Aspirin use for primary prevention in elderly patients

Submitted: May 24, 2016
Accepted: May 24, 2016
Published: June 22, 2016
Abstract Views: 2398
PDF: 1275
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The net clinical benefit of aspirin in primary prevention is uncertain as the reduction in occlusive events needs to be balanced against the increase in gastro-intestinal and cerebral bleedings. The meta-analysis of ATT (Anti Thrombotic Trialists) Collaboration in 2009 showed that aspirin therapy in primary prevention was associated with 12% reduction in cardio-vascular events, due mainly to a reduction in non-fatal myocardial infarction (0.18% vs 0.23% per year, p<0.0001). However, the benefit in term of coronary events was almost balanced by the increase in major bleedings. The balance between potential benefit and harm of aspirin differs in each person and appears to be favorable in subjects at higher cardio-vascular risk. Older people have increased risk of hemorrhage as well as increased risk of heart attack and stroke. As a consequence, it is important consider both likelihoods of benefits as well as harm within the lifespan and functioning of the person. The older people who most likely benefit from aspirin in primary prevention are those at higher cardio-vascular risk, with preserved functional abilities, low comorbidity, low risk of bleeding and a prolonged life expectancy.

 

Riassunto

Il beneficio clinico netto dell’aspirina in prevenzione primaria è poco chiaro, a causa del bilancio critico tra riduzione delle occlusioni vascolari e aumento dei sanguinamenti gastro-intestinali e cerebrali. La metanalisi del 2009 del ATT (Anti Thrombotic Trialists) Collaboration mostra che l’aspirina in prevenzione primaria determina una riduzione del 12% degli eventi cardiovascolari, principalmente dovuta ad una riduzione dell’infarto miocardico non-fatale (0.18% vs 0.23% per anno, p<0.0001). Tuttavia il beneficio in termini di eventi coronarici è controbilanciato dall’incremento dei sanguinamenti maggiori. Ne deriva che il bilancio tra vantaggi ed effetti avversi differisce nel singolo soggetto ed appare potenzialmente favorevole nei casi a più elevato rischio cardiovascolare. Nella popolazione anziana è aumentato sia il rischio trombotico che quello emorragico. Di conseguenza, è importante considerare il rapporto rischio/beneficio in relazione alla aspettativa di vita e alla capacità funzionale. In sostanza gli anziani che possono trarre vantaggio dall’aspirina in prevenzione primaria sono quelli a più alto rischio cardiovascolare, con mobilità conservata, scarsa comorbidità, basso rischio emorragico e lunga aspettativa di vita.

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How to Cite

Terrosu, Pierfranco. 2016. “Aspirin Use for Primary Prevention in Elderly Patients”. Monaldi Archives for Chest Disease 84 (1-2). https://doi.org/10.4081/monaldi.2015.728.