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Heart Disease and Stroke

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Most patients with coronary artery disease take aspirin to prevent strokes and heart attacks, but some do not

Use of aspirin by patients with coronary artery disease (CAD) reduces heart attacks, strokes, and CAD-related death. Aspirin and other antiplatelet agents sufficiently thin the blood to prevent clot formation leading to these problems.

A new study shows that 85 percent of CAD patients referred to a major medical center for a cardiovascular procedure were taking aspirin after discharge. This is a higher rate than reported in previous studies, which is good news. Nevertheless, an estimated 6 percent of CAD patients who had no contraindications for taking aspirin or another antiplatelet agent (for example, allergy, stomach ulcer, or use of other blood thinning medications) were not using either agent. The study was supported in part by the Agency for Healthcare Research and Quality (HS10548) and conducted by researchers at the Duke CERTs (Centers for Education and Research on Therapeutics) at the Duke Clinical Research Institute in Durham, NC.

Increasing use of aspirin or another antiplatelet agent among these eligible patients could further reduce the number of CAD-related events in the over 12 million patients with CAD in the United States, according to the researchers. They analyzed survey responses from a subgroup of 1,626 CAD patients identified from a clinical database at Duke University Medical Center who had undergone a cardiac procedure at the Center since 1969. The survey examined aspirin use and factors associated with its use or nonuse. Responses were extrapolated to the large database (16,174 patients) of CAD patients.

Overall, 58 percent of survey respondents reported taking aspirin (extrapolated to 85 percent of CAD patients in the database), and 42 percent reported no aspirin use. Of the 948 patients who used aspirin, 85 percent said they took it every day, and 7 percent took it only as needed. The most frequent aspirin dose (60 percent of respondents) was 325 mg. Twenty-two percent reported a dose of 81 mg (the dose of a children's aspirin). Most patients (87 percent) said that their doctors were the ones who convinced them to take aspirin.

See "Patient-reported frequency of taking aspirin in a population with coronary artery disease," by Nancy M. Allen LaPointe, Pharm.D., Judith M. Kramer, M.D., M.S., Elizabeth R. DeLong, Ph.D., and others, in the American Journal of Cardiology 89, pp. 1042-1046, 2002.

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