#Risk of major #haemorrhage after #clopidogrel with #aspirin

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    •  Univadis Medical News

A new analysis in JAMA Neurology suggests that treatment with clopidogrel plus aspirin after transient ischaemic attack (TIA) or minor acute ischaemic stroke (AIS) increases the risk of major haemorrhage over aspirin alone, although the risk is low.

Researchers performed a secondary analysis of the Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) trial which randomised patients in 269 sites worldwide to receive clopidogrel (600 mg loading dose on day one, followed by 75 mg daily for days 2-90) or placebo. All patients also received open-label aspirin 50-325 mg/d.

In the as-treated analyses (4,819 patients), major haemorrhage occurred in 21 patients receiving clopidogrel plus aspirin and six receiving aspirin alone (hazard ratio [HR] 3.57; 95% CI 1.44-8.85; number needed to harm, 159). There were four fatal haemorrhages—three in the clopidogrel plus aspirin group and one in the aspirin alone groupand there were seven intracranial haemorrhages: five in the clopidogrel plus aspirin group and two in the aspirin plus placebo group. The most common location of major haemorrhages was the gastrointestinal tract.

The authors estimated that for every 1,000 patients treated, adding clopidogrel might prevent about 15 major ischaemic events and cause five more major haemorrhages.

#Aspirin and #omega-3 reduce #precancerous bowel polyps

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    • Lancet


  • Aspirin and the omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) failed to reduce the incidence of colorectal adenoma in a high-risk population, but a secondary analysis showed reduction in the mean number of polyps, especially when the 2 agents were combined.

Why this matters

  • Aspirin is not used for sporadic colorectal cancer prevention because of uncertainty about the best dose and the target population.
  • Reduction in polyp number likely translates to a clinically meaningful effect.

Study design

  • Multicenter, placebo-controlled seAFOod Polyp Prevention trial of 709 participants classified as high risk after colonoscopy.
  • Participants were randomly assigned to receive placebo, aspirin (300 mg), EPA (2 g 99% EPA or 2780 mg 90% EPA), or aspirin+EPA. Surveillance colonoscopy at 1 year.
  • Funding: Efficacy and Mechanism Evaluation Programme.

Key results

  • Mean adenomas per participant:
    • Placebo: 1.4 (SD, 2.0).
    • EPA: 1.6 (SD, 2.1).
    • Aspirin: 1.3 (SD, 1.6).
    • EPA+aspirin: 1.0 (SD, 1.2).
  • All colorectal adenomas:
    • EPA vs no EPA: risk ratio (RR), 0.98 (95% CI, 0.87-1.12).
    • Aspirin vs no aspirin: RR, 0.99 (95% CI, 0.87-1.12).
  • Advanced colorectal adenomas:
    • EPA vs no EPA: incidence RR (IRR), 0.82 (95% CI, 0.43-1.56).
    • Aspirin vs no aspirin: IRR, 0.99 (95% CI, 0.52-1.86).


  • Short surveillance interval.

#Stopping #aspirin increases #risk of second MI and stroke by 37%

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Adherence to low-dose aspirin treatment may be an important treatment goal.
 Findings from a new study suggest discontinuation of long-term low-dose aspirin for the prevention of cardiovascular disease in the absence of major surgery or bleeding may be hazardous.
For the study, published in Circulation, investigators examined data on 601,527 users of low-dose aspirin for primary or secondary prevention identified in the Swedish drug prescription register.
They found patients who discontinued aspirin had a 37 per cent higher rate of cardiovascular events than those who continued therapy. The risk increased shortly after discontinuation and did not appear to diminish over time.
The authors noted aspirin discontinuation appeared “especially perilous among patients with previous cardiovascular disease”, with an additional cardiovascular event per year in one of every 36 patients who discontinued aspirin compared with an additional cardiovascular event per year in one of every 146 primary prevention patients who discontinued aspirin.
The findings come at a time when studies detail aspirin discontinuation rates of up to 30 per cent have been reported, and poor aspirin compliance has been noted in up to 50 per cent.
The authors said they hoped the findings help physicians to make an informed decision on whether to discontinue aspirin.

Can aspirin prevent miscarriage?

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The ability of aspirin to sustain pregnancy was linked to levels of C-reactive protein.

Findings from a new analysis suggest taking daily low-dose aspirin (LDA) may increase clinical pregnancy and live birth rates in women attempting conception who have elevated high-sensitivity C-reactive protein (hsCRP) and prior pregnancy loss.

In making the findings, researchers examined data originally obtained from the Effects of Aspirin in Gestation and Reproduction  (EAGeR) trial which sought to determine if LDA could prevent subsequent pregnancy loss among women who had one or two prior losses.

For this study, women were classified into three groups: those with low CRP, mid CRP and high CRP. Each received either daily LDA or a placebo.

The authors found those with high CRP in the placebo group had the lowest rate of live births at 44 per cent, while those taking daily aspirin had a live-birth rate of 59 per cent. Aspirin also appeared to reduce CRP levels in the high CRP group. There were no significant differences in birth rates between those receiving aspirin or placebo in the low and mid CRP groups.

The authors said more research is needed to confirm the findings.

Aspirin reduces mortality in colon cancer patients

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Treatment reduces mortality by 15 to 25 per cent in patients with colorectal cancer.

Taking aspirin can increase the likelihood of surviving colorectal cancer. According to a Norwegian study published in the “Journal of Clinical Oncology”, treatment using the drug reduced mortality after diagnosis by 15 to 25 per cent.

Researchers from the University of Oslo analysed data from 23,000 patients with colon cancer. Of these, 6,102 (26.3 per cent) were treated with aspirin after the diagnosis. The average follow-up period was three years.

In the aspirin group, 32.9 per cent of the participants died, 19 per cent of these deaths were directly associated with the cancer. In contrast, 42.3 per cent of the participants in the control group died; they had not been exposed to aspirin. 31.5 per cent of these deaths were directly linked to cancer.

Aspirin use after diagnosis of colorectal cancer therefore correlated with a better overall and cancer specific survival, concluded the scientists. From a cost-benefit perspective and in regards to the discussion on aspirin as a method of cancer prevention, this is interesting not only because aspirin is inexpensive, but also because the risk of relapse is significantly higher than the risk of initial onset of cancer, said study author Kjetil Tasken.

Aspirin could increase survival of cancer patients

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British study finds 20 per cent reduced mortality and slower cancer spread.

Taking low-level doses of aspirin could increase the survival chance of cancer patients, according to a systematic review by British researchers that was published in “PLOS One”.

Previous studies have shown that taking aspirin can reduce the incidence of certain cancer types. The research team from Cardiff University wanted to find out whether the drug can also help in the treatment and set out to conduct a systematic search of all the scientific literature, looking at all of the available data including five randomised trials and 42 observational studies of colorectal, breast and prostate cancers. The average follow-up period was five years.

The team’s results suggest that low-dose aspirin taken by patients with bowel, breast or prostate cancer, in addition to other treatments, is associated with a reduction in deaths of about 15-20 per cent, together with a reduction in the spread of the cancer. The results from six studies of other cancers also suggest a reduction, but the numbers of patients were too few to enable confident interpretation. The mutation PIK3CA was present in about 20 per cent of patients; this explained much of the reduction in colon cancer mortality by aspirin.

As one of the concerns about taking aspirin is the potential for intestinal bleeding, the researchers specifically looked at the available evidence of bleeding. However, in no study was serious or life-threatening bleeding reported.”

Said lead researcher Peter Elwood: “While there is a desperate need for more detailed research to verify our review and to obtain evidence on less common cancers, we’d urge patients diagnosed with cancer to speak to their doctor about our findings so they can make an informed decision as to whether or not they should take a low-dose aspirin as part of their cancer treatment.”

Aspirin improves survival rates in intestinal cancer patients

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Survival for patients who took a daily dose of ASA was 75 per cent after five years, compared with 42 per cent in the control group.

Survival rates increase for intestinal cancer patients who take aspirin (ASA) after being diagnosed, according to a Dutch study presented at the European Cancer Congress in Vienna, Austria. The intake of ASA significantly reduced mortality after five years.

For the study, researchers at the University of Leiden analysed data from 14,000 individuals diagnosed with bowel, rectal, and esophageal cancer between 1998 and 2011 and associated prescription data with disease progression. 30.5 per cent of the subjects had already taken ASA for heart attack or stroke prevention and were excluded from the study. Of the remaining subjects, 8.3 per cent began taking low doses of ASA (80 to 100 milligrammes per day), while 61.1 per cent received no ASA drugs.

The researchers found that the results were very clear: “Carcinoma patients who began taking aspirin after being diagnosed had a survival rate of 75 per cent. The survival rate in gastrointestinal cancer patients who did not take aspirin was 42 per cent,” said study author Martine Frouws. A Dutch prospective study now aims to provide definitive proof of the protective effect aspirin has in such cases of cancer.

The researchers believe that the beneficial effect comes from the aspirin’s anti-thrombocyte effect. The circulating tumour cells are thought to “hide” from the immune system’s defence; and with the thrombocyte’s function thusly inhibited, this also inhibits the tumour cells’ ability ti protect themselves against the immune system.