Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer

The point of this article focused on the impact of long-term aspirin and the risk of cancer. The study stemmed from the recommendation of the US Preventive Services Task Force that aspirin can be used to help prevent colorectal cancer and cardiovascular disease. The study wanted to address the effectiveness of aspirin in other cancers. In the study they took two large US prospective cohort studies that had over 135,000 participants. The studies were long term and done over many years and accessed medical records to evaluate a patient’s different types of cancers. The study was completed over 32 years. By the end of the study it was found that aspirin can reduce the overall risk, especially in GI cancers.

I think this study was important since aspirin is such a widely utilized and recommended medication by doctors and pharmacists. Aspirin is primarily recommended for heart protection and health, but now shows an even added benefit of cancer prevention. As pharmacists this gives another important tool for showing patients the benefit of taking aspirin on a regular basis. While I think this is an important indication, I do no think there is enough evidence to support aspirin therapy simply for cancer prevention. More research should be done to continue to weigh the pros and cons of aspirin therapy for the prevention of cancer.

 

Cao Y, Nishihara R, Wu K, et al. Population-wide Impact of Long-term Use of Aspirin and the Risk for Cancer. JAMA Oncol. Published online March 03, 2016. doi:10.1001/jamaoncol.2015.6396.

http://oncology.jamanetwork.com.pitt.idm.oclc.org/article.aspx?articleid=2497878

Stopping vs. Continuing Aspirin before Coronary Artery Surgery

Many patients who are at risk for MI and stroke will be on an aspirin therapy. However, when these patients are undergoing surgery aspirin poses an increased bleeding risk during surgery. The normal practice is to have patients stop their aspirin regimen 5 to 7 days before surgery. However, the beneficial results of aspirin could outweigh the bleeding risk during surgery. This study examined whether an aspirin regimen should be stopped before coronary artery surgery.

The study enrolled patients who were going to have coronary artery surgery, and were at an increased risk for complications due to age or other comorbidities. Patients were then randomized, and if on warfarin therapy had to stop 7 days before surgery. Patients were randomly assigned evenly to receive 100 mg aspirin or a placebo. Data on patients risk scores were recorded, and then twelve-lead electrocardiography was preformed before the surgery, and one, two, and tree days post-operation, and at discharge. Blood samples were obtained 12 to 24 and 48 to 72 hours after surgery to measure troponin or CK-MB. Patients were also contacted 30 days after surgery. Outcomes measured were death and negative cardiac events. There were 1047 patients in the aspirin group and 1054 patients in the placebo group. Within the 30 days after surgery the amount of deaths or thrombotic complications in the two groups was 202 patients (19.3%) in the aspirin group, and 215 patients (20.4%) in the placebo group. Myocardial infarction within the first 30 days was 144 patients in the aspirin group (13.8%) and 166 patients (15.8%) in the placebo group.

Ultimately, this study found that these results were not significant enough to indicate that preoperative aspirin resulted in more health risks due to increased bleeding during coronary artery surgery. It further supported the idea that withdrawal of aspirin regimens pre-op could potentially harm patients. However, there are a lot of areas in this study that still need to be further examined in order to find more definitive recommendations. For example, the study used a low dose of aspirin (100 mg), and patients could be resistant to the antiplatelet effect of aspirin. Hopefully there will be more studies performed that examine aspirin use pre coronary artery surgery, in order to more appropriately dose patients and provide more successful patient outcomes.

 

 

Link: http://www.nejm.org/doi/full/10.1056/NEJMoa1507688#t=articleDiscussion

 

Citation:

 

Myles, PS, Smith JA, Forbes A, et al. Stopping vs. Continuing Aspirin before Coronary Artery Surgery. N Eng J Med. 2016; 374:728-737.