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Tag: Aspirin

  • Aspirin is good at preventing blood clots post-surgery. Why don’t hospitals use it?

    Aspirin is good at preventing blood clots post-surgery. Why don’t hospitals use it?

    A recent study found that patients benefit as much from aspirin post-surgery as they do from costly and painful injectables. Both prevent blood clots in patients who have severely fractured a bone, but most hospitals continue to treat patients with the costly injectables. Researchers make the case that prescribing the injectables has serious health equity consequences in a Stat News op-ed and question provider behavior.

    Patients are burdened with far lower costs for aspirin than the low-molecular weight heparin injectables. And, it’s easier for them to take a pill than to get an injection. However, hospitals and physicians appear not to consider health equity issues or simple cost-effectiveness, for that matter, when they treat patients.

    The goal post bone-fracture surgery is to prevent clots, which keep blood from flowing in the lungs and can cause deadly embolisms. And, again, two aspirins a day work just as well as the painful injections into patients’ stomach wall twice a day for three or four weeks post surgery, even for high-risk patients. Moreover, six days of injections cost at least $70 and as much as $300, while the bottle of aspirin costs a few dollars.

    Health insurers will generally pay for the injectable drug even though the less costly aspirin alternative is just as good. But, the injectable drug drives up  patients’ out-of-pocket costs and members’ premiums. Moreover, people prescribed the injectable after their surgery post bone fracture often don’t take it, making it more likely that they will have a blood clot.

    Physicians do not appear to consider that lower-income people, in particular, often do not have the means–financial or social–to comply with the injectable regimen. Only about 15 percent of physicians prescribe aspirin directly after surgery to treat a bone fracture. Only about half of physicians prescribe aspirin to patients after they are discharged.

    At many hospitals, policies have not changed notwithstanding the results of the clinical study showing aspirin’s efficacy. It appears that the hospitals would benefit financially if they used aspirin and stopped using the injectables.

    The insurers should have a role to play. After all, the insurers claim that they offer “value.” Why aren’t they insisting that aspirin is the most cost-effective treatment and refusing to cover the injectable drug post bone-fracture surgery? Are they somehow benefiting financially from patients taking the injectables?

    Here’s more from Just Care:

  • Should you be taking aspirin every day?

    Should you be taking aspirin every day?

    When it comes to health care, everyone needs options tailored to their particular needs. That’s the beauty of traditional Medicare–it is one size fits all, working for everyone, so long as they have supplemental coverage. It’s also why the US Preventive Services Task Force’s recommendation against the use of daily aspirin for most people does not apply to everyone. Should you be taking aspirin every day?

    As reported in Just Care last week, the USPSTF recently recommended against the use of daily low-dose aspirin for most people because it determined that the risk of internal bleeding was greater than the benefits. However, that recommendation is the rule, for which there are likely exceptions. Andrew Chan, the director of cancer epidemiology at the Mass. General Cancer Center and a professor at Harvard Medical School, believes that powerful evidence indicates that low-dose aspirin can be effective in preventing colorectal cancer.

    Chan argues that the USPSTF is wrong to suggest that the evidence of the benefits of low-dose daily aspirin use is inconclusive when it comes to colorectal cancer. Chan’s research team found that people can benefit from taking aspirin if they start before they turn 70 and ward off colorectal cancer. If they start at 70, the data indicates that it might be too late to ward off cancer.

    Chan appreciates that there are serious risks of internal bleeding for some people who take low-dose aspirin daily. The key is to identify those people and make sure that they are not prescribed daily aspirin use. At the same time, Chan believes that low-dose aspirin can have beneficial anticancer effects for some people. It’s important to understand who can benefit.

    Science is evolving so it will likely be possible to understand a lot more about the population who benefits from taking daily aspirin and the population whose health is endangered from daily aspirin intake. Chan would like to see studies that identify biomarkers or another molecular factor that is able to calibrate risks and benefits of aspirin for particular individuals. He says that preventive medicine should be looking into this.

    Here’s more from Just Care:

  • Daily use of baby aspirin can present greater risks than benefits

    Daily use of baby aspirin can present greater risks than benefits

    For quite some time now, older adults with certain health conditions have been told to take a daily dose of baby aspirin in order to ward off heart disease. A panel of independent experts at the US Preventive Services Task Force now recommends against this treatment, finding that daily use of baby aspirin generally presents greater risks than benefits for people over 60.

    People at high risk of a heart attack or stroke are generally better off not starting a daily regimen of baby or low-dose aspirin (81-100 milligrams), according to the recommendations of the US Preventive Services Task Force “USPSTF.” Apparently, the side effects of daily low-dose aspirin intake are more grave than originally understood. Internal bleeding is more likely than heart attack prevention. Moreover, aspirin use has never reduced the risk of death from heart disease.

    The expert panel also does not recommend taking baby aspirin daily for the prevention of colorectal cancer any longer. One recent study found that taking aspirin nearly doubled the number of colorectal cancer deaths after five years. But, aspirin has been found to reduce the risk of polyp growth in the colon as well as the risk that polyps will become cancerous.

    The panel believes that, for people over 60, daily intake of low-dose aspirin can lead to a higher risk of internal bleeding that can be life-threatening. Aspirin reduces the formation of blood clots, which can block arteries.

    Aspirin increases the likelihood of bleeding in the brain and digestive tract, especially for older people. For this reason, the panel discourages older adults from starting a daily aspirin regimen.

    The recommendations do not apply to people already taking daily aspirin or to people who have had a heart attack. The panel recommends that these people should speak to their doctor regarding the best course of action.

    Here’s more from Just Care:

  • Aspirin may not help to prevent heart problems

    Aspirin may not help to prevent heart problems

    People who are at a moderate risk of developing cardiovascular disease who take a low-dose aspirin daily do not have fewer heart problems compared to those who don’t take anything, according to a new study.

    Researchers enrolled more than 12,500 people aged 55 and older (men) or 60 and older (women) considered to be at moderate risk of cardiovascular disease because of high cholesterol, high blood pressure or smoking. Half were given a low dose (100 mg) of aspirin daily, while the others were given a placebo. Patients were followed for an average of five years. The study was sponsored by Bayer, which manufactures brand-name aspirin.

    Results, published in the Lancet, showed aspirin did not help to prevent a first heart attack or stroke any more than a placebo.

    About 4% in each group suffered a heart issue after five years. Study author J. Michael Gaziano, MD, of Brigham and Women’s Hospital in Boston, said one reason the rate of cardiovascular events was so low is that many of the patients were taking cholesterol and hypertension drugs that may have already been helping to cut cardiovascular risk.

    Results also showed gastrointestinal bleeding events were higher in the aspirin group. Dr. Jane Armitage, University of Oxford, worked on the study and told the Associated Press that if you are healthy, it’s not worth taking a daily aspirin. Low-dose aspirin is still recommended for people who have had a heart attack or other cardiovascular event, as studies have shown it is effective in preventing another one from happening.

    This article originally was published on Medshadow.org

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  • More proof aspirin helps prevent heart attacks and stroke

    More proof aspirin helps prevent heart attacks and stroke

    More people use aspirin than any other medicine. It relieves fever, pain, swelling, and keeps blood clots from forming in your arteries. It can also help prevent cardiovascular disease and colorectal cancer, lower your risk of stroke or heart attack; and, it costs about a penny a day. In April, the U.S. Preventive Services Task Force recommended daily use of aspirin to help prevent heart attacks and stroke in 50-59 year olds at high risk of cardiovascular disease and at low risk of bleeding complications.

    In short the USPSTF found moderate evidence that starting daily use of low-dose aspirin (81mg) for this population of 50-59 year olds lowers their risk of colorectal cancer and cardiovascular disease. It found less evidence of 60-69 year olds at high risk of heart disease benefiting from beginning the use of aspirin.The USPSTF did not recommend beginning use of aspirin in people under 50 or over 59 because of lack of evidence.

    The benefits for initiating aspirin use for 50-59 year olds at high risk of cardiovascular disease and at low risk of bleeding complications outweigh the harms. But, for some people, aspirin can cause severe harm, including gastrointestinal ulcers and hemorrhagic stroke. Other side effects include stomach pain, skin rash, nausea, diarrhea and itching.

    Talk to your doctor about whether you should be taking aspirin daily. Note that the USPSTF recommendation applies to the age range for which there may be benefits in initiating aspirin use. If you are taking aspirin, you should talk to your doctor about whether to continue or stop taking it as you age. There may be benefits to continuing aspirin use into your later years. Also, keep in mind that if you are taking aspirin you should talk to your doctor before taking ibuprofen, Advil or Motrin, to treat pain or fever.

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