The Exchange

Commentary and Observations from
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The Continued Study of an Old Drug: Aspirin

The Continued Study of an Old Drug: Aspirin

It started out by taking extract from the willow tree and using it as a medicinal agent well over 150 years ago. Today, this extract, now transformed into acetylsalicylic acidor aspirinis still being studied and needs the continued attention of NPs and PAs.

Three recent trials have looked at the use of aspirin and its effects, both in primary disease prevention and in reduction of all-cause mortality. The Aspirin to Reduce Risks of Initial Vascular Events (ARRIVE) trial studied patients with cardiovascular (CV) comorbidities, but without diabetes; A Study of Cardiovascular Events in Diabetes (ASCEND) trial focused on patients with diabetes but without CV comorbidities; and the Aspirin in Reducing Events in the Elderly (ASPREE) trial followed patients over 65 years of age without CV comorbidities.

The results of these three trials have not differed from prior studies in revealing a new clinical use for aspirin, but do show that aspirin still offers benefits for most patients. Additionally, these trials were unique in the specific groups that were targeted for study, and they bring to light how aspirin's effects can vary in different patient populations. For example, while risk of bleeding is still a concern for all groups, there was a higher risk for those in the older population of the ASPREE trial. These three trials, along with ten prior trials, represent over 164,000 patients and well over 1 million patient years to look at the effects of aspirin and its CV benefits.

As NPs and PAs, we must continually keep up to date on trials that impact our patients, especially for the medications we regularly prescribe. Even though aspirin has been around for a very long time, we are still perplexed by its activity and potential use in the reduction of CV disease.

References
  • ASCEND Study Collaborative Group, Bowman L, Mafham M, et al. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379:1529-39.
  • Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018;392:1036-46.
  • McNeil JJ, Nelson MR, Woods RL, et al. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018;379:1519-28.
  • McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379:1509-18.
  • McNeil JJ, Woods RL, Nelson MR, et al. Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. 2018;379:1499-1508.

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Filed under: Cardiometabolic, Miscellaneous

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