Do not wait for a cardiac event to start Low Dose Aspirin Therapy-Prof.Samad


Aspirin Session at PHL Conference at Peshawar
Do not wait for a cardiac event to start
Low Dose Aspirin Therapy-Prof.Samad
One can add PPIs to take care of the risk of GI bleeding

PESHAWAR: Keeping up its past traditions, Paksitan Aspirin Foundation organized an Aspirin session during the 23rd Annual Conference of Paksitan Hypertension League here on March7th 2020. It was chaired by Prof.Abdus Samad, an eminent cardiologist and former President of Paksitan Aspirin Foundation. The speakers were Dr. Fawad Farooq from NICVD Karachi and Dr. Kashif Ali Hashmi from Nishtar Medical University, Multan. The members of the Experts Panel included Prof. M. Akbar Chaudhry, Prof. Feroze Memon, Prof. M. Ishaq Current President of Pakistan Aspirin Foundation, Prof. Ahmad Bilal Consultant Physician and Diabetologist from Faisalabad Medical University.

Dr. Fawad Farooq was the first speaker who discussed the role of Aspirin in Primary Prevention of Cardiovascular Diseases. He first described in detail the pathophysiology and how the thrombosis takes place. He pointed out that use of low dose aspirin reduces the severity of events. Abnormal thrombolytic events can also be reduced. His suggestion was that while prescribing Aspirin take patients into confidence. While managing very high risk patients use of aspirin is recommended in all the guidelines. As such, in high risk patients, Aspirin can be used as primary prevention if there are no contra indications.

Prof. Ahmad Bilal, Prof. Feroze Memon, Prof.M.Ishaq, Prof.Akbar Chaudhry and Prof.
Abdus Samad photographed during the panel discussion on Aspirin during the PHL
Conference held at Peshawar recently.

Dr. Kashif Hashmi spoke about significance of Aspirin in secondary prevention of cardiovascular diseases. He suggested that one should always calculate the risk of patients. Advise the patients to use healthy diet, regular exercise, life style modifications, manage diabetes mellitus and hypertension. There are numerous studies which have showed that the regular use of Low Dose Aspirin Therapy reduces the morbidity and mortality in cardiovascular diseases, hence it can be safely prescribed for secondary prevention of coronary artery disease.

Participating in the discussion Prof. Ahmad Bilal said that all principles of treatment just give you guidelines. Drugs should be prescribed keeping in view the individual needs. All those patients who suffer from diabetes mellitus are high risk patients. They must ensure both diabetes and blood pressure control. Use of Aspirin in these patients could be helpful and beneficial.

Responding to a question regarding the dose, it was pointed out that all the studies which were done in North America has used the dose of 81mg or 100mg as this is the dose available there while the studies done in Europe has used 75mg. However, there is no difference and any of the above dosages can be used which is safe and effective.

Pakistan Aspirin Foundation organized an Aspirin Update session during the PHL
conference held at Peshawar recently. Group photograph taken on the occasion
shows from (L to R) Dr. Faisal, Mr. Kashif Riaz, Dr. Raj Kumar, Dr. Kashif Hashmi,
Prof. M.Ishaq, Prof.Rashid, Maj. Gen.M.H.Nuri, Prof. Abdus Samad, 
Akbar Chaudhry, Mr.Shaukat Ali Jawaid and Mr.Akhtar from Atco Labs.

Prof. Ishaq pointed out that as regards secondary prevention there is no controversy regarding use of Aspirin. In primary prevention, one should work out the risk assessment, look at the family history. See if there is a case for the use of aspirin and review it if there is some contraindication. With the use of Aspirin, GI upset is minimum and we have been using Aspirin now for many years and have not come across any serious case of bleeding. As such we should not deprive patients who are eligible for aspirin therapy. In secondary prevention hundred percent patients should be put on Low Dose Aspirin therapy while for primary prevention it can be used as per patients needs. It is an economically priced antiplatelet which is highly useful drug and its use should be promoted in its well established indications.

Prof.Akbar Chaudhry another former President of Pakistan Aspirin Foundation and a noted cardiologist stated that the issue of Aspirin resistance is very little. In fact there are some patients who are non-responders. It is a very useful antiplatelet agent which should be prescribed to all the patients suffering from Acute Coronary Syndrome unless there is some contra indication.

In his concluding remarks, Prof. Abdus Samad said that we need to look at which plaque is vulnerable to rupture. Fibrous plaque will not rupture. In stable angina, it can be a stable lesion. It is the fatty core where it ruptures. Remember 40% plaque is more dangerous than 90% plaque as it has high chances of rupture. He was of the view that there is no distinction in Primary prevention and secondary prevention as regards regular use of Low Dose Aspirin Therapy. Why to let the patient have some event and then use it for secondary prevention. Why not use it and prevent any event. Do not wait for the event to happen and then think of secondary prevention. Take an expert opinion and confirm your findings. While using Aspirin one can also start PPIs to take care of any GI bleeding. He also suggested that those patients on Aspirin therapy should be advised to have periodic Haemoglobin Test to ensure there is no bleeding. Triple therapy i.e. Aspirin, Clopidogrel and Statin is expensive. Physicians are also worried of cerebral hemorrhage. They are worried of stroke, hence be careful while withdrawing Aspirin. In case of atrial fibrillation stop aspirin. We need to work on primary prevention and Coronary Artery Diseases, he added.

Prof.M. Ishaq president Pakistan Aspirin Foundation alongwith Prof. Rashid, Prof.Shahbaz
Kureshi Prof.Feroz Memon, Prof. Samad, Gen. Nuri, Prof. Shaukat Malik and Prof. Akbar
Chaudhry cutting the cake to celebrate 25 Years of Ascard during the PHL
conference held at Peshawar recently.

Earlier Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation welcomed the guest speaks and the participants to the meeting. He also made it clear that though this meeting and the speakers are sponsored by Atco Laboratories who are sponsoring all our CME activities for the last many years but we in Pakistan Aspirin Foundation follow professional ethics. We do not allow any drug or company banner to be displayed in the hall where meeting is taking place. We do not patronize any company or promote a particular brand of Aspirin. Our objective is to create awareness among public as well as healthcare professionals to promote the use of Aspirin in its well established and emerging indications of Aspirin therapy. It is upto the doctors to prescribe whatever brand they wish to use. However, he thanked Atco Laboratories in general, Mr. Akhtar and Mr.Kashif Riaz in particular for sponsoring all such activities for the last many years. The meeting as usual started in time at 8.30 AM in the morning and finished at 9.30 AM so that the scientific sessions to follow could start in time.

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