Rivaroxaban as addition to aspirin and clopidogrel for an acute coronary syndrome

For patients who have had an acute coronary syndrome (ACS) and who are taking dual antiplatelet therapy with low-dose aspirin and clopidogrel 75 mg daily, one should add rivaroxaban 2.5 mg twice daily if there are no risk factors for bleeding present.

The duration of treatment with rivaroxaban is approximately one year, as studied in the randomized trial. Patients may reasonably choose to not take rivaroxaban if they are particularly concerned about the bleeding risk. This recommendation does not apply to patients taking either prasugrel or ticagrelor.

(ATLAS 2 ACS-TIMI 51 trial)

Aspirin for the primary prevention of cardiovascular disease and cancer

People above the age of 50 without excess bleeding risk should take low-dose daily aspirin (75 to 100 mg) as per the current recommendations.

Patients who are more concerned about the bleeding risks than the potential benefits (prevention of cardiovascular events and cancer) may reasonably choose to not take aspirin for primary prevention.

Meta-analyses of randomized trials have shown aspirin to reduce the risk of non-fatal myocardial infarction (Arch Intern Med 2012; 172:209) and long-term aspirin use reduces overall cancer risk (Lancet 2012; 379:1602).

A meta-analysis addressing this combined outcome suggests that aspirin use in 1000 average risk patients at age 60 years would be expected to result, over a 10-year period, in six fewer deaths, 19 fewer non-fatal myocardial infarctions, 14 fewer cancers, and 16 more major bleeding events.

Aspirin after 50 for the primary prevention of cardiovascular disease and cancer

For people age ≥50 years without excess bleeding risk, the new recommendation is to take a low-dose daily aspirin (75 to 100 mg).

Patients who are more concerned about the bleeding risks than the potential benefits (prevention of cardiovascular events and cancer) may reasonably choose to not take aspirin for primary prevention.

Meta-analyses of randomized trials have shown aspirin to reduce the risk of non-fatal heart attacks and long-term aspirin use reduces overall cancer risk.

A new meta-analysis suggests that aspirin use in 1000 average risk patients at age 60 years would be expected to result, over a 10-year period, in six fewer deaths, 19 fewer non-fatal myocardial infarctions, 14 fewer cancers, and 16 more major bleeding events. (Chest 2012;141:e637S)

Women above 65 to take extra care of their health

Women aged 65 and above should take low dose aspirin routinely to prevent heart attack and paralysis..

1.      All women are urged to exercise a minimum of 30 minutes per day, but women who need to lose weight or maintain weight loss are now advised to engage in 60 to 90 minutes of moderate-intensity activity
on most, or preferably all, days of the week.
2.      A heart-healthy diet should be rich in fruits, whole grains and fiber foods with a limited intake of alcohol and sodium.
3.      Saturated fat should be reduced to less than 7 percent of calories.
4.      Women at very high risk for heart disease should try to lower their LDL ("bad") cholesterol to less than 70 mg/dL.
5.      Women aged 65 and over should consider taking low-dose aspirin on a routine basis, regardless of their risk. Aspirin has been shown to prevent both heart attacks and stroke in this age group.
6.      The upper dose of aspirin for high-risk women is 325 mg per day.
7.      Hormone replacement therapy, selective estrogen receptor modulators nor antioxidant supplements such as vitamins C and E should be used to prevent heart disease.
8.      Folic acid should also not be used to prevent cardiovascular disease.
9.      Women should eat oily fish or some other source of omega-3 fatty acids at least twice a week.
10.     Women should not only quit smoking but should use counseling, nicotine replacement or other forms of smoking cessation therapy.

Emedinews:Makesure: A patient of asthma worsened on aspirin.

Situation: A patient of asthma worsened on aspirin.
Reaction: Oh my God! Why was history of allergy not taken?
Lesson: Make Sure that patients with asthma are not given aspirin without asking a history of allergy.