USPSTF updates recommendations for aspirin use

June 10, 2016

The guidelines, which update the group's 2007 and 2009 recommendations, are published in the "Annals of Internal Medicine."

Anna Garrett

The U.S. Preventive Services Task Force (USPSTF) recommends aspirin for primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in some high-risk adults in their 50s and 60s. The guidelines, which update the group's 2007 and 2009 recommendations, are published in the Annals of Internal Medicine. To support the revisions, the USPSTF reviewed five additional studies of aspirin for the primary prevention of CVD and several additional analyses of CRC follow-up data. 

Highlights of the new recommendations include the following. 

* Low-dose aspirin is recommended for adults aged 50-59 who have at least a 10% risk for a cardiovascular event in the next decade, low bleeding risk, and a life expectancy of at least 10 years; patients must also be willing to take aspirin daily for at least 10 years (grade B recommendation).

* For adults aged 60-69 fitting the above criteria, the decision to start aspirin should be an individual one (grade C).

* For patients younger than 50 and older than 69, there is not enough evidence to make recommendations (grade I).

Source: Bibbins-Domingo K. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2016Published online April 12, 2016.

See also: Fall-related ICH incidence in elderly on warfarin

Ticagrelor no better than aspirin for CVD prevention

The antiplatelet ticagrelor (Brilinta; AstraZeneca) is no better than aspirin for preventing cardiovascular events in patients with acute ischemic stroke or transient ischemic attack, the manufacturer has announced.

In the international SOCRATES trial, adults ages 40 and older who had had a stroke or TIA within the past 24 hours were randomized to receive ticagrelor (90 mg twice daily) or aspirin (100 mg once daily) for 90 days. The primary efficacy endpoint was the time to first occurrence of stroke (ischemic or hemorrhagic), myocardial infarction, or death.

The manufacturer said that while fewer endpoint events occurred with ticagrelor, the difference between groups was not statistically significant.

Source: News release. "AstraZeneca reports top-line results from the Brilinta SOCRATES trial in stroke." http://bit.ly/ticagreloraspirin. Accessed May 4, 2016.

See also: ICH volume smaller with DOACs than with warfarin

 

Risk of complications low with well-managed warfarin

The availability of newer anticoagulants (NOAC) for stroke prevention in atrial fibrillation (AF) has created a perception that warfarin use is associated with more complications.

A recent study evaluated the efficacy and safety of well-managed warfarin therapy in patients with non-valvular AF. The Swedish study followed a total of 40,449 patients starting warfarin therapy for non-valvular AF over a five-year period. The investigators evaluated the efficacy and safety of warfarin treatment in patients with concomitant aspirin therapy and those with no additional antiplatelet medications. They measured the annual incidence of complications in association with individual TTR (iTTR), INR variability, and identification of factors indicating the probability of intracranial bleeding.

Of the 40,449 patients included in the study, 16,201 (40%) were women. Mean age of the cohort was 72.5 years, and the mean CHA2DS2-VASc score was 3.3 at baseline. The annual incidence, reported as percentage of all-cause mortality, was 2.19% and, for intracranial bleeding, 0.44%.

Patients receiving concomitant aspirin had annual rates of 3.07% for any major bleeding and 4.9% for thromboembolism; those with renal failure were at higher risk of intracranial bleeding (hazard ratio, 2.25). Annual rates of any major bleeding and any thromboembolism in patients with iTTR less than 70% were 3.81% and 4.41%, respectively, and, in high INR variability, were 3.04% and 3.48%, respectively. For patients with iTTR 70% or greater, the level of INR variability did not alter event rates.

The authors concluded that well-managed warfarin therapy is associated with a low risk of complications and is still a valid alternative for prophylaxis of AF-associated stroke. Therapy should be closely monitored for patients with renal failure, concomitant aspirin use, and poor INR control.

Source: Björck F, Renlund H, Lip G, et al. Outcomes in a warfarin-treated population with atrial fibrillation. JAMA Cardiol. Published online April 20, 2016.