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An interesting patient take on aspirin utilization

Posted by plosmedicine on 30 Mar 2009 at 23:49 GMT

Author: Rakesh Biswas
Position: Associate professor,
Institution: Internal Medicine, Vydehi Institute of Medical Sciences and research, Whitefield, Bangalore
Submitted Date: December 23, 2005
Published Date: January 5, 2006
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

A broad array of randomized trials have demonstrated the benefits of low doses of aspirin (75mg), for both the primary and secondary prevention of CVD. Most trials demonstrate a 15-40% reduction in cardiovascular events with chronic aspirin use. Unfortunately many of our patients don't consume based on that information. Why they do take or do not take it has been the subject of this illuminating article.

A few patients who don't relish reular use of aspirin do take it during brief episodes of chest pain, maybe once or twice a week. That has led generalist physicians (who weakly boast of belonging to a problem-solving specialty and who have been accused in this present article of being guilty of not stuffing aspirin down their patient's gullets) to ask the question whether the aspirin effect is related to its preventing thrombus formation during acute plaque fissuring in acute coronary syndromes or does it have any effect on the chronic stable plaque? If the effect is only on the fissured plaque, which is a one-time event, does it justify consuming aspirin daily?

Would it be ethically justified to have a trial of aspirin to patients administered only during episodes of sustained chest pain and not on a regular basis?

No competing interests declared.