Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events

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Nelson Vergel

Founder, ExcelMale.com
Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events

What Is New?
• Discontinuing long-term low-dose aspirin treatment in the absence of major surgery or bleeding may be hazardous.
• We investigated that question among 601 527 users of low-dose aspirin for primary or secondary prevention identified in the Swedish drug prescription register.
• Patients who discontinued aspirin had a 37% higher rate of cardiovascular events than those who continued, corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin.
• The risk increased shortly after discontinuation and did not appear to diminish over time.
What Are the Clinical Implications?
• Adherence to low-dose aspirin treatment in the absence of major surgery or bleeding is likely an important treatment goal.
• Millions of patients worldwide take aspirin on a daily basis and might consider stopping at some time during their lives.
• This article may help physicians and patients to make an informed decision on whether to stop aspirin use.

Background: There are increasing concerns about risks associated with aspirin discontinuation in the absence of major surgery or bleeding. We investigated whether long-term low-dose aspirin discontinuation and treatment gaps increase the risk of cardiovascular events.

Methods: We performed a cohort study of 601 527 users of low-dose aspirin for primary or secondary prevention in the Swedish prescription register between 2005 and 2009 who were >40 years of age, were free from previous cancer, and had ≥80% adherence during the first observed year of treatment. Cardiovascular events were identified with the Swedish inpatient and cause-of-death registers. The first 3 months after a major bleeding or surgical procedure were excluded from the time at risk.

Results: During a median of 3.0 years of follow-up, 62 690 cardiovascular events occurred. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37; 95% confidence interval, 1.34–1.41), corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin. The risk increased shortly after discontinuation and did not appear to diminish over time.

Conclusions: In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding was associated with a >30% increased risk of cardiovascular events. Adherence to low-dose aspirin treatment in the absence of major surgery or bleeding is likely an important treatment goal.

Sundstrom J, Hedberg J, Thuresson M, Aarskog P, Johannesen KM, Oldgren J. Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events. Circulation 2017;136(13):1183.
 
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