Seminars on Aspirin Update at Tando Adam Khan and Hala
Aspirin therapy is now also being increasingly used for primary
prevention of CAD
All high risk patients with absolute ten years risk of
more than 15% must be prescribed Aspirin along
with other drugs - Dr. Maqbool H. Jafary

From our correspondent

TANDO ADAM KHAN AND HALA: While safety and efficacy of Aspirin therapy in secondary prevention of coronary artery disease is well established, it is now also being increasingly used in primary prevention of cardiovascular diseases. This was stated by Dr. Maqbool H. Jafary a noted physician and President of Pakistan Aspirin Foundation. He was addressing seminars organized by Pakistan Aspirin Foundation in collaboration with local PMA at Tando Adam Khan and Hala on October 9th 2008. Both these meetings were sponsored by Atco Laboratories as a service to provide Continuing Medical Education for the healthcare professionals.

A group photograph of some of the participants to the seminar on Aspirin Update and local PMA office bearers photographed along with the speakers at Taulka Hospital Tando Adam Khan

In his comprehensive presentation on Aspirin Update titled as Aspirin- the Wonder Drug, Dr. Maqbool H. Jafary first traced the historical back ground and discussed at length that how  Dr.Flex Hoffman discovered this agent. At present 37.6% of Aspirin is being used in cardiovascular diseases and more than hundred billion tablets are consumed annually. It was Dr. Peter Elwood a Scottish Physician who did pioneering work as regards use of aspirin in cardiovascular diseases and showed in 1974 that it prevents myocardial infarction. Now Aspirin is being used for not only secondary prevention but also primary prevention of cardiovascular diseases.  There are numerous studies to prove that all high risk patients with absolute ten years risk of more than 15% must be prescribed Aspirin therapy along with other drugs. If the ten years absolute risk is less than 6%, no aspirin is required but if this risk is between 7-14% it should he left at patient choice. Obese patients, those with family history of cardiovascular disease, those suffering from high blood pressure, diabetics all come into high risk group.

Pakistan Aspirin Foundation in collaboration with PMA Tando Adam Khan organized a seminar on Aspirin Update on October 9^th 2008. Picture shows Dr. Maqbool H. Jafary President of PAF, Dr. Gada Husssain Bhellr, Mr. Shaukat Ali Jawaid, Dr. Abdul Hameed Ghauri and Dr. Bashir Khaskheli speaking at the occasion.

As regards secondary prevention of cardiovascular diseases, numerous studies has shown that it reduces non-fatal MI by 32%; non-fatal strokes by 27%, total cardiovascular mortality by 15% and  vascular events by 15%.  In case of acute myocardial infarction the patient must be advised to take a full tablet of aspirin immediately chew it or use soluble aspirin followed by 75mg of enteric coated Aspirin indefinitely unless there are contra indications. Aspirin therapy alone reduces 25% mortality in AMI if taken immediately but if it is combined with streptokinase within six hours, the mortality reduction is increased to 42%. Most often there is no increased risk of bleeding. In Acute Coronary Syndromes risk of another MI and death is reduced by 50% as shown in ISIS-II study.

Talking about the use of Aspirin therapy in stroke, Dr. Jafary pointed out that 150-300mg of Aspirin is the drug of choice within forty eight hours. He made it clear that even if it is hemorrhagic stroke, one tablet of 300mg used immediately in case of myocardial infarction  is not going to do much harm but it can prove to be life saving. Once the patient is stable, then investigations can be undertaken to determine whether it is ischaemic or hemorrhagic stroke. Aspirin has proven benefits in secondary prevention of secondary strokes. In high risk individuals, Aspirin is combined with clopidogrel which ensures 20% relative risk reduction of second MI or stroke. In patients who have had intervention procedures like angioplasty or stenting, combination of Aspirin and Clopidogrel is used unless there is some contra indication. Regarding its use in hypertension, it is important that first blood pressure should be controlled and then the patient should be put on Aspirin therapy. All Type-2 diabetics should also be put on regular aspirin therapy, he added.

Some office bearers of PMA Hala and participants to Aspirin seminar photographed after the meeting on October 9^th 2008.

He then briefly discussed the emerging indications for use of Aspirin therapy like colorectal cancer, esophageal and gastric cancer, pulmonary embolism, DVT, renal diseases etc. He also briefly referred to the ARRIVE study which will enroll over twelve thousand patients at four hundred centers in five countries which will complete in 2013. It will provide sufficient evidence regarding use of Aspirin therapy in primary prevention of coronary artery diseases, he added.

Responding to various questions Dr. Jafary stated that Experts Panel of Pakistan Aspirin Foundation in its Consensus Statement on Medical Uses of Aspirin has clearly stated the dosage, indications and contra indications for use of Aspirin. Copies of this consensus statement will be distributed among the participants later and they are also available on the website of Pakistan Aspirin Foundation.(www.pakaspirin.org)

On left Dr. Maqbool H. Jafary President Pakistan Aspirin Foundation presenting Life Membership shield to Dr. Abdul Hameed Ghauri while other pictures show guests being presented traditional Sindhi Ajrak and flowers during the seminar on Aspirin Update held at Tando Adam Khan recently.

Dr. Abdul Hameed Ghauri in charge of Coronary Care Unit at the local hospital in his presentation pointed out that there is need to educate the healthcare professionals on the safety and efficacy of Aspirin in cardiovascular diseases. It has proved to be a life saving drug. We as cardiologists are aware of its benefits though it is still being under used. A vast majority of deaths in the developing countries, he said, are due to cardiovascular diseases and  hypertension requires life long therapy. The doctors need to be updated on preventive properties of anti platelet and anti cholesterol drugs. We can prevent a large number of these deaths by taking simple measures, life style modification, use of healthy diet and appropriate drugs. GPs, he said, play an important role in health delivery system hence they need to be kept update through such CME programmes.

Dr. Maqbool H. Jafary emphasized upon the family physicians that they must ensure more and more use of Aspirin in its well established indications. The Aspirin Awareness and Usage Study (AAUS) conducted by Pakistan Aspirin Foundation which enrolled over fourteen hundred ACS patients in seventeen coronary care units across the country showed that only 16% patients used Aspirin therapy at home and only 20% of the GPs prescribed Aspirin while only 52% of the patients discharged from the CCUs were prescribed aspirin along with other drugs. This is a very dismal picture and we need to improve it for the safety of the patients, he added.

The meeting at Tando Adam Khan was also attended by healthcare professionals from Shahdadpur and other adjoining areas and they showed keen interest and wished that a similar programme should be organized at Shahdadpur as well.

Earlier Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation highlighted the activities and accomplishments of the Pakistan Aspirin Foundation. He made is clear that they do not promote any particular brand of Aspirin keeping up professional ethics. He however thanked Atco Laboratories and their cardiovascular team headed by Mr. Akhtar and Product Manager Mr. Farhan Raza for making arrangements to sponsor CME programmes of the Pakistan Aspirin Foundation for the last many years. Dr.Bashir Khaskheli General Secretary PMA welcomed the speakers and the participants of the seminar.  Dr. Gadda Hussian Bheller In charge of Taulka Hospital Tando Adam Khan, President of local PMA and Medical Supdt. of Shahdadpur Taulka Hospital presented traditional Sindhi Ajrak among the guest speakers. The meeting was conducted by Mr. Farhan Raza Product Manager from Atco Laboratories while Mr. Akhtar Business Unit Head of Cardiology in Atco was also present on the occasion.

At Hala, the meeting was chaired by Dr. Abdul Rashid Memon President elect of Hala PMA while the programme was conducted by Dr. Ateeque. Guest speakers and the participants were welcomed by Dr. Abdul Sattar Meer General Secretary of Hala PMA.

Presentation by Dr. Maqbool H. Jafary was followed by lively discussion.  Replying to a question regarding role of Aspirin in smokers, Dr.Jafary said that smoking is an important risk factor in coronary artery disease and hypertension; hence Aspirin has a role in these people. Responding to another question he said that as a rule, all such drugs must be avoided during pregnancy, Aspirin is no exception. If there is a need, some other pain killer like paracetamol can be used. Some experts say that in case of IHD, one can continue Aspirin therapy during pregnancy but if one can avoid it, it is much better. Regarding effects of Aspirin on liver, Dr. Jafary said it has no effect and it does not disturb liver enzymes. In case of fatty liver, one must look at the back ground like obesity. These are some of the manifestations in pre diabetic stage and these patients will eventually develop diabetes. As a primary prevention one can use Aspirin particularly if other risk factors are also present.