Regular use of Low Dose Aspirin Therapy reduces morbidity and mortality in ACS


 Regular use of Low Dose Aspirin Therapy
reduces morbidity and mortality in ACS

Aspirin should be prescribed to patients with
hypertension after their BP has been controlled

RAJANA: Pakistan Aspirin Foundation as a part of its Continuing Medical Education programme organized a panel discussion at Foundation Hospital Rajana to highlight the safety and efficacy of regular use of Low Dose Aspirin Therapy on April 20th 2016. The meeting was jointly chaired by Prof. Altaf Hussain Rathore and Dr. Zeeshan Medial Superintendent of the Hospital. It was attended by all the consultant staff and Medical Officers of the hospital while Dr. Salman Athar Consultant Cardiologist at DHQ Hospital Toba Tek Singh also specially came to attend this meeting which was sponsored by Atco Laboratories.

Copies of the Guidelines for Medical Uses of Aspirin prepared by the Experts Panel of Pakistan Aspirin Foundation headed by Prof. Abdus Samad an eminent cardiologist of Pakistan as well as an informative booklet in Urdu entitled “Aspirin- the lifesaving miracle drug” were distributed among the participants.  Earlier a similar meeting was organized at Gogra on April 19th which was attended by a select group of cardiac physicians and Family Physicians. In his introductory remarks at both the meetings Mr.Shaukat Ali Jawaid General Secretary of the Foundation traced the history of the formation of this multidisciplinary group and its achievements, accomplishments so far.

Prof. Altaf Hussain Rathore and Dr. Mian Zeeshan Omar chairing the
panel discussion on Medical Uses of Aspirin organized by Pakistan
Aspirin Foundation at Foundation Hospital Rajana on April 20,2016.

The main objective is to promote the use of Aspirin in its well established indications by creating, awareness among the healthcare professionals and the public. The established uses of Aspirin include Acute Myocardial Infarction, Acute Coronary Syndromes, Secondary prevention of AMI, Primary Prevention of CAD, Acute Ischemic Strokes, TIAs, Hypertension, Diabetes Mellitus, Acute Rheumatic Fever, prophylaxis against Deep Vein Thrombosis and Pulmonary Embolism. In addition it has many emerging uses like pregnancy induced hypertension, Phospholipids Antibody Syndrome, colorectal cancer etc.

During the discussions Dr. Mian Omar Zeeshan and Dr. Salman Athar shared their views on the use of low dose aspirin therapy in ACS and other cardiovascular diseases and termed it as a lifesaving drug which is extremely economically priced and affordable for everyone and which is also easily available. However, it was pointed out that sometimes patients with severe hypertension come and when they are asked which drug they are taking, they say Aspirin which needs to be discouraged. Patients need to be educated that Aspirin is not a drug for treatment of high blood pressure. However, it should be used once the blood pressure has been controlled. In the past it was said that one should stop Aspirin before surgery but now it is recommended that one does not need to stop it and surgery can be performed safely. It was emphasized that in case of Acute Myocardial Infarction one full tablet of Aspirin 325 should be used and soluble Aspirin should be preferred in such cases. It was also stated that there is no difference in the efficacy of various doses of Aspirin and one can take 75mg, 81mg and 100mg whichever is available for long term use for prevention of cardiovascular events. Maintenance dose for Stroke and other cerebrovascular disorders including diabetes mellitus was 150mg daily. Responding to a question it was stated that there are no studies to prove that if one takes Aspirin on alternate days or once a week full tablet of 325 mg Aspirin which proves effective. Hence one has to take low dose aspirin therapy daily and enteric coated tablets were quite safe in long term use.

Participants of the panel discussion on Medical Uses of
Aspirin organized at Gojra on April 19th 2016.

The participants were also informed that though one can take aspirin after meal any time in the day but now it is preferred that one should take it after dinner at bed time because it takes care of the early morning spikes as most of the cardiovascular events occur early in the morning. Aspirin was also being used with good results in patients with bad obstetric history, recurrent miscarriages in combination with low molecular weight heparin and in cases of infertility.

Hypersensitivity to Aspirin, Hemorrhagic diathesis, documented acute gastric or duodenal ulcer and pregnancy after thirty six weeks of gestation are some of the absolute contra indications for the use of Aspirin. The relative contra indications include G6PD deficiency, breast feeding, chronic and recurrent peptic ulcer, and bronchial asthma, severs renal or hepatic damage. Bronchial asthma is one of the contra-indications due to Aspirin sensitivity.  Guidelines on Aspirin it was stated have reviewed the literature on Aspirin till 2014 before finalizing this document which gives comprehensive details about its use, dosage in various disorders and contra indications. Pakistan Aspirin Foundation keeping up professional ethics, Mr. Shaukat Ali Jawaid stated does not recommend any particular brand of Aspirin and it is up to the physicians to use any aspirin preparation. However, we are extremely grateful to Atco Laboratories which is helping Pakistan Aspirin Foundation by sponsoring its CME programmes. Recommendations of the US Preventive Services Task Force on Aspirin Use for the Primary Prevention of Cardiovascular Diseases and colorectal cancer released on April 13, 2016 were also shared with the participants.  They recommend use of low dose Aspirin Therapy for primary prevention in patients with no risk of bleeding and one or two risk factors after the age of fifty years.  Since our life expectancy is about ten years less as compared to the developed countries, Pakistan Aspirin Foundation recommends it after the age of forty years.

In the end Dr. Mian Zeeshan Omarand Prof. Altaf Hussain Rathore thanked Pakistan Aspirin Foundation and Atco Laboratories for organizing this academic activity at Foundation Hospital Rajana which the participants found quite informative and useful. The participants were encouraged to share their observations and in case they have any queries, send it to Pakistan Aspirin Foundation and an effort will be made to provide an answer in the shortest possible time. Mr. Kashif Riaz from Atco Laboratories thanked the management of Foundation Hospital and the participants for sparing some of their precious time to attend this meeting.

The meeting at Gojra was attended by cardiac physician Dr. Mian Atif Mahmood andDr. M. Sultan, noted Family Physicians Dr. M. Ishfaq Wahla, Dr. M. Akram, Dr.M. Ishfaq, Dr. Asif Mehmood, and Dr. M. Waseem ophthalmologist.