Transcript of Aspirina e Prevenzione primaria Ci sono nuove evidenze ? Aspirina e Prevenzione primaria Ci sono...
- Slide 1
- Aspirina e Prevenzione primaria Ci sono nuove evidenze ?
Aspirina e Prevenzione primaria Ci sono nuove evidenze ? III
Congresso Nazionale 17/19 Maggio 2013 Atlantic Hotel - Riccione
Claudio Ferri Universit dellAquila Cattedra e Scuola di Medicina
Interna Dipartimento MeSVA Divisione di Medicina Interna
Universitaria Ospedale San Salvatore
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- Antithrombotic therapy and prevention of CV disease Eur Heart J
2012, 33:1636-1701 SCA Sec.Pr. MI Sec.Pr. MI Sec.Pr. STROKE Sec.Pr.
STROKE
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- Absolute risk difference in relation to placebo in primary
prevention trials Absolute number of nontrivial bleedings caused
versus nonfatal MIs averted Absolute number of nontrivial bleedings
caused versus total CV events averted Seshasai SR et al, Arch
Intern Med. 2012;172(3):209-216
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- 3.1.1-3.1.5. For patients with established coronary artery
disease (CAD), defined as patients 1-year post-acute coronary
syndrome (ACS), with prior revascularization, coronary stenoses
> 50% by coronary angiogram, and/or evidence for cardiac
ischemia on diagnostic testing, (including patients after the first
year post-ACS and/or with prior coronary artery bypass graft [CABG]
surgery): We recommend long-term single antiplatelet therapy with
aspirin 75 to 100 mg daily or clopidogrel 75 mg daily over no
antiplatelet therapy (Grade 1A). We suggest single over dual
antiplatelet therapy with aspirin plus clopidogrel (Grade 2B).
Antithrombotic Therapy and Prevention of Thrombosis, 9th ed:
American College of Chest Physicians Evidence-Based Clinical
Practice Guidelines Aspirina e Prevenzione cardiovascolare
secondaria Copyright: American College of Chest Physicians 2012 -
Chest. 2012; 141(2 Suppl): e637Se668S. Summary of
Recommendations
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- 2.1.For persons aged 50 years or older without symptomatic
cardiovascular disease, we suggest low-dose aspirin 75 to 100 mg
daily over no aspirin therapy (Grade 2B). Remarks: Aspirin slightly
reduces total mortality regardless of cardiovascular risk profile
if taken over 10 years. In people at moderate to high risk of
cardiovascular events, the reduction in myocardial infarction (MI)
is closely balanced with an increase in major bleeds. Whatever
their risk status, people who are averse to taking medication over
a prolonged time period for very small benefits will be disinclined
to use aspirin for primary prophylaxis. Individuals who value
preventing an MI substantially higher than avoiding a GI bleed will
be, if they are in the moderate or high cardiovascular risk group,
more likely to choose aspirin. Copyright: American College of Chest
Physicians 2012 - Chest. 2012; 141(2 Suppl): e637Se668S.
Antithrombotic Therapy and Prevention of Thrombosis, 9th ed:
American College of Chest Physicians Evidence-Based Clinical
Practice Guidelines Aspirina e Prevenzione cardiovascolare primaria
Summary of Recommendations
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- Variables Changes vs usual care HbA 1c 037% (95% CI 028045; 120
trials) LDL cholesterol 010 mmol/L (0050.14; 47 trials) Statin use
(RR 112, 099128, 10 trials) SBP 313 mm Hg (219406, 65 trials) DBP
155 mm Hg (095215, 61 trials) Hypertension control (RR 101, 096107,
18 trials) Smoking cessation (RR 113, 099129, 13 trials) Likelihood
to receive: Aspirin (RR 133, 121145,11 trials) Antihypertensive
drugs (RR 117, 101137, 10 trials) Screening for: Retinopathy (RR
122, 113132, 23 trials) Renal function (RR 1.28, 113144, 14 trials)
Foot abnormalities (RR 127, 116139, 22 trials) Tricco AC et al
Lancet. 2012;379(9833):2252-61. Effectiveness of quality
improvement strategies on the management of diabetes: a systematic
review and meta-analysis 48 cluster trials 84.865 patients
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- The Melbourne Colorectal Cancer Study Distribution of
medication among cases and controls and relative risk estimates The
Melbourne Colorectal Cancer Study Distribution of medication among
cases and controls and relative risk estimates * 0,63 (0.50-0.78)
p
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- Meta-analyses of the effect of aspirin on risks of incident
cancer, major vascular events, and major extracranial bleeds during
six randomised trials of daily low-dose aspirin versus control in
primary prevention of vascular events stratified by period of trial
follow-up Rothwell PM et al Lancet 2012, 379, 9826: 16021612
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- RR of colorectal cancer for highest vs lowest categories of ASA
use Dose of ASA use and risk of colorectal cancer Frequency of ASA
use and risk of colorectal cancer Years of ASA use and risk of
colorectal cancer Ye X et al Plos One 2013; 8(2): e57578. 18%
decreased risk for 10 years aspirin increment
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- Global Health Benefits from ASA: Pooled analyses of the six
randomised trials of daily low-dose (75100 mg daily) aspirin versus
placebo in primary prevention (A) composite outcome of major
vascular events, cancer, or fatal extracranial haemorrhage (B)
major vascular events, cancer, or any extracranial haemorrhage
Global Health Benefits from ASA: Pooled analyses of the six
randomised trials of daily low-dose (75100 mg daily) aspirin versus
placebo in primary prevention (A) composite outcome of major
vascular events, cancer, or fatal extracranial haemorrhage (B)
major vascular events, cancer, or any extracranial haemorrhage
Rothwell PM et al Lancet 2012, 379, 9826: 16021612
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- Aspirin use and risk of cancer Algra AM and Rothwell PM Lancet
Oncol. 2012;13(5):518-27.
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- Aspirin use and risk of cancer metastasis Algra AM and Rothwell
PM Lancet Oncol. 2012;13(5):518-27.
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- Gobal benefits from ASA: Reduction in CV events and cancer
incidence 1) The time-dependent ability of ASA to reduce cancer
incidence (not only colo-rectal and even metastatic) is evident 2)
This cancer reduction modulates benefits and risk in favour of ASA
use even in primary prevention 3) We need appropriate trials (?) 4)
We need to understand
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- Hasan DM et al J. Am. Heart Assoc. 2013, 2 Evidence That
Acetylsalicylic Acid Attenuates Inflammation in the Walls of Human
Cerebral Aneurysms
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- Michael J. Thun, Eric J. Jacobs and Carlo Patrono Nat. Rev.
Clin. Oncol. 2012, 9, 259267 The role of aspirin in cancer
prevention Females, age 5059 years Females, age 6574 years Males,
age 6574 years Males, age 5059 years
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- Liao X et al. N Engl J Med 2012;367:1596-1606. Mortality among
Patients with Colorectal Cancer, According to Regular Use or Nonuse
of Aspirin after Diagnosis and PIK3CA Mutation Status. HR = 0.18 HR
= 0.93
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- Gobal benefits from ASA: Reduction in CV events and cancer
incidence 1) The time-dependent ability of ASA to reduce cancer
incidence (not only colo-rectal and even metastatic) is evident 2)
This cancer reduction modulates benefits and risk in favour of ASA
use even in primary prevention 3) We need appropriate trials (?) 4)
We need to understand 5) Future surprises from ASA ?
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- Change in MMSE by ASA in women followed from 2000 to 2005 Kern
S et al BMJ, 2012 Oct 3;2(5) 1 0 -1 -2 -3 No ASA (n.338) ASA (n.66)
P=0.04
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- Serum TXB 2 (ng/ml) 24222018161412 4 3 2 1 0 post-aspirin
interval hr slope 0.07 [0.054-0.079] ng/ml hr -1 post-aspirin
interval 24 hr222018161412 4 3 2 1 0 slope 0.14 [0.11-0.20] ng/ml
hr -1 2422201816141 2 4 3 2 1 0 hr slope 0.02 [0.01-0.03] ng/ml hr
-1 post-aspirin interval HS Rocca B. et al. J Thromb Haemost
2012;10:1220-30 Serum TXB2 recovery slopes according to
tertile
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- Serum TXB 2 recovery slopes in diabetic patients in the upper
tertile, before and after the randomized phase of the study Rocca
B. et al. J Thromb Haemost 2012;10:1220-30
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