Patients with high risk of CVD should be put on regular use of low dose Aspirin therapy - Dr. Fawad Farooq

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 Use of Aspirin in Primary Prevention of Heart Diseases

Patients with high risk of CVD should
be put on regular use of low dose|
Aspirin therapy - Dr. Fawad Farooq

Lays emphasis on risk calculation and|
rational use of anti-platelet drugs

From our correspondent

ISLAMABAD: Identifying and treating single risk factor is not enough to reduce cardiovascular diseases. It requires composite risk assessment of modifiable risk factors and then treatment with low dose Aspirin Therapy should be the goal. This was stated by Dr. Fawad Farooq, Assistant Professor of Cardiology at National Institute of Cardiovascular Diseases, Karachi. He was speaking on Medical Uses of Aspirin with special reference to primary prevention at the recently held MID YEAR DOCTORSCON 2016 organized by Pakistan Academy of Family Physicians at Islamabad on July 17th 2016. The meeting was very well attended by family physicians from over sixty two cities from all over Pakistan. This session was chaired by Prof. Javed Akram, Vice Chancellor of Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences Islamabad along with Dr. Ajmal Khan Chief Operating Officer of Punjab Health Care Commission,   Dr. Aftab Iqbal Sheikh and Dr. Altaf Cheema.

Aspirin, Dr. Fawad Farooq pointed out is a golden drug which has been in clinical use for over hundred years. It was first used as an anti-inflammatory drug but later on it became much more useful when its antiplatelet properties were highlighted. Hence, it is the duty of every healthcare professional to judge judiciously if the patient was a candidate for regular use of Low Dose Aspirin Therapy.

Speaking about Athero-thrombotic disease Dr. Fawad Farooq said that we need to devise some strategy to treat these patients. We cannot prevent athero-thrombotic disease but we should know why and when we should be using Aspirin. He laid emphasis on rational use of anti-platelet drugs. He discussed in detail the assessment of cardiovascular disease and Risk calculation before initiating the use of Aspirin therapy. Lipid deposit is followed by inflammation and then it leads to thrombosis. It is the thrombotic event which brings the patient to the doctor. Atherosclerosis leads to progression of vascular disease. It is a gradual progression process which starts with unstable angina, Acute Coronary Syndrome, Ischaemic Strokes etc. Adhesion and aggregation of platelets is dangerous but there is a collagen cover which prevents rupture of the plaque. Studies have shown that Streptokinase if used within six hours of an event has the same mortality reduction benefit as that of single tablet of Aspirin. In acute conditions one has to prefer Dispirin and use full tablet of 325mg to prevent consequences and further events.

Continuing Dr. Fawad Farooq said that in unstable angina and critical ischemia, different doses of Aspirin were used and it showed that 75mg dose was good, safe and effective in maintenance therapy. It is quite effective to provide protection. However, he clarified that one has to take the low dose aspirin therapy daily regularly because if the event takes place on the day when Aspirin was not taken, it will be of no use if one has been taking low dose aspirin therapy regularly for the last many years. As such the healthcare professionals must emphasize on taking low dose aspirin therapy daily without any break. In acute conditions full tablet of 325mg should be used but for maintenance therapy, one can use 75-81mg daily. Enteric coated tablets of Aspirin are also preferred for safety reasons. He was of the view that one must match the risk benefit ratio. In case there is a high risk of cardiovascular disease, benefits will exceed harm but if there is low risk of CVD, harm will increase. Hence, risk calculation and assessment which is quite easy must be ensured taking into account the age of the patient, race, co-morbidities like diabetes, hypertension, smoking, HDL, LDL. One must take care of everything.  Total care of the patient demands that if there is low risk, do not use Aspirin but in case of moderate risk, one must discuss with the patient and use patient’s preference. However, in case of high risk, the patient must be put on regular use of low dose aspirin therapy. He further emphasized that one must calculate the risk and then use Aspirin.

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