LDA therapy has proved to be highly safe and effective in still births, fetal growth restriction, pre-term birth, early pregnancy loss and pre-eclampsia –
Jahan Ara Ainuddin
Aspirin Update Session during PSIM Conference at Karachi
KARACHI: A scientific session which covered Update on Aspirin Therapy was part of the scientific programme of Pakistan Society of Internal Medicine (PSIM) 6th International Conference held at Karachi from April 17th to April 20th 2025. It was chaired by Prof Abdus Samad an eminent Interventional Cardiologist and former President of Pakistan Aspirin Foundation. The Panel of Experts included Prof. Masood Hameed former Vice Chancellor of DUHS, Prof. Feroz Memon President of Pakistan Aspirin Foundation, Prof. Shaheen Naz Masood and it was moderated by Dr. Fareed Uddin from DUHS. The speakers included Prof. Azizur Rehman an eminent physician and executive member of PSIM and Prof. Jahan Ara Ainuddin Professor of Obstetrics & Gynecology who has been named as the Acting Vice Chancellor of Dow University of Health Sciences.
Prof. Abdus Samad chairing the Aspirin Update Session during the Pakistan Society of Internal Medicine 6th Int. Conference held at Karachi from April 17th to 20th April 2025. Also sitting on the dais from (L to R) members of the Experts Panel are Prof. Mansoor Ahmad, Prof. Feroz Memon President Pakistan Aspirin Foundations, Prof. Masood Hameed former VC DUHS and
Prof. Shaheen Naz Masood.
Prof. Azizur Rehman was the first speaker who discussed Use of Aspirin in Cardiometabolic Disorders specially diabetes. He first traced the history of discovery of Aspirin over one hundred fifty years ago and the discoverer earned the Nobel Prize in 1897. Until 1950s it was used for pain relief and its other clinical properties were discovered later. It has an antiplatelet effect and makes it the most safe, effective, antiplatelet preparation which is being extensively used in various disorders for the last over hundred years.
Various studies, Prof. Azizur Rehman stated, have showed that Aspirin resistance is seen in 5-30% of the patients. American College of Cardiology and American Heart Associator, both have included it in Class-I A level indications. If it is not prescribed it is considered as a serious professional negligence. Various studies have established its safety and efficacy in secondary prevention of Cardiovascular Disorders, ASCVD. Aspirin is an important combination in Dual Antiplatelet Therapy. American College of Chest Physicians recommend use of 75mg to 100mg Aspirin daily and in case of resistance, one can use clopidogrel. All major societies recommend low dose Aspirin therapy for twelve months in Dual Antiplatelet therapy followed by Aspirin alone. Low Dose Aspirin therapy has to be used for lifelong in most cases.
Prof. Abdus Samad presenting a Memento to Prof. Azizur Rehman
who was one of the speakers in the Aspirin Update session.
Speaking about the use of low dose aspirin therapy in primary prevention, Prof. Azizur Rehman pointed out that data may not be strong but it is recommended in all high-risk patients. American College of Cardiology and American Heart Associator both recommend its use in patients between the age of 40-70 years who are at high risk of developing cardiovascular diseases. Diabetes Mellitus has the same risk that of CAD hence if patients have diabetes for over ten years with additional risk factors, they must be put on low dose Aspirin therapy. People suffering from Diabetes Mellites has three times more risk of developing cardiovascular disease. Similarly, they haves three times more chances of developing complications and procedure failure. In newly diagnosed patients suffering from diabetes, there is no clear benefit of low dose aspirin therapy.
However, in case of multiple co-morbidities in case of interventional procedures, CABG, TIAs low dose Aspirin therapy is highly beneficial. While deciding for use of Aspirin for primary prevention, it is advisable to calculate risk benefit ratio. In high-risk cases, do prescribe Aspirin therapy. Patients with diabetes for more than ten years, those suffering from hypertension, obesity, smoking history, high HbAIc levels are all candidates for low dose Aspirin therapy. It is also useful in Alzheimer’s disease, different types of cancers. He concluded his presentation stating that in most cases Aspirin is the first line drug for secondary prevention. For primary prevention, look at the risk benefit ratio and individualized therapy is preferred for which one must take the patient in to confidence. There is no doubt that Aspirin is a wonder drug, he remarked.
Prof. Abdus Samad presenting a Memento to Prof. Jahan Ara Ainuddin one of the speakers at the Aspirin Update Session during PSIM 6th Int. Conference. Picture also shows from (L to R) Prof. Masood Hameed, Prof. Feroz Memon, Prof. Shabeen Naz Masood, Prof. Javed Akram and Prof. Mansoor Ahmed.
Prof. Jahan Ara Ainuddin was the next speaker in this session who highlighted the use of low dose Aspirin therapy in Gynecology. Aspirin, she opined, has been proved to be highly safe and effective in still births, fetal growth restriction, pre-term birth, early pregnancy loss and pre-eclampsia.
In hypertensive disorders in pregnant women, low dose aspirin therapy should be started in a dose of 150mg between 11-14 weeks of gestation. It is helpful in preventing eclampsia. Early introduction of low dose aspirin therapy is desirable in renal insufficiency, liver transplant, neurological complications, utero placental dysfunctions, still births. During first trimester start LDA therapy as a prophylactic Take care of the risk factors. Use of Aspirin is contra indicated in active peptic ulcer disease, active bleeding, threatened miscarriage, underlying bleeding disorders. Pregnant women should be advised to take Aspirin at night. It has added benefits for the patients as it does not cross the placenta and has no effects on the baby. Aspirin therapy should be stopped three days before the planned procedure. Start Aspirin therapy 75mg from sixth to twelve weeks of gestation and continue it till 37th week. Aspirin has an important place in treatment of various disorders during pregnancy. Its safety and efficacy have also been established in colon, gastric, pancreatic, ovarian cancers in elderly women. Low Dose Aspirin therapy, she stated, is very safe, economically priced therapy, it can be used in ovulation induction, is safe in pre-eclampsia. Start early in high-risk cases with a dose of 150mg daily and stop it three days before the planned surgical procedure, she remarked.
Pakistan Aspirin Foundations in collaboration with Pakistan Society of Internal Medicine organized an Aspirin Update Session during the PSIM 6th Int. Conference on April 18th 2025. Group photograph taken on this occasion shows the Chairperson Prof. Abdus Samad, Members of the Experts Panel, speakers and some of the participants.
Prof. Javed Akram gave details of the planned A4P (Aspirin in primary prevention in Pakistani Patients) study which the Pakistan Aspirin Foundation had planned but could not be initiated due to COVID. It is planned to start is soon. It will enroll over twenty-seven thousand patients. Physicians, specialists in various disciplines, Primary care physicians will enroll the patients. The protocol has been prepared giving details of inclusion and exclusion criteria. It will be conducted at numerous centers and all those interested to get involved in the study are requested to get in touch with Pakistan Aspirin Foundation. M/s Atco has promised to finance this investigator-initiated study, provide us with placebo tablets. The study will be approved from the National Bioethics Committee, Drug Regulatory Authority of Pasian and approval will also be taken from the institutions where the patients are enrolled. An important CRO headed by Mr. Khurram Zaki has also promised to help us in this regard. This study will provide us local data. Patients between the age of 18-65 years will be enrolled. Those with history of CVD events, Atrial fibrillation, severe illness, anemia, those allergic to Aspirin will be excluded. We will also see the prevalence of Aspirin resistance in this study.
Prof. Masood Hameed remarked that A4P is an important study and we must take care of side effects of Aspirin, its use in primary prevention, family history of patients with co-morbid conditions, auto immune diseases must also be looked into Prof. Shaheen Naz Masood highlighted the importance of reference of studies from Pakistan and using the Guidelines on low dose Aspirin therapy.
Prof. Abdus Samad in his concluding remarks stated that advanced in technology has resulted in patients living longer. Use of Low Dose Aspirin therapy keeps patients going. It is a very safe and effective antiplatelet preparation. Over 60% of pregnant women also suffer from valvular heart disease. Aspirin is a wonder drug in Rheumatic Heart Disease. Rheumatic Fever and Rheumatic Heart Disease remains neglected and the patients develop valvular heart disease. He reminded those present not to forget the Rheumatic Fever and Rheumatic Heart Disease. If neglected, it can have serious complications with increased morbidity and mortality. A4P is an important study and one hopes it gets going which will provide lot of useful local data, he remarked.
Participating in the discussion Mr. Shaukat Ali Jawaid Secretary of Pakistan Aspirin Foundation remarked that the foundation revises its Gudens on Medical Uses of Aspirin after few years regularly. The Experts panel revising the guidelines is headed by Prof. Samad. The section related to use of Aspirin in Guidelines prepared by Pakistan Aspirin Foundation was contributed by Prof. Jahan Ara Ainuddin which was later also approved by Gynecologist’s at meeting held at Lahore, Rawalpindi-Islamabad and Peshawar for which we are extremely grateful to her. This session was sponsored by M/s Atco Laboratoires which are sponsoring all academic activities of Pakistan Aspirin Foundation for the last many years.
