Impact of Long-Term Aspirin Use on Cardiovascular Disease Prevention and Bleeding Risks
DOI:
https://doi.org/10.62497/IRABCS.2024.77Keywords:
Aspirin, cardiovascular disease, bleeding complications, gastrointestinal bleeding, intracranial hemorrhage.Abstract
Background: The advantages of long-term aspirin usage for preventing cardiovascular disease must be balanced against the danger of bleeding.
Objective: This study aimed to evaluate the impact of long-term aspirin therapy on cardiovascular disease prevention and to assess the associated risks of bleeding complications.
Methodology: A prospective cohort research comprising 270 adult patients aged 40 and above who were on long-term aspirin treatment was carried out at the University of the Punjab from January 2023 to December 2023. A minimum of six months of aspirin treatment for primary or secondary cardiovascular prevention was necessary to meet the inclusion criteria. With an emphasis on cardiovascular outcomes, bleeding problems, and pertinent laboratory indicators, we gathered data via patient interviews, medical record checks, and laboratory testing. Frequency distributions and t-tests were used in statistical studies to contrast aspirin users with non-users.
Results: Among the 270 participants, 25 aspirin users (11.90%) experienced gastrointestinal bleeding (GI Bleeding), while no non-users reported this complication. Additionally, 10 aspirin users (4.76%) had intracranial hemorrhage, whereas no cases were observed in the non-user group. Laboratory analyses revealed that aspirin users had significantly higher platelet counts (230 ± 40 x10^9/L) compared to non-users (210 ± 35 x10^9/L, p = 0.01) and longer prothrombin times (14.2 ± 1.5 seconds) compared to non-users (13.5 ± 1.2 seconds, p = 0.03). Hemoglobin levels were not significantly different between aspirin users (13.2 ± 1.8 g/dL) and non-users (13.8 ± 1.9 g/dL, p = 0.12).
Conclusion: Long-term aspirin usage successfully lowers the risk of cardiovascular events, but it also raises the risk of bleeding in the brain and gastrointestinal tract. These results emphasize the need of doing a thorough risk assessment before beginning long-term aspirin medication in patients.
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Joseph P, Leong D, McKee M, Anand SS, Schwalm JD, Teo K, Mente A, Yusuf S. Reducing the global burden of cardiovascular disease, part 1: the epidemiology and risk factors. Circulation research. 2017;121(6):677-94. https://doi.org/10.1161/CIRCRESAHA.117.308903.
Kelly BB, Narula J, Fuster V. Recognizing global burden of cardiovascular disease and related chronic diseases. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine. 2012;79(6):632-40. https://doi.org/10.1002/msj.21345.
Passacquale G, Sharma P, Perera D, Ferro A. Antiplatelet therapy in cardiovascular disease: Current status and future directions. British Journal of Clinical Pharmacology. 2022;88(6):2686-99. https://doi.org/10.1111/bcp.15221.
Ornelas A, Zacharias-Millward N, Menter DG, Davis JS, Lichtenberger L, Hawke D, Hawk E, Vilar E, Bhattacharya P, Millward S. Beyond COX-1: the effects of aspirin on platelet biology and potential mechanisms of chemoprevention. Cancer and Metastasis Reviews. 2017;36:289-303. https://doi.org/10.1007/s10555-017-9675-z.
Lucotti S, Cerutti C, Soyer M, Gil-Bernabé AM, Gomes AL, Allen PD, Smart S, Markelc B, Watson K, Armstrong PC, Mitchell JA. Aspirin blocks formation of metastatic intravascular niches by inhibiting platelet-derived COX-1/thromboxane A 2. The Journal of clinical investigation. 2019;129(5):1845-62. 10.1172/JCI121985.
Raber I, McCarthy CP, Vaduganathan M, Bhatt DL, Wood DA, Cleland JG, Blumenthal RS, McEvoy JW. The rise and fall of aspirin in the primary prevention of cardiovascular disease. The Lancet. 2019;393(10186):2155-67. https://doi.org/10.1016/S0140-6736(19)30541-0.
Walker J, Cattaneo M, Badimon L, Agnelli G, Chan AT, Lanas A, Rocca B, Rothwell P, Patrignani P, Langley R, Vilahur G. Highlights from the 2019 International Aspirin Foundation Scientific Conference, Rome, 2019: benefits and risks of antithrombotic therapy for cardiovascular disease prevention. ecancermedicalscience. 2020;14. doi: 10.3332/ecancer.2020.998.
Dai Y, Ge J. Clinical use of aspirin in treatment and prevention of cardiovascular disease. Thrombosis. 2012;2012(1):245037. https://doi.org/10.1155/2012/245037.
Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. Jama. 2019;321(3):277-87. doi:10.1001/jama.2018.20578.
García Rodríguez LA, Martín-Pérez M, Hennekens CH, Rothwell PM, Lanas A. Bleeding risk with long-term low-dose aspirin: a systematic review of observational studies. PLoS one. 2016;11(8):e0160046. https://doi.org/10.1371/journal.pone.0160046
Whitlock EP, Burda BU, Williams SB, Guirguis-Blake JM, Evans CV. Bleeding risks with aspirin use for primary prevention in adults: a systematic review for the US Preventive Services Task Force. Annals of internal medicine. 2016;164(12):826-35. https://www.acpjournals.org/doi/full/10.7326/M15-2112?download=true&journalCode=aim.
Li L, Geraghty OC, Mehta Z, Rothwell PM. Age-specific risks, severity, time course, and outcome of bleeding on long-term antiplatelet treatment after vascular events: a population-based cohort study. The Lancet. 2017;390(10093):490-9. https://doi.org/10.1016/S0140-6736(17)30770-5.
Wu IC, Hsieh HM, Yu FJ, Wu MC, Wu TS, Wu MT. A long‐term risk‐benefit analysis of low‐dose aspirin in primary prevention. European journal of clinical investigation. 2016;46(2):130-40. https://doi.org/10.1111/eci.12575.
Iwamoto J, Saito Y, Honda A, Matsuzaki Y. Clinical features of gastroduodenal injury associated with long-term low-dose aspirin therapy. World journal of gastroenterology: WJG. 2013;19(11):1673. doi: 10.3748/wjg.v19.i11.1673.
Lanas A, Wu P, Medin J, Mills EJ. Low doses of acetylsalicylic acid increase risk of gastrointestinal bleeding in a meta-analysis. Clinical Gastroenterology and Hepatology. 2011;9(9):762-8. https://doi.org/10.1016/j.cgh.2011.05.020.
Huang WY, Saver JL, Wu YL, Lin CJ, Lee M, Ovbiagele B. Frequency of intracranial hemorrhage with low-dose aspirin in individuals without symptomatic cardiovascular disease: a systematic review and meta-analysis. JAMA neurology. 2019;76(8):906-14. doi:10.1001/jamaneurol.2019.1120.
Biffi A, Halpin A, Towfighi A, Gilson A, Busl K, Rost N, Smith EE, Greenberg MS, Rosand J, Viswanathan A. Aspirin and recurrent intracerebral hemorrhage in cerebral amyloid angiopathy. Neurology. 2010;75(8):693-8. https://doi.org/10.1212/WNL.0b013e3181eee40f.
Di Minno G. Aspirin resistance and platelet turnover: a 25-year old issue. Nutrition, Metabolism and Cardiovascular Diseases. 2011;21(8):542-5. https://doi.org/10.1016/j.numecd.2011.04.002.
Gulpinar K, Ozdemir S, Ozis E, Sahli Z, Demirtas S, Korkmaz A. A preliminary study: aspirin discontinuation before elective operations; when is the optimal timing?. Journal of the Korean Surgical Society. 2013;85(4):185-90. https://doi.org/10.4174/jkss.2013.85.4.185.
Gaskell H, Derry S, Moore RA. Is there an association between low dose aspirin and anemia (without overt bleeding)?: narrative review. BMC geriatrics. 2010;10:1-7. https://doi.org/10.1186/1471-2318-10-71.
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Copyright (c) 2024 Asif Iqbal, Awais Ahmed Uttra, Shafiq ul Rehman, Ramzan Ali (Author)
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