Physicians' Academy for Cardiovascular Education

Aspirin discontinuation in CVD prevention is associated with increased CV risk

Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort Study

Sundström J, Hedberg J, Thuresson M, et al. - Circulation. 2017;136:1183-1192

Background

Guidelines recommend low-dose aspirin for the secondary prevention of CVD, however there are discontinuation rates of up to 30% and poor compliance in up to 50% of patients [1,2]. The discontinuation of aspirin in secondary prevention has been associated with a higher CV risk shortly after discontinuation [3,4]. Aspirin discontinuation is common when bleeding occurs or major surgery is necessary, however, in settings other than surgery or bleeding the effects of aspirin discontinuation are not known. Moreover, the benefit of aspirin use in primary prevention is under investigation.

In this study, the associations of aspirin treatment persistence patterns and aspirin discontinuation with the CV risk was evaluated, in a large nationwide cohort of patients on long-term low-dose aspirin therapy for primary and secondary prevention between 2005 and 2009. Eligible patients were older than 40 years of age, and had ≥80% adherence during the first year of treatment, had no history of cancer at baseline, and no CV event or death during the first year of aspirin treatment, based on the Swedish inpatient and cause-of-death register.

A major bleeding or a surgical procedure during the study corresponded to a 3-month refractory period from the time at risk, during which person-time was not counted and outcomes were not considered.

Main results

Conclusion

The discontinuation of low-dose long-term aspirin use for CVD prevention in the absence of major surgery or bleeding, was associated with a >30% increased CV risk, shortly after discontinuation. These findings support the use of aspirin in CVD prevention, and justifies further measures to ensure treatment persistence in this setting.

References

Show references

Find this article online at Circulation