectal cancer but does not seem to have an effect on non-GI cancers including breast, advance prostate and lung cancer. Studies have showed that it does reduce the GI cancers including colorectal and may be gastro esophagus cancer as well.

Earlier speaking about the historical background of discovery of Aspirin and its mechanism of action, Dr. Shahbaz Kureshi said that it took a long time and course of experimental research to understand the mechanism between COX acetylation by acetylsalicylic acid and platelet function inhibition. Aspirin leads to prostaglandin intermediates, which are the precursors of thromboxane. Platelet activation occurs upon stimulation of thromboxane A2 of TP receptor on the platelet membrane, similar to the action of ADP on the P2Y12 receptor. These two amplification loops are not redundant, which explains why targeting different receptors with different agents simultaneously can give added benefit.

Prof. Mustafa Kamal Pasha Vice Chancellor of Nishtar Medical University with members of the
Pakistan Aspirin Foundation presenting a cheque to the Citizens Foundation on behalf of Atco Laboratories
during the Aspirin Session at the recently held Cardiology conference at Multan on November 24th 2018.

Athero thrombosis is the unhealthy coupling of atherosclerosis and thrombosis. This process can affect any vessel of the body, i.e. coronary, cerebral and peripheral arteries. Atherosclerosis can affect multiple vascular beds; about 15% of patients have poly vascular disease. In response to a vascular injury, the platelet has an important function in preventing thrombus formation, hence the role of antiplatelet therapy in preventing platelet activation upstream, and platelet aggregation downstream. Numerous antiplatelet approaches exist. The data for “humble aspirin” are extremely robust. There is no difference is seen between lower and medium doses in reducing cardiovascular death, myocardial infarction and stroke. Keeping in mind the risk of gastrointestinal bleeding, the lower dose seems to be the way to go for chronic therapy. CAPRIE trial demonstrated that clopidogrel is more effective than aspirin in reducing event rate and the rate of rehospitalisation in patients with recent ischemic stroke, myocardial infarction or symptomatic peripheral arterial disease. Antiplatelet therapy is used in higher risk patients. However, the guidelines still recommend aspirin, to be continued indefinitely in stable ischemic heart disease, and clopidogrel is only used if aspirin is contraindicated, Prof.Shahbaz Kureshi concluded. Dr. Farooq Fawad from National Institute of Cardiovascular Diseases moderated the session.

Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation welcomed the guest speakers and participants to the session and Mr. Kashif Riaz Business Unit Head from, Atco Laboratories and his team for making all the arrangements.. He also clarified that though M/s Atco Laboratories are sponsoring our CME activities for the last many years but keeping up the processional ethics, we do not patronize and promote any particular company or brand name of Aspirin. Later, a cheque was presented on behalf of Atco Laboratories to the Citizen Foundation to promote education in the country as one of their Corporate Social Responsibilities.

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