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(Topic): aspirin primary secondary prevention

, ,
Request: aspirin primary, secondary prevention

Objective: (literature review) aspirin primary, secondary

prevention
Data Sources: Sciencedirect, Ovid, Pubmed, Micromedex, Search engine
(google) Aspirin, Primary prevention and Secondary prevention, Clopidogrel,
Efficacy of Aspirin, Optimal dose of Aspirin for Primary prevention and Secondary prevention
Study selection and data extraction:
Aspirin Primary prevention and Secondary prevention for
cardiovascular disease
American Heart Association
(AHA)

literature review Aspirin primary prevention for cardiovascular
disease Aspirin
Aspirin Aspirin
Data synthesis: United State Preventive Services Task Force (USPSTF)
aspirin primary prevention of cardiovascular disease Aspirin 81 mg 325 mg
(myocardial infarction (MI)) 32%
(ischemic stroke) 17% 4579 , 5579
American Diabetes Association (ADA) American Heart
Association (AHA) aspirin 75-162 mg primary prevention of
cardiovascular disease 40 cardiovascular
disease aspirin secondary prevention of cardiovascular disease
American Heart Association (AHA) Aspirin 75-162 mg/d

Aspirin Primary prevention of cardiovascular disease
75-162 mg/d AHA/ADA Aspirin
Clopidogrel Primary secondary prevention of cardiovascular disease
Aspirin Clopidogrel Secondary prevention of
cardiovascular disease Aspirin coronary heart disease (myocardial
infarction, cardiac arrest, chronic coronary heart disease) 31% Clopidogrel
coronary heart disease 33.7%
coronary heart disease 37.2% coronary
heart disease 3 2.8-2.9% Aspirin
Clopidogrel
Conclusion: AHA Aspirin Primary prevention of
cardiovascular disease aspirin 75-160 mg/d aspirin
aspirin
(upper gastrointestinal bleeding) (hemorrhagic stroke)
primary prevention aspirin 75-160 mg/d
Secondary prevention of
cardiovascular disease AHA 2006
75-162 mg/d
Aspirin
coronary artery bypass grafting aspirin 48 hr
Saphenous vein graft closure 100-325 mg/d 162
mg/d >1 Percutaneous coronary intervention with stent
placement aspirin 325 mg/d
KEY WORDS: Aspirin, Primary prevention and Secondary prevention, Clopidogrel, Efficacy of
Aspirin, Optimal dose of Aspirin for Primary prevention and Secondary prevention

:
aspirin primary, secondary prevention
:
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084-606-8745
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:
aspirin

Aspirin (primary secondary prevention)

(cardiovascular disease)
aspirin
(cardiovascular disease)
clopidogrel aspirin
clopidogrel aspirin
:
American Heart Association(AHA)*
aspirin
[1,2] 2
1. (primary prevention of cardiovascular disease)

(cardiovascular disease) (stroke)
(peripheral Arterial Disease)
[3]
2. (secondary prevention of cardiovascular disease)

* American Heart Association(AHA)

(systemic review) US Preventive Services Task

Force (USPSTF)** MEDLINE and Cochrane Library ( 1
2001 28 2008) ) aspirin
(primary prevention of cardiovascular disease) aspirin

(myocardial infarction) (stoke) [4,5,6]
1
1. aspirin 4579
(myocardial infarction (MI)) 32% (stoke)
(USPSTF (A
recommendation))
2. aspirin 5579
(ischemic stroke) 17%
(USPSTF (A recommendation))
3. aspirin 80
(USPSTF

(I statement))
4. aspirin
55 45 (USPSTF
(D recommendation))[4,6]
aspirin

(serious upper GI bleeding)
aspirin 60
8 4 60-69
24 12 70-79
36 18 aspirin
NSAID (hemorrhagic stroke)
[4,6]
** US Preventive Services Task Force (USPSTF) (primary care)

1 : summary of the recommendations and suggestions for clinical practice [4]

aspirin
aspirin 5 [4,6]
USPSTF aspirin baby aspirin (81 mg) one regular
aspirin (325 mg) [6] American Heart Association(AHA)
75-160 mg ( 10-year risk of coronary heart disease
> 10%) aspirin [1]
aspirin American Diabetes Association(ADA)
American Heart Association (AHA) aspirin 75-162 mg primary
prevention of cardiovascular disease 40
cardiovascular disease aspirin[4]

Aspirin Primary prevention of cardiovascular disease 75-162 mg/d
AHA/ADA[3]
(cardiovascular disease)

20 [1]

( 2 )
(lipid profile) 5
( 2 )
>40 [2]
>40 2 10 year-risk of coronary
heart disease 5



10 year-risk of coronary heart disease >20%
coronary heart disease

secondary prevention of cardiovascular disease American Heart Association (AHA)

cardiovascular disease

ASA 75-162 mg/d

coronary artery bypass grafting ASA 48 hr
Saphenous vein graft closure 100-325 mg/d
162 mg/d >1
Percutaneous coronary intervention with stent placement ASA
325 mg/d 1 bare metal stent 3 sirolimus-eluting
stent 6 paclitaxel-eluting stent[2,7]
2 : secondary prevention of cardiovascular disease AHA/ACC Guidelines
for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular
Disease: 2006 Update: Endorsed by the National Heart, Lung, and Blood Institute.[7]

Aspirin Clopidogrel Gaspoz JM

Aspirin Clopidogrel Secondary prevention
Aspirin coronary heart disease (myocardial
infarction, cardiac arrest, chronic coronary heart disease) 31% Clopidogrel

coronary heart disease 33.7%

coronary heart disease 37.2% coronary
heart disease 3 2.8-2.9% Aspirin
Clopidogrel
Aspirin Clopidogrel
Aspirin Clopidogrel
Aspirin Aspirin[8]
:
1. American Heart Association. Primary Prevention in the Adult. Available at:
http://www.americanheart.org/presenter.jhtml?identifier=4704. Accessed July 19, 2009.
2. American Heart Association. Secondary Prevention. Available at:
http://www.americanheart.org/presenter.jhtml?identifier=4723. Accessed July 19, 2009.
3. , , , , ,
. . Available at:
http://www.rcpt.org/news/news.asp?type=GUIDELINE&news. Accessed July 22, 2009.
4. U.S. Preventive Services Task Force recommendation statement. Aspirin for the prevention of
cardiovascular disease. Annals of Internal Medicine. 2009 March 17; 150(6): 396-404.
5. Wolff T, Miller T, Ko S. Aspirin for the Primary Prevention of Cardiovascular Events: An Update
of the Evidence for the U.S. Preventive Services Task Force.2009 March 17; 150(6): 405-410
6. Partnership of Health. Clinical Fact Sheet: Using Aspirin for the Primary Prevention of
Cardiovascular Disease : Clinical Fact Sheet. Available at:
http://www.ahrq.gov/clinic/cvd/aspprovider.htm. Accessed July 22, 2009.
7. Smith SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. AHA/ACC Guidelines for
Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease:
2006 Update. American Heart Association. 2006;113:2363-2372.
8. Gaspoz JM, Coxson PG, Goldman PA, Williams LW, Kuntz KM, Hunink M.et al. Cost
Effectiveness of Aspirin, Clopidogrel, or Both for Secondary Prevention of Coronary Heart
Disease. The New England Journal of Medicine. 2003;348(6):560.