Pakistan Aspirin Foundation publishes revised Guidelines on Medical Uses of Aspirin


Pakistan Aspirin Foundation publishes revised
Guidelines on Medical Uses of Aspirin

KARACHI: Pakistan Aspirin Foundation has published the revised guidelines on Medial Uses of Aspirin which can be viewed on its website These guidelines have been jointly authored by Prof. Abdus Samad, Prof. Ejaz Ahmad Vohra, Prof. Muhammad Akbar Chaudhry and Mr.Shaukat Ali Jawaid. A significant contribution to this final document has been made by Lt. Gen. Prof. Mahmud Ahmad Akhtar former Surgeon General of Pakistan Army who is considered an authority on clinical pharmacology.
Others who have contributed to this document in different ways, i.e. participating in the discussion at various CME meetings organized by Pakistan Aspirin Foundation in different parts of the country or looking at the revised document before it was given final touches include Prof. Khawar Kazmi, Prof. M. Ishaq, Prof. Mansoor Ahmad, Dr. A. Rashid, Prof. Waris Qidwai, Dr. Basheer Haneef, Prof. Shareef Chaudhry, Prof S.H. Shafqat from Karachi, Prof. Nazir Memon, Prof. Feroze Memon and Dr. Fazlur Rehman Memon from Hyderabad, Dr. Maqbool H. Jafary from Lahore, Dr. Ijaz Ahmad from Multan, Major Gen. Ashur Khan from Rawalpindi, Dr.Shaukat Malik from Islamabad besides others.
This 28-page document also carries an Executive Summary and the information provided has been supported with relevant references. Information given in the guidelines include mechanism of action of Aspirin, its pharmacokinetics, use of Aspirin in acute ST elevation Myocardial Infarction, effects of anti-platelet therapy on vascular events, Use of Aspirin in secondary prevention, Aspirin in primary prevention, use of Aspirin after PCI, combination therapy with clopidogrel, recommendations regarding use of Aspirin for prevention of MI and Stroke, use of Aspirin after CABG, in acute ischaemic stroke, in diabetes mellitus. One of the primary indications for updating these guidelines was to focus on the GI bleeding risk in patients taking long term aspirin therapy. The physicians have been advised to calculate the ten years risk of all individuals who are candidates for preventive therapy. Framingham, Risk Score Calculator has been mentioned for Men and Women which will help the physicians in calculating the risk of all patients who are going to be put on long term low dose aspirin therapy. Use of Aspirin in TIAs, primary and secondary prevention of stroke, use of Aspirin in Hypertension, Aspirin prophylaxis against Deep Vein Thrombosis and Pulmonary Embolism, emerging uses of Aspirin particularly in different types of Cancer in general and colorectal cancer in particular, use of Aspirin in Gout, dental treatment, Absolute and relative contra indications to the use of Aspirin have all been covered in detail. The recommended dose of Aspirin in its well established indications have all been provided.

Executive Summary

“Aspirin remains the cornerstone of anti platelet therapy in patients with cardiovascular diseases. It decreases mortality and recurrence of cardiovascular events when used as acute therapy following acute coronary syndrome, thrombotic stroke and Kawasaki’s disease. It has proven benefits in secondary prevention in acute coronary syndrome, stable angina, revascularization, stroke, TIAs and atrial fibrillation. As such Use of Aspirin in ST elevation Myocardial Infarction or Acute Coronary Syndrome offers a substantial benefit regarding mortality, re-infarction and stroke.
Use of Aspirin in primary prevention is associated with clinical benefit only in high risk individuals. The physicians starting an individual for a life long low dose aspirin therapy for primary prevention must calculate the overall risk of the individual and only high risk patients should be advised to start low dose aspirin Therapy.
Patients with diabetes mellitus should also be put on low dose aspirin therapy if there are no contra indications.
Patients with high blood pressure may be started on low dose aspirin only when their blood pressure is well controlled for a prolonged period of time.
The role of Aspirin in prevention of deep vein thrombosis in major surgery and Air travel is still under investigation. Another emerging indication is prevention of colorectal cancer and other major cancers including reduction in distant metastasis.
Enteric coated aspirin preparations developed to attenuate local gastric erosion and minimize this side effect are preferred for long term use in patients on low dose aspirin therapy. The concept of aspirin resistance is still an emerging and important clinical question which needs to be studied further
These guidelines also give some details of combination with Clopidogrel in acute coronary syndrome and coronary stenting as well as Coronary Artery Bypass Graft Surgery (CABG). “

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