Low Dose Aspirin therapy is indicated in all patients of atherosclerotic diseases and for primary prevention in high risk patients- Dr. Fawad Farooq


Aspirin Session at CARDIOCON 2019
Low Dose Aspirin therapy is indicated in all
patients of atherosclerotic diseases and for
primary prevention in high risk patients-
Dr. Fawad Farooq
Aspirin resistance should be properly investigated
and we as scientists should promote Evidence
Based Medicine-Prof. Samad
Regular use of Aspirin leads to significant reduction
in Stroke-Prof. Akbar Chaudhry

ISLAMABAD: As a part of its continuing medical education programme to create awareness and promote the use of Aspirin in its well established indications, Pakistan Aspirin Foundation organized a session during the CARDIOCON 2019 held at Islamabad on November 23, 2019. This session was chaired by Prof. Abdus Samad alongwith Prof.Shahryar Sheikh, Prof. M. Ishaq President of PAF and Prof. Feroze Memon.

Dr. Medawar Noor from AFIC was the first speaker who talked about Aspirin Resistance- an emerging threat to Cardiovascular Disease patients. He pointed out that different studies done in Pakistan has showed the prevalence of aspirin resistance between 12-47%. He then gave details of their own study which included 384 patients between the ages of 18-70 years. Those patients who were taking any other antiplatelet were excluded. Aspirin resistance was seen in 13.8% of patients. He further stated that women may have more aspirin resistance.

Pakistan Aspirin Foundation organized a session on Aspirin update during the
CARDCICON 2019 at Islamabad. Photograph shows Prof. Abdus Samad
(second from right) chairing the session alongwith Prof. Feroze Memon,
Prof. M. Ishaq and Prof. Shahryar Sheikh.

Prof. M. Akbar Chaudhry was the second speaker who talked about safety and efficacy of Aspirin in cerebrovascular diseases. He highlighted the known risk factors and pointed out that as per US Prevention Task Force regular use of low dose Aspirin leads to 37% reduction of stroke in Male and 17% reduction of stroke in female population. He also referred to the Chinese Acute Stroke study (CAST) which showed reduction in stroke by 17% in women and 14% in men. If Aspirin was combined with Clopidogrel, it resulted in risk reduction by 20%.

Speaking about the emerging use of Aspirin, he mentioned about its efficacy in colorectal cancer, Alzheimer’s disease, Pre eclampsia or Pregnancy induced hypertension, pulmonary embolization, gastric, esophageal cancer, it delays cataract while its regular use is also recommended in high risk Type2 diabetes mellitus. However, as regards its use in primary prevention, ARRIVE study has created some controversy but in high risk patients, it can still be used for primary prevention, he added.

Dr. Fawad Farooq from NICVD Karachi spoke about the use of Aspirin in prevention of cardiovascular diseases. He discussed in detail the lipid deposition, inflammation, thrombosis, athero thrombosis, thrombus formation in detail. In low risk patients, Aspirin he stated, has no role as regards primary prevention. However, in case of endothelial damage, plaque rupture we use aspirin. Plaque rupture is the real culprit. He also talked about the new antiplatelet agents, safety and efficacy of dual antiplatelet therapy, use of aspirin in stable Ischemic Heart Disease, Acute Coronary Syndrome, NSTEMI, Unstable angina and STEMI. After stenting and angioplasty, low dose Aspirin therapy is used as a routine and there are no problems in secondary prevention of cardiovascular diseases wherein its efficacy and safety is very well established.

He concluded his presentation by stating that atherosclerosis starts early in life. It eventually leads to major vascular events. Use of low dose Aspirin therapy is indicated in all patients of atherosclerotic diseases as well as for primary prevention in high risk patients.

Photographed after the Aspirin Session during CARDIOCON at Islamabad on November
23, 2019 from (L to R) are Dr. A. Rashid Khan, Mr. Kashif Riaz, Prof .M. Ishaq, Prof.
Shahryar Sheikh, Prof. Abdus Samad, Dr. Zohra Samad, Mr.Shaukat Ali Jawaid, Prof.
Feroze Memon, Prof. M. Akbar Chaudhry and Mr. Waqar from Atco Labs.

During the discussion it was pointed out that the prevalence of Aspirin resistance is very low as there may be many patients who are non-responders to Aspirin like all other drugs or there may be problem with compliance. Prof. Abdus Samad remarked that Aspirin is being used in patients since long and it has played a vital role in reducing morbidity and mortality in cardiovascular diseases. Referring to the study presented by Dr. Muddasar Noor from AFIC, he raised serious concerns saying that there was no randomization and one needs case control study which should be properly designed, planned and conducted. These are the qualities of any good study done on scientific basis which this study lacks. From the presentation it is not clear what type of population was selected for this study? What was the sample size and how it was calculated? In view of these important deficiencies this study was not valid. He advised that such studies should be scientifically planned and conducted after proper randomization.

Continuing Prof. Samad further stated that there are very few reports of Aspirin resistance in Asian population. Most of the results relate to western population. He further advised the speaker that instead of reading from the slides, it is better to learn the art of making a presentation. Dr. Muddasar Noor responded by saying that it was randomized but it was not blinded. Prof. Samad remarked that there are so many papers on Aspirin and it remains the most widely investigated drug. Every day we see some papers on Aspirin which are published in some parts of the word. Thrombus is our real problem. As regards its use in primary prevention, it needs to be properly investigated in Asian population. At present it is difficult to answer this question but the proposed A4P study planned by Prof. Javed Akram if conducted might provide us some answer. Medicine, Prof. Samad further stated is an Art and Science. One may know the science but has to learn the Art. One should not deprive the patients of such a safe and effective antiplatelet agent due to politicking and because of some vested interests. We as scientists must promote Evidence Based Medicine.

Prof. Shahryar Sheikh in his remarks also supported the regular use of low dose aspirin in high risk patients wherein its safety and efficacy has been very well documented, he added. The meeting was sponsored by Atco Laboratories and it was very well attended by cardiologists attending the international cardiology conference organized by Pakistan Cardiac Society.