Revised Guidelines on Use of Aspirin by Pakistan Aspirin Foundation to be finalized soon

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 Aspirin Session at Cardiology conference

Revised Guidelines on Use of Aspirin
by Pakistan Aspirin Foundation to
be finalized soon

All individuals at 10% of more risk of developing
CAD must be put on Low Dose Aspirin therapy

ISLAMABAD: As a part of its Continuing Medical Education programme, Pakistan Aspirin Foundation organized a panel discussion on Medical Uses of Aspirin at the recently held International Cardiology conference at Islamabad on December 22nd 2012. The session was chaired by Major Gen. Ashur Khan former President of Pakistan Aspirin foundation along with Prof. Khawar Kazmi from AKUH and Dr. Shaukat Malik from Islamabad. Prof. M. Akbar Chaudhry Principal Azra Nahid Medical College from Lahore who is the current President of PAF was the main speaker.
In his brief introductory remarks, Prof. Akbar Chaudhry highlighted the well established indications for the use of Low Dose Aspirin Therapy besides its new and emerging indications. Speaking about the efficacy of antiplatelets and cardiovascular diseases, he said that as per WHO estimates by 2030 as many as 23.6 million deaths will take place in the world due to cardiovascular disease and most of these deaths will be in developing countries which are already faced with the problem of communicable diseases. Cardiovascular disease is also on the increase in low income countries. CAD is very high in countries like China, India as well as Pakistan where it has become an epidemic.
According to National Health Survey by PMRC about 18% of our adult population suffers from hypertension. We need to do something about modifiable risk factors like hypertension, diabetes mellitus, dyslipidemia, obesity, metabolic syndrome and smoking. According to reports we have 17% male smokers while in female the prevalence of smoking was about 3%. It is recommended that all healthy individuals at risk of cardiovascular diseases should be prescribed Low Dose Aspirin therapy and enteric coated tablets of Aspirin should be preferred as they are safe in long term use. Aspirin prevents myocardial infarction while it also reduces the risk of secondary MI and stroke. As regards primary prevention, all those patients who have a risk of more than 10% of developing cardiovascular diseases should be prescribed Aspirin therapy. In case the risk is less than 10%, then one must discuss with the patient and then take a decision. Risk factor screening was suggested at the age of thirty years. Diet therapy, weight control, lipid control, control of hypertension along with Aspirin therapy will be quite helpful.
Studies have revealed that use of Aspirin in primary prevention results in 33% risk reduction of Myocardial Infarction, it reduces the risk of stroke by 25% and other cardiovascular events by 17%. During the discussion Prof. Khawar Kazmi referred to the Aspirin resistance which has been noted. Mr. Shaukat Ali Jawaid pointed out that like all other drugs, apart from resistance; there are some non-responders as well. Dr. Basheer Haneef from Taba Heart Institute Karachi talked about indications for use of Aspirin in primary prevention. He also stated that some time back Dr. Naveed Akhtar from Islamabad was conducting a study and he had noticed Aspirin resistance as high as 22%. It was pointed out that there are conflicting reports but now one of the largest primary prevention study with Aspirin (ARRIVE) which has enrolled over twelve thousand patients in five countries including Germany and China is underway. The results will be available by the end of 2013 and it will give us the clear cut answer on this issue. Dr. Shaukat Malik also raised the issue of Aspirin resistance. He further stated that it was a very economically priced drug, hence no manufacturer can add anything in this as it was already quite cheap. Some of the participants raised the issue of quality of locally manufactured drugs. They were informed that most of the national pharmaceutical companies were producing quality drugs. Mr. Shaukat Ali Jawaid Secretary General of Pakistan Aspirin Foundation informed the audience that at present the Foundation was revising the guidelines on use of Aspirin. Prof. Abdus Samad and Prof. Ejaz Ahmad Vohra have prepared the draft guidelines and they have been sent to some eminent cardiologists and physicians for their input. The main emphasis in these revised guidelines is on risk assessment score for which the formula used in Framingham study has been used. The physicians will be educated on how to do this risk assessment score before prescribing Aspirin therapy. Once the input is received from others, then these guidelines will be finalized, he added.
Summing up the discussion Major Gen. Ashur Khan said that enteric coated aspirin tablets provide safety in long term use. All healthcare professionals particularly the Medical Officers in the hospitals should be educated to prescribe Aspirin along with other medications while the cardiac patients are discharged unless there are some contraindications. He also referred to the indiscriminate use of PPIs and H2 blockers. In case of MI, one full dose tablet of Aspirin 325mg should be used. Previously Aspirin despite lot of useful studies was quite underused but now ever since the CME programmes started by Pakistan Aspirin Foundation, usage of Aspirin has increased in its established indications.
The programme was sponsored by Atco Laboratories who are taking care of all CME pogrammes organized by Pakistan Aspirin Foundation. However, Prof. M. Akbar Chaudhry did point it out that the Foundation keeping up professional ethics, does not endorse the use of any particular brand name and it is up to the physicians to select a suitable Aspirin preparation.