Safety and efficacy of Low Dose Aspirin therapy in Acute Coronary Syndromes highlighted

Print

 Safety and efficacy of Low Dose Aspirin therapy
in Acute Coronary Syndromes highlighted

Healthcare professionals advised to promote this economically
priced anti-platelet therapy in its well established indications

BUREWALA: Pakistan Aspirin Foundation in collaboration with the local Pakistan Medical Association organized a CME meeting here on December 20, 2016 which was very well attended by cardiologists, leading family physicians and some members of the local PMA.  The objective was to create awareness and promote Aspirin low dose therapy in its well established indications particularly in acute coronary syndrome. The other objective was to provide an opportunity to the local healthcare professionals to share their knowledge and experience in the use of low dose Aspirin therapy.  Dr. Imran Samiullah, Consultant Cardiologist was the moderator of the session. The meeting was very well attended by eminent family physicians, office bearers of local PMA besides some Obstetricians & Gynecologists.

Dr. Imran Samiullah shared his own experience of using low dose Aspirin therapy in acute coronary syndrome. He pointed out that it was a wonder drug which can prove lifesaving in acute myocardial infarction if one full tablet of Aspirin is taken immediately after chest pain. Studies have shown that it reduced mortality by 23% in AMI and if it is combined with streptokinase, the mortality reduction is over 40% provided the patient is managed within six hours of the onset of chest pain. It also reduced morbidity and mortality in a number of other disorders like TIAs, Stroke, Coronary Artery Disease, Hypertension and Diabetes Mellitus. Some other members also shared their experience of using low dose Aspirin therapy.


Dr. Maqsood Sheikh on behalf of  PMA Burewala presenting a memento to
Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation
and Chief Editor Professional Medical Publications at the meeting organized
by Pakistan Aspirin Foundation here on December 20, 2016.    

Earlier Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation in his introductory remarks said that revised updated Guidelines of Medical uses of Aspirin were now being widely distributed among the healthcare professionals all over the country at such CME meetings which are being organized by the Pakistan Aspirin Foundation.  These guidelines were finalized by the Experts Panel of Pakistan Aspirin Foundation headed by Prof.Abdus Samad, an eminent interventional cardiologist, Prof. Ejaz Ahmad Vohra and Prof. M.Akbar Chaudhry with input from many other distinguished cardiologists and physicians from all over Pakistan. While preparing these guidelines we have looked at and reviewed all the studies on Aspirin published till December 2014. These Guidelines give detailed account of well-established indications for Aspirin Therapy like AMI, ACS, Secondary prevention of AMI, Primary prevention of CAD, TIAs, Stroke, Hypertension, and Diabetes Mellitus besides its use in prophylaxis in Pulmonary Embolism and Deep Vein Thrombosis. It  also gives details about the mechanism of action of Aspirin, dose in each disorder, absolute and relative contra indications. In acute emergency only soluble Aspirin 300mg should be used for quick relief. Aspirin is inexpensive, economically priced ideal antiplatelet agent. Enteric coated aspirin therapy is preferred because of its safety in long term use. Use of Aspirin after PCI, its combination therapy with clopidogrel, use of low dose Aspirin in CABG have all been  included in the guidelines.  Use of Aspirin is recommended for prevention of athero-thrombotic and thromboembolic events in patients with Atrial Fibrillation and at least one risk factor for a vascular events and for whom Warfarin is unsuitable. Those patients who are taking Warfarin should be given Clopidogrel and Aspirin should be stopped.

These Guidelines also include Framingham Risk Scoring to calculate the risk. Those patients who have absolute risk of less than 7% should not be given Aspirin, those having risk of 7-10%, it should be the patients choice but if the absolute risk is more than10%, these patients must be put on long term low dose Aspirin therapy 75-100mg daily.

Hypersensitivity to Aspirin, Hemorrhagic diathesis, documented acute gastric or duodenal ulcer and pregnancy after 36 weeks of gestation are some of the absolute contra indications for the use of Aspirin therapy. However, Aspirin can be used with caution in G6PD deficiency, breast feeding, chronic or recurrent peptic ulcer, severe renal or hepatic damage. Bronchial asthma is one of the contra-indications due to Aspirin sensitivity. Earlier Dr. Hafeezullah recited from the Holy Quran and also highlighted the meanings of the verses which were recited.


Dr. Imran Samiullah, Mr.Shaukat Ali Jawaid, Dr. Hafeez Mian and Mr. Kashif Riaz speaking
at a meeting organized by Pakistan Aspirin Foundation at Burewala on December 20, 2016.

The meeting at Dera Ghazi Khan on December 21, 2016 was moderated by Dr. Khalil Rahman, Consultant Cardiologist at the DG Khan Teaching Hospital. It was very well attended by medical officers, postgraduates from Dept. of Cardiology, CCU, emergency besides leading family physicians of the city.

In his address Dr. Khalilur Rehaman highlighted the safety and efficacy of Aspirin in acute coronary syndrome, AMI, secondary prevention of CAD. Use of Aspirin in primary prevention also figures in the discussion. Aspirin he pointed out was an ideal wonder drug which reduces morbidity and mortality in various medical conditions. While combining it with clopidogrel, one must weigh the risk and benefit as the combination will also increase the risk of bleeding. One tablet of Aspirin 300mg taken immediately or within six hours of onset of chest pain AMI, can prove to be lifesaving. A higher dose is needed in TIAs and Stroke for prevention. In CVA and DVT one will have to use a dose of 300mg daily. Enteric coated Aspirin, he said, was quite safe in long term use.

The meeting at Sahiwal was organized on December 22, 2016.  Dr. Samar Kazmi Consultant Cardiologist was the main speaker while Dr. Ghazzanfar Ali Shah Bukhari, Assistant Professor of Medicine   at   Sahiwal Medical College was the other speaker. Prof. Zafar H. Tanveer Principal Sahiwal Medical College also graced the occasion with his presence.  Some faculty members from Sahiwal Medical College, leading family physicians and Medical Officers from the Dept. Of cardiology, DHQ Teaching Hospital were also present. Dr. Kazmi discussed in detail the use of Low Dose Aspirin therapy in a wide range of cardiovascular disorders where use of aspirin has now been very well established. It includes ACS, AMI, and secondary prevention of AMI, TIAs and Stroke. Its emerging indications include colorectal cancer but for this one has to take Aspirin for a couple of years. Enteric coated tablet, he opined, might not ensure optimal bioavailability while for primary prevention, it was still being debated.


Dr. Samar Kazmi, Dr. Ghuzzanfar Ali Shah Bukhari, Mr.Shaukat Ali Jawaid and Mr.Abid speaking 
at a meeting organized by Pakistan Aspirin Foundation at Sahiwal on December 22, 2016.

Aspirin Dr. Kazmi further stated was an ideal antiplatelet drug which is lifesaving. He also briefly discussed its mechanism of action. Patients with cardiovascular events, he stated, were strong candidates for long term use of low dose aspirin therapy 75mg or 81mg. It reduces the mortality by 34% in AMI and results in 43% reduction in Unstable Angina. It also reduces the chances of sudden death by 25% and mortality reduction in TIA was about 23%.  Patients with dyspepsia should also be given proton pump inhibitors along with the Aspirin. In primary prevention one has to weigh the benefit risk. After PCI, angioplasty and Stenting one should use the dose of 300mg for one month and then follow it up with 75-100mg daily. Aspirin used in diabetics helps in achieving good glycemic control. One must be careful in patients with impaired renal failure.

Dr. Ghazzanfar Ali Shah Bukhari discussed other medical uses of Aspirin, its antipyretic and analgesic properties and highlighted its safety and efficacy in rheumatoid arthritis, osteoarthritis. Those patients taking COX inhibitors, NSAIDS, Aspirin and Proton Pump Inhibitors can be added. For prevention of colorectal cancer, the dose used is high and one has to take for long term to have any benefit. Aspirin, he said, was a wonder drug, economically priced. Patients with Asthma may develop some respiratory problems if Aspirin is used, that is why it is contra indicated. Some patients may have allergy to Aspirin. Yet another quality of Aspirin he said was that it combines various specialties of medicine i.e. surgeons, cardiologists, gastroenterologists, oncologists, orthopedic surgeons because they all use this drug for various indications. He laid emphasis that healthcare professionals should know where to use this wonder antiplatelet agent to get its maximum benefits and avoid complications.

During the discussion it was also pointed out that these Guidelines developed by Pakistan Aspirin Foundation was not the final word.  This provides useful information but it is up to the healthcare professionals to use Aspirin keeping in view the clinical condition of the patient as therapy has to be individualized and treating physician is the best judge. It was also highlighted that some obstetricians & Gynecologists are using low dose Aspirin Therapy in patients with bad obstetrics history, repeated miscarriages and infertility with excellent results. It is also being used in pregnancy induced hypertension. Since it is an era of evidence based medicine, Pakistan Aspirin Foundation Guidelines covers only those conditions where some data, evidence is available. The information included in the guidelines is all properly referenced. More recently it has been shown that if low dose Aspirin is taken at bed time, it is more beneficial as it takes care of the early morning spike in blood pressure. It is important to first control the blood pressure before prescribing low dose aspirin therapy in these patients. Mr. Shaukat Ali Jawaid further stated that Aspirin Foundations in the developed world promote Aspirin direct to the public but keeping in view the low literacy rate in Pakistan and our peculiar conditions, Pakistan Aspirin Foundation from the very first day had decided to promote it through the healthcare professionals who can then advise the patients. He urged the Family Physicians to asks their high risk patients to keep Aspirin at home all the time as it may prove lifesaving if some patient suffers from AMI at odd hours at night when doctors and healthcare facilities are not easily accessible.


Dr. Imran Samiullah, Dr. Mian Hafeez and some other members of PMA Burewala, Mr. Kashif Riaz and Mr.Abid
from Atco photographed during the meeting organized by Pakistan Aspirin Foundation here on December 20, 2016.

Mr. Shaukat Ali Jawaid thanked Atco Laboratories who are sponsoring these CME activities for the last many years but hastened to add that keeping up the professional ethics they do not patronize any particularly company or promote any particular brand name. Pakistan Aspirin Foundation was only interested in creating awareness and promotion of Aspirin therapy. It is up to the healthcare professionals to use whatever brand of Aspirin they wish to use.

Mr. Kashif Riaz Business Unit Head from Atco Laboratories welcomed the moderators and participants of the meetings at all the places and thanked them for their participation and their confidence, trust in Atco quality products.