Dear sir/madam, With reference to the meta-analysis performed by De Berardis et al (1), we should just like to comment on some points which, in our opinion, may well detract from the study’s internal and external validity. Aspirin may not benefit this population and may increase the risk of major bleeding events. Our objective was to determine the adherence to the ADA guidelines for ASA therapy in DM using a national database. The present review aims to provide an overview of the current knowledge on platelet abnormalities in patients with DM, focusing on the challenges and perspectives of antiplatelet treatment strategies in this population. is a statistical consultant for the Research Institute for Production Development, a nonprofit research foundation; has received research grants from Bayer Yakuhin and Daiichi Sankyo Co.; and has received lecturer’s fees from Bayer Yakuhin, Daiichi Sankyo Co., Dainippon Sumitomo Pharma, Kowa Co., Otsuka Pharmaceutical Co., and Pfizer Japan for the past 5 years. Aspirin is usually administered in peroral doses of 75–325 mg daily. For those at intermediate risk, the use of aspirin can be “considered” until further research is available.
By comparison, the numbers needed to harm to cause 1 major bleeding is 299. Considerations for healthy women differ from those for healthy men (Mosca L, Benjamin EJ, Berra K, et al. adults have a history of heart attack, approximately 7 million U.S. adults have a history of stroke (1), and, approximately 16 million U.S. In women, however, the benefit seems to be limited to stroke, and the risk for bleeding, particularly gastrointestinal bleeding, is also real and almost matches, 1 for 1, the cardiovascular events that aspirin is intended to prevent. In the low-risk group, consisting of older patients without risk factors and younger patients (n=728), aspirin did not reduce cardiovascular events (HR, 0.55; 95% CI: 0.23-1.21). In 2010, the estimated annual cost (direct and indirect) of CVD in the United States was approximately $450 billion, including $109 billion for CHD and $54 billion for stroke alone (3).
The Japanese Primary Prevention Project was sponsored by the Japanese Ministry of Health, Labor, and Welfare and the Waksman Foundation of Japan. Taking aspirin or other antiplatelet medications is one of several preventive interventions that can provide substantial benefit for patients with ischemic vascular disease and is strongly recommended in practice guidelines (6,7). Consider the risks when you discontinue ASA in patients who have been using it daily for primary prevention. Preventive Services Task Force (USPSTF) and other major guidelines (8–15). Previous research has indicated that the use of aspirin among eligible patients is suboptimal, even for those patients at highest risk (16). In persons who do not have a history of ischemic vascular disease, the net benefit is dependent upon the patient’s risk for suffering a stroke or myocardial infarction compared with their chances of harm from treatment. Hiatt says in his editorial: “What is striking about the negative effect of aspirin [in POPADAD] is that people .
It is particularly important to know the risk of harmful effects when considering an intervention for primary prevention since by definition it will be used by a population people who are well and free from CVD or cancer. Consequently, the benefit/harm ratio can vary wildly from highly advantageous to seriously unfavourable, necessitating careful assessment of patients before prescription of this agent. These two national surveys collect data annually on the provision of ambulatory care services to patients of all ages from office-based physicians and in-hospital outpatient departments. Ongoing primary prevention clinical trials aim at higher risk subjects in an attempt to define the population that will benefit. Pregnant women (ICD-9-CM codes: V22, V23, and V28), visits for pre- or postsurgery follow-up, patients with documented contraindications to chronic aspirin use (coagulation defects, purpura and other hemorrhagic conditions, subarachnoid hemorrhage, intracerebral hemorrhage, acute hepatic failure, and gastrointestinal hemorrhage), and persons prescribed anticoagulant medication (warfarin, heparin, or low molecular weight heparins) were excluded from this analysis of patients with or without ischemic vascular disease. Regular use of nonsteroidal anti-inflammatory drugs may increase the risk for chronic renal disease and may impair blood pressure control in hypertensive patients.