Life Saving properties of Aspirin in Acute Myocardial Infarction highlighted

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 Interactive small Group Discussions on Medical Uses of
Aspirin at Mianwali, D. I. Khan and Rawalpindi

Life Saving properties of Aspirin in Acute
Myocardial Infarction highlighted

Regular Low Dose Aspirin Therapy reduces morbidity and
mortality, adverse events in a wide range of medical disorders

Healthcare professionals advised not to deprive their patients of
Aspirin Therapy in its well established indications like ACS, primary
and secondary prevention of CAD, TIAs, Stroke, Hypertension
and Diabetes, prophylaxis against DVT/PE

From our correspondent

MIANWALI & DERA ISMAIL KHAN: Pakistan Aspirin Foundation in collaboration with Atco Laboratories as a part of its Continuing Medical Education programme to promote the medical uses of Aspirin in its well established indications organized interactive small group discussions at Mianwali, Dera Ismail Khan and Rawalpindi recently. The meetings were attended by cardiologists, physicians, postgraduates and resident staff in Cardiology Departments, CCU and Emergency besides a select groups of eminent Family Physicians at all these places. The main objective of these meetings were to share with the participants 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 and  listen to their own experiences where do they use Aspirin, in which indications.

The meeting at Mianwali was organized on August 22nd 2017. Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation who is also Chief Editor of Pulse International and Pakistan Journal of Medical Sciences in the introductory remarks first introduced Pakistan Aspirin Foundation, its historical background and its accomplishments so far. He pointed out that it was established in 1995 by a multidisciplinary group of cardiologists, physicians, oncologists, obstetricians & gynecologists. Since then it has been organizing CME activities in major cities as well as small towns all over the country. So far it has organized five national conferences which are held after every two to three years. It has a very democratic set up and so far eminent medical personalities who have served as its President include Prof. Mahmood Ali Malik, Prof.Abdus Samad, Dr.Maqbool H.Jafary, Gen.Ashur Khan, Prof. Ejaz Ahmad Vohra and Prof. M. Akbar Chaudhry.  Prof.Javed Akram is the current President.


Group photograph of participants in the interactive small group discussions on Medical Uses
of Aspirin organized at Mianwali on August 21st 2017.

In October 2014 it published its revised Guidelines on Medical Uses of Aspirin. He further stated that the entire literature on Aspirin published till September 2014 was reviewed by a committee consisting of Prof.Abdus Samad, Prof. Ejaz Ahmad Vohra, Prof. M.Akbar Chaudhry and Mr.Shaukat Ali Jawaid. The recommendations were later circulated among the leading cardiologists to get their feedback which was incorporated. The final document published in October 2014 gives a comprehensive picture about the well established indications for Aspirin therapy. These include  AMI, ACS, Secondary prevention of AMI,  Primary prevention of CAD, Acute Ischaemic strokes, TIAs, Primary and secondary prevention of Stroke, Hypertension, Diabetes Mellitus,


Acute Rheumatic Fever, It also includes prophylaxis against Deep Vein Thrombosis and Pulmonary Embolism while its emerging uses include Pregnancy, Phospholipids Antibody Syndrome, Colorectal Cancer and different types of cancers. The guidelines give details about the dosage in various indications, contra indications for use of Aspirin and where one can use Aspirin in combination with Clopidogrel.

Participating in the discussion Dr.Riaz Ahmad Head of Dept. of Cardiology at DHQ Hospital said that we use Aspirin regularly. It is a life saving drug in AMI in fact it is a wonder drug in cardiovascular diseases. In emergency we use soluble aspirin. As pointed out it has a wide range of indications in surgery, obstetrics and gynaecology. What is more important was the fact that it was an economically priced drugs which is easily available everywhere. It acts very quickly to prevent thrombus formation. It is used in hypertension, Type 2 diabetes mellitus, coronary artery disease, stroke and TIAs.


Participants of the small group discussion on Medical Uses of Aspirin at Dera Ismail Khan specially found the Booklet
on Aspirin in Urdu very informative and useful. Picture shows some of them looking at the booklet during the meeting.

Dr. Major Muhammad Arshad Sheikh opined that everybody above the age of forty years should regularly take low dose aspirin 75-100mg. In AMI one should use soluble Aspirin and in Stroke the dose should be 300mg in emergency and later 150mg or 300mg as is indicated. Those with one or two risk factors should also be put on low dose aspirin therapy.


Dr. Asifullah Khan Medical Specialist at PAF Hospital Mianwali appreciated the efforts of Pakistan Aspirin Foundation. The Guidelines are very comprehensive and very informative, useful. He specially commended the publication of booklet on Aspirin in Urdu which he felt should be extensively distributed among the Family Physicians as well as educated patients. He further suggested that it was extremely important to educate and create awareness about the safety and efficacy of Aspirin among the Nurses and Paramedics particularly those working in Emergency and CCUs so that they do not wait for the doctor and any patient coming with chest pain gets Aspirin immediately. It is extremely cost effective. 

Mr. Shaukat Ali Jawaid pointed out that recent studies have showed that in primary and secondary prevention low dose aspirin 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. Otherwise it is upto the treating physicians to decide when the patients should take Aspirin since elderly patients or even other patients with some other comorbids may be taking some other drugs as well. Hence the treating physician will decide when Aspirin has to be taken. In hypertension, one should be careful to ensure that blood pressure must be first controlled and then the patient should be put on low dose aspirin therapy. The dose recommended in Type-2 diabetes is 150mg.


A view of the interactive Small Group Discussion on Medical Uses of Aspirin organized by Pakistan Aspirin Foundation in collaboration with Atco Laboratories at Dera Ismail Khan on August 22nd 2017.

The meeting at Dera Ismail Khan was organized on August 23rd 2017. It was very well attended by consultants from local DHQ Hospital, Mufti Mahmood Teaching Hospital including cardiologists, physicians, postgraduates and selected family physicians. After brief Introduciton, responding to various questions Mr.Shaukat Ali Jawaid pointed out that one has to take low dose Aspirin daily. Taking it on alternate days or 300mg once or twice a week is not beneficial. Studies have shown that even a small dose of 35mg of Aspirin is effective. Platelets are added daily and it could be that the day one has not taken aspirin the patient might develop thrombus and suffer from acute myocardial infarction.  That is why low dose of Aspirin is recommended daily. The enteric coated tablets of Aspirin are further safe and do not cause any major adverse effect of ulcer. The chances of any bleeding are also eliminated or minimized to a great extent. While using dual antiplatelet therapy combining it with clopidogrel one must be mindful of the fact that it may also increase the chances of adverse effects. Hence use the combination where indicated and for a short duration of four to six months. Even in Stroke one can use the combination therapy for six months which should be followed by low dose Aspirin therapy. Patients suffering from CAD, ACS or those taking it for primary and secondary prevention will have to take it lifelong. It should be avoided after the age of eighty years and do not use it in children.


Continuing Mr.Shaukat Ali Jawaid pointed out that we are living in an evidence base era of medicine hence we cannot recommend anything where we do not have proper scientific evidence. However, there are anecdotal evidence which is increasing day by day that low dose Aspirin therapy is extremely safe and effective in patients with bad obstetrics history, repeated miscarriages and infertility. Many gynecologists are using it with excellent results. However from the Pakistan Aspirin Foundation platform we cannot recommend it unless there are proper scientific studies and they are published in standard peer review journals.  Everything that we have incorporated in these guidelines is properly references. He further suggested that they should educate their patients to immediately take one full tablet of Aspirin 300mg in case of chest pain irrespective of the fact whether it is cardiac or non-cardiac. Similarly since most of the strokes are ischaemic, they should not hesitate to use one tablet of 300mg of Aspirin immediately which could be life saving. Later when the patient is saved, stabilized, then one can take CT scan or MRI and rule out if they are hemorrhagic strokes in which there is a risk of bleeding. Even in case of active peptic ulcer disease, in acute conditions like AMI, one tablet of Aspirin won’t do any harm but it might save the life of the patient. Family Physicians were advised to keep Aspirin always with them and at their home, advise their patients to keep Aspirin at home because they might need it any time even at night when it is not possible to take the patient to any doctor or healthcare facility.


Group photograph of participants in the interactive small group discussions on Medical Uses of Aspirin 
organized at Dera Ismail Khan on August 22st 2017.

The interactive small group discussion at Rawalpindi was organized on August 24th.Here again the discussion was quite lively. The participants pointed out the psychology of the patients and opined that when they pay five to six hundred rupees consultation fee and they are prescribed Aspirin, they do not feel satisfied. Those who prescribe expensive drugs are given more respect. At this it was suggested that they should take some time to talk to the patient and educate them about the safety, efficacy of this economically priced antiplatelet which is mother of all antiplatelet agents. Its low cost should not work against it. It was also pointed out that though Aspirin was discovered by Bayer-Pharma a German Multinational pharmaceutical concern but they do not market it in Pakistan and many other countries simply because it is very low priced and there is not much profit.


We should be grateful to Pakistani companies who are producing Aspirin and many other expensive molecules at an affordable price while maintaining the quality. If these Pakistani companies were not there, we would have to import all these drugs at much higher cost. One of the participants said that they had found the discussion very informative and useful but their seniors have never talked about this drug in such detail ever.  This was because of Lack of awareness and that is one of the reasons that we are organizing all these activities, Mr.Shaukat Ali Jawaid stated. He also informed the participants that to promote the use of Aspirin, Pakistan Aspirin Foundation had placed Aspirin Boxes in seventeen CCUs all over the country and filled them with single cut Aspirin tablets for a period of two years so that any patient coming in emergency gets Aspirin tablet immediately.

At Rawalpindi meeting Dr. Dawar Majeed Head of the Dept. of Cardiology at Fauji Foundation Hospital made a major contribution to the discussion and highlighted the safety and efficacy of low dose Aspirin therapy in ACS, CAD, TIAs, Stroke, Hypertension, and Type 2 Diabetes Mellitus. Those patients undergoing interventional procedures like Angioplasty and stenting will also require low dose aspirin therapy for life long. It is a miracle life saving drug. He commended the efforts of Pakistan Aspirin Foundation which has taken up the challenge of creating awareness and promoting the use of low dose aspirin therapy in its well established indications apart from its new and emerging indications.


One of the participants also referred to quackery which is flourishing in the country.  Even institutions like Punjab Healthcare Commission is making the life of qualified medical practitioners miserable by coming up with guidelines and SOPs for medical practice which can be fully practiced and implemented once we have the necessary basic  infrastructure and the menace of quackery is eliminated. NSAIDs and PPIs besides antimicrobial agents are so commonly misused and abused that many of these antibiotics have developed resistance and patients have also developed ulcers. Conventional first or second line drugs are no more effective and this has also increased the cost of treatment manifold. Patients come with diagnosis and demand expensive diagnostic investigations. It is a very difficult situation and to practice ethical medicine has become a lot difficult.

Summing up the discussion Mr.Shaukat Ali Jawaid thanked the participants of the meetings at all these places and hoped that they will spread the message of Pakistan Aspirin Foundation. In view of the low literacy rate, we in Pakistan do not promote Aspirin therapy direct to the patients but wish the healthcare professionals to take up this responsibility. He also thanked Atco Laboratories which has been sponsoring all these CME activities for the last many years. However, he hastened to add that Pakistan Aspirin Foundation keeping up the professional ethics do not patronize any particular pharmaceutical company or brand name of Aspirin. It is up to the healthcare professionals to select any brand of Aspirin. Atco Laboratories has been very kind and the Foundation is extremely grateful to them that they were involved in such CME programmes, academic activities. Their efforts will be rewarded by God Almighty and the patients who get benefit from all such activities which improve the patient care. Maj. Gen. Ashur Khan one of the former Presidents of Pakistan Aspirin Foundation also joined us at Tea and he was briefed about the CME meetings organized at Mianwali, Dera Ismail Khan and Rawalpindi.


Atco team from Mianwali and Dera Ismail Khan which organized the small group discussions on
Medical Uses of Aspirin photographed with Mr. Kashif Riaz Business Unit Head in Atco and
Mr.Shaukat Ali Jawaid
General Secretary of Pakistan Aspirin Foundation.

Mr. Kashif Riaz Business Unit Head in Atco Laboratories who had organized all these meetings in his welcome address at all these places disclosed that recently Atco has signed a Memorandum of Understanding with The Citizens Foundation which runs about fifteen hundred schools all over the country.  As per this MOU Atco will pay them 1% of the entire sale of Ascard (low dose Aspirin) as a Corporate Social Responsibility and it will help promote literacy and education in the country. Hence while prescribing Ascard they will also be participating in this noble cause. We will be paying about twenty five lacs of rupees to the Citizens Foundation in quarterly installments, Mr.Kashif Riaz added. Mr.Zaheer and Mr.Niazi from Atco Laboratories along with their Area teams worked hard to make these small group discussions a success.