The Study of the Week reviews a sub-analysis of the recent ARTESIA trial of apixaban vs aspirin in low-burden AF. The findings relate to left atrial appendage closure
Regardless if within statistical 95% confidence that you show where OAC is relatively same, what justification is that for approving a new, more exlensive drug to treat a problem where there are establishrd treatments like asprin that are cheaper? Why not make the burden of approval for these heavily marketed pharma soljtions be some significant benefit in outcome vs traditional medicine already available.
The only answer to that is big pharma's hold on our FDA and health agencies involved in approving these drugs with the sole benefit being the pockets of the Pharma company, and to the detriment of healthcare costs and possibly patient outcome in this case (even if w/in 95% confidence).
It's surprising how many patients come to me on a baby aspirin because they have heard (often from such stellar sources as Dr. Oz) that it should be taken for reducing cardiovascular risk. They think it is benign and may not even mention it as a medication they are taking.
Thus, it is always a good idea to make it clear that aspirin increases bleeding risk.
My major concern with bleeding risk with DOACs or aspirin is the life-threatening intracranial hemorrhage, either spontaneous or related to ground-level falls.
Aspirin and DOACS seem to be roughly equivalent at increasing the risk of these often life-threatening events.
What’s with the poke at Dr. Oz? I have heard him talk about aspirin and heard him warn about the side effects. I have been prescribed aspirin for years and many cardiologists still recommend it. Appreciate the information you have provided.
"Dr. Oz, on the other hand, came to St. Louis in 2011 to have lunch with five hundred women and advised them all to take a baby aspirin daily (and fish oil, which is not indicated for primary prevention as I have discussed here). When I saw these women subsequently in my office I had to spend a fair amount of our visit explaining why they didn’t need to take aspirin and fish oil."
Using ASA is not a harmless tradeoff. So in instances where the indication is already dubious, such as LAAC, requiring pts to nonetheless remain on ASA represents an additional risk and cost. But that is not the same as the risk/benefit balance of ASA in secondary prevention, post MI, or post PCI, where the benefits outweigh those risks.
"“we should no longer believe that low-dose aspirin is a safe drug to give to our older patients.”
Not safe seems a very harsh conclusion to draw from the data presented."
It doesn't seem benign given it has bleeding on par with novel oral anticoagulants, so absent a clear indication, it's likely not a good idea to use it.
When I take aspirin, unless I take K2 MK4, I get bleeding. I used to be amazed nobody ever points this out, but now I understand, this is health research as usual.
I’ve had many people tell me this is impossible, K2 MK4 is not vitamin K, and has no effect.
Sad that relative cost is not a consideration. Aspirin is dirt cheap and OAC I suspect is a lot more expensive what is the number of strokes prevented per dollar spent on therapy?
Regardless if within statistical 95% confidence that you show where OAC is relatively same, what justification is that for approving a new, more exlensive drug to treat a problem where there are establishrd treatments like asprin that are cheaper? Why not make the burden of approval for these heavily marketed pharma soljtions be some significant benefit in outcome vs traditional medicine already available.
The only answer to that is big pharma's hold on our FDA and health agencies involved in approving these drugs with the sole benefit being the pockets of the Pharma company, and to the detriment of healthcare costs and possibly patient outcome in this case (even if w/in 95% confidence).
With all due respect, your argument falls flat.
It's surprising how many patients come to me on a baby aspirin because they have heard (often from such stellar sources as Dr. Oz) that it should be taken for reducing cardiovascular risk. They think it is benign and may not even mention it as a medication they are taking.
Thus, it is always a good idea to make it clear that aspirin increases bleeding risk.
My major concern with bleeding risk with DOACs or aspirin is the life-threatening intracranial hemorrhage, either spontaneous or related to ground-level falls.
Aspirin and DOACS seem to be roughly equivalent at increasing the risk of these often life-threatening events.
What’s with the poke at Dr. Oz? I have heard him talk about aspirin and heard him warn about the side effects. I have been prescribed aspirin for years and many cardiologists still recommend it. Appreciate the information you have provided.
From a post (https://theskepticalcardiologist.com/2014/05/should-i-take-aspirin-to-prevent-stroke-or-heart-attack/) I wrote in 2014 when the FDA first recommended against the use of aspirin for primary prevention:
"Dr. Oz, on the other hand, came to St. Louis in 2011 to have lunch with five hundred women and advised them all to take a baby aspirin daily (and fish oil, which is not indicated for primary prevention as I have discussed here). When I saw these women subsequently in my office I had to spend a fair amount of our visit explaining why they didn’t need to take aspirin and fish oil."
Great review and take home points.
I might phrase the conclusion a bit differently.
Using ASA is not a harmless tradeoff. So in instances where the indication is already dubious, such as LAAC, requiring pts to nonetheless remain on ASA represents an additional risk and cost. But that is not the same as the risk/benefit balance of ASA in secondary prevention, post MI, or post PCI, where the benefits outweigh those risks.
As a retired physician and patient, I must admit that I prefer to take Aspirin in these situations.
And what are we to do with these folks if/when bleeding happens beyond immediate care?>
"“we should no longer believe that low-dose aspirin is a safe drug to give to our older patients.”
Not safe seems a very harsh conclusion to draw from the data presented."
It doesn't seem benign given it has bleeding on par with novel oral anticoagulants, so absent a clear indication, it's likely not a good idea to use it.
John,
I have no dog in this hunt, as my patients are at the other end of life.
And I appreciate your reliance on the data you present. But…
How do you get from
“the long-term use of aspirin in patients who have left atrial appendage closure is not as protective as proponents think”
to
“we should no longer believe that low-dose aspirin is a safe drug to give to our older patients.”
Not safe seems a very harsh conclusion to draw from the data presented.
Which method is used for closing the left atrial appendage? The watchman, or the physical clamp on the LAA?
When I take aspirin, unless I take K2 MK4, I get bleeding. I used to be amazed nobody ever points this out, but now I understand, this is health research as usual.
I’ve had many people tell me this is impossible, K2 MK4 is not vitamin K, and has no effect.
A lot of people in this field are morons.
*than (not meaning to be a smart Alec, just that it’s in the title)
:) Fixed
Sad that relative cost is not a consideration. Aspirin is dirt cheap and OAC I suspect is a lot more expensive what is the number of strokes prevented per dollar spent on therapy?