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Item
#13
Aspirin
Alone Works Fine for Heart Patients
A
huge scientific study has found that aspirin alone is just as
effective as aspirin and the anti-clotting drug warfarin in
preventing death, second heart attacks and stroke.
Both aspirin and warfarin (brand name Coumadin) have been shown to
reduce a person's risk of heart attack or stroke by slowing
clotting in the body's blood vessels, but each does it at
different stages of the clotting process.
"They're working on two different mechanisms," says Dr.
Stephen Siegel, a clinical assistant professor of cardiology at
New York University School of Medicine. "Aspirin works on the
platelets, which are initiating the clot, and warfarin works on a
later stage of clotting."
Generally, doctors prefer aspirin because it's easy to take and
costs less than warfarin. The risk is that both drugs, especially
warfarin, can cause internal bleeding.
Because the two drugs worked well independently, researchers
thought they would work even better together.
Unfortunately, they were wrong.
"It didn't happen," says Dr. Louis Fiore, lead
investigator and an assistant professor of medicine and public
health at Boston University School of Medicine and School of
Public Health.
The main issue was the dosage, and the researchers say there may
still be a chance the combination therapy will prove more
effective with a higher dose of warfarin.
The study involved 5,050 men and women at 78 different sites, and
lasted more than six years. Researchers lowered the aspirin dose
to 81 milligrams -- versus 162 milligrams when taking the drug
alone -- and the warfarin dose to between 1.5 and 2.5
International Units -- the standard dose is 2.5 to 3.5
International Units.
"We used a lower intensity than recommended when using
warfarin alone because we thought putting them together would
cause too much bleeding," Fiore explains. "In
retrospect, we now think that was the mistake, that you need to
use both drugs at full dose. If we did it again, we would leave
aspirin at 81 milligrams and use the standard dose of
warfarin."
All of the 5,050 participants had suffered a heart attack within
14 days of enrolling in the study. Each was followed for a median
of 2.7 years.
When all was said and done, there were no appreciable differences
between the two groups. In the segment of patients receiving the
combined therapy, 17.6 percent died, compared with 17.3 percent in
the aspirin-only group. In the combination group, 13.3 percent had
a second heart attack versus 13.1 percent in the aspirin group. A
small number -- 3.5 percent -- of patients receiving both drugs
had a stroke, while a slightly smaller number -- 3.1 percent -- of
aspirin-only participants suffered a stroke.
People in the combination group had nearly twice as many major
bleeding episodes as the aspirin group. The bleeding, however,
stayed within acceptable levels in both groups, Fiore says.
"It would have been nice if it had positive results because,
at low dosages, it was a very safe combination," Fiore says.
"We tried for a home run with big efficacy and low toxicity,
but it was a long shot."
Fiore's initial study proposal had called for a higher dose of
warfarin, but the reviewing committee refused to approve it.
Source: Circulation 02-2002
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DID
YOU KNOW:
Sixty
percent of people with diabetes surveyed do not feel at risk for
either high blood pressure or cholesterol problems.
Fact: Diabetes is most often accompanied by other cardiovascular risk
factors such as high blood pressure and elevated cholesterol. In
fact, up to 60% of adults with diabetes have high blood pressure
and nearly all have one or more cholesterol problems, such as
increased triglycerides, low HDL (“good”) cholesterol, or
elevated LDL (“bad”) cholesterol. While the management of
blood sugar has always been and remains a cornerstone of diabetes
care, diabetes requires a comprehensive program of management that
includes management of blood glucose, management of blood pressure
and management of cholesterol. These are the ABCs of diabetes. The
A stands for A1C, the test which measures average blood sugar over
the previous 3 months. B is for blood pressure, and C is for
cholesterol.
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