"The study provides clear, consistent evidence that low-dose
aspirin can help to prevent new venous blood clots and other cardiovascular
events among people who are at risk because they have already suffered a blood
clot," says the study's lead author, University of Sydney Professor, John
Simes.
"The treatment effect of aspirin is less than can be achieved
with warfarin or other new generation direct thrombin inhibitors, which can
achieve more than an 80 per cent reduction in adverse circulatory and
cardiopulmonary events.
"However, aspirin represents a useful treatment option for
patients who are not candidates for anticoagulant drugs because of the expense
or the increased risk of bleeding associated with anticoagulants."
Key results
Compared to placebo patients, those who took 100mg daily of aspirin
had a one-third reduction in the risk of:
• thromboembolism, which
is the obstruction of a blood vessel by a clot that has dislodged from another
site in the circulation.
• deep vein thrombosis
(DVT), which is the formation of a blood clot in a deep vein, predominantly in
the legs.
• pulmonary embolism,
which is a blood clot affecting the arteries that supply blood to the lungs.
• myocardial infarction
(heart attack), stroke or cardiovascular death.
Most people who have had a blood clot in a leg vein (deep-vein
thrombosis) or an embolism (where the clot blocks the blood flow) have
anticoagulant drug treatment (such as warfarin) for at least 6 months, first to
dissolve the clot and then to prevent it happening again.
However, long-term anticoagulant drugs are expensive and inconvenient,
requiring frequent regular blood tests and adjustments to the dosage. Further,
there is an elevated risk that the treatment could cause bleeding in some
patients. For people who are not able to cope with this, the viable alternative
of taking regular aspirin will be a great benefit.
"The study provides evidence that after a first venous thrombosis
or embolism, daily aspirin reduces the risk of another event, without causing
undue bleeding. This treatment is an alternative to long-term anticoagulation
and will be especially useful for patients who do not want the inconvenience of
close medical monitoring or the risk of bleeding," says Professor Simes.
"Aspirin will be ideal in the many countries where prolonged
anticoagulant treatment is too expensive. A major benefit of this treatment is
its cost-effectiveness. Aspirin is cheap, but it will save the treatment costs
of the many recurrent clots that are prevented. This could mean a saving of
millions of healthcare dollars worldwide."
Co-investigator Tim Brighton, a senior haematologist at Sydney's
Prince of Wales Hospital, adds: "This important study demonstrates clearly
that low-dose aspirin reduces the risks of further blood clot. This is
especially important for patients who are not able to take long-term
anticoagulant medications for whatever reason, such as personal preference,
adverse effects of anticoagulant or cost."
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