Aspirin should not be used to prevent the first stroke – 08/23/2023 – Equilibrium

A new analysis of data from a study carried out with the elderly, Aspree (Aspirin in Reducing Events in the Elderly; aspirin in the reduction of events in the elderly, in Portuguese), reinforces that aspirin should not be used daily by healthy people with no history of cardiovascular therapy for the primary prevention of cerebrovascular accident (CVA) or other cardiac events. This is because the continuous use of the medication increases the risks of more serious events, such as cerebral, intracranial and gastrointestinal bleeding, thus overcoming the effects of the medication.

Conducted in Australia and the United States (USA), the study included more than 19,000 individuals aged at least 70 years and without cardiovascular disease. The group was followed over an average of five years. The analysis, published on Jama Network, revealed that the rates of occurrence of ischemic stroke and hemorrhagic stroke were similar between patients who received a daily dose of 100 mg of aspirin and those who took a placebo. In addition, researchers identified a 38% increase in the risk of bleeding among those who used the drug daily.

The results indicate that patients who made regular use of aspirin suffered 20 fewer ischemic strokes, but had 29 events of intracranial hemorrhage. The risk of intracranial hemorrhage was 1.1% for aspirin users and 0.8% for placebo users — therefore, the authors state that there is no advantage in this supposedly preventive use.

The work endorses the US Preventive Services Task Force recommendation published last year. The guideline was developed by a group of independent experts and states that aspirin should not be prescribed to prevent a first heart attack or stroke in healthy elderly people. On the other hand, for people who have already suffered a stroke or a heart attack, for example, the daily use of the medicine continues to be indicated as part of preventive care for a new occurrence.

“For more than two decades, aspirin has been one of the leading drugs recommended to prevent stroke recurrence in patients who have had an ischemic stroke. [quando a circulação sanguínea é interrompida pela formação de um coágulo]. It is a medication that has an antithrombotic property, prevents the formation of clots, and therefore, it works as a prevention for this population”, explained Gisele Sampaio, neurologist at Hospital Israelita Albert Einstein.

However, due to its protective effect in preventing a second stroke, aspirin was used indiscriminately for a long time by people who had never suffered a cardiovascular event in an attempt to prevent the occurrence of the first stroke or heart problem.

“The problem is that every medication has its risk-benefit ratio and the mechanism by which aspirin protects against a second cardiovascular event is by making the blood less clottable, and that can have consequences. There is a risk associated with long-term drug use and this risk outweighs the benefits that aspirin can bring in a patient who does not have a high enough cardiovascular risk to use the medication”, explained the neurologist.

According to Sampaio, the evidence has shown that there are no benefits in the daily use of aspirin by healthy people. “In fact, there has never been a study that proved that the primary use of aspirin in patients at low cardiovascular risk would bring benefits to people. The use took place in clinical practice, but without a supporting study. And this current work reaffirms what we have been seeing observing in larger epidemiological studies that the prophylactic use should not be done because of the risks”, reinforced the neurologist.

Seek medical advice

The findings of this study do not apply to everyone: people who have already had a cardiovascular event and use the medication are indicated for it. Therefore, the doctor points out that no one should abruptly interrupt the medication without first talking to the doctor to assess whether or not it is in the profile of people in whom the risks of aspirin outweigh the benefits. “The final message is not to stop or start taking aspirin without medical advice,” she added.