The Power of Aspirin: Primary and Secondary Prevention Explained

It has been more than 125 years since Aspirin appeared in the world of medical treatments. In its early days, it was just a medicine to relieve pain wherever it was in the body, and a medicine to reduce fever.

But after several decades of these practices, doctors noticed that aspirin has a blood clotting effect. In particular, a dentist in the 1930s noticed that people who take aspirin to treat joint pain experience more bleeding when their teeth are extracted. Other doctors have also noticed that people who take aspirin to relieve pain have lower rates of heart attacks.

Benefits of aspirin for the heart

These two medical studies were the basis for discovering that aspirin has antimicrobial activity that prevents platelets from sticking together. This confirmed the possibility of benefiting from this feature in the treatment of arterial diseases, whether in the heart, brain or organs.

Indeed, the first medical study was published in an issue of the New England Journal of Medicine (NEJM) in 1974, and the results showed that aspirin is effective in preventing the recurrence of myocardial infarction in the ones he got before. This case put on board a cardiologist for the first time a drug that can be relied upon clinically as part of the progressive prevention of the consequences of widespread heart diseases.

In 1980, aspirin was approved by the US Food and Drug Administration (FDA) for the advanced prevention of stroke, in 1984 for the advanced prevention after a heart attack, and in 1985 for the prevention of intractable angina pain attacks. In 1988, cardiologists around the world began to accept aspirin therapy as a standard practice immediately when a heart attack was suspected.

Then, three medical studies (Physicians’ Health Study, Nurses’ Health Study, and Women’s Health Study) during that time showed the positive effects of aspirin in primary prevention in healthy people from effects of heart disease. Therefore, aspirin has “immediate therapeutic” uses, “advanced prevention” uses, and “primary prevention” uses.

“Antiplelet”

Aspirin is, basically, one of the medications in the “antiplatelet” category. Antiplatelet agents work to prevent platelets from sticking together, thereby preventing the formation of a blood clot, which can block the artery or cause it to become very narrow.

What is clinically important in this regard is that a blood clot may sometimes be inside blood vessels that are affected by an inflammatory process, or in which cholesterol deposits accumulate, leading to atherosclerosis. Then, the platelets can form a blood clot inside the artery. Therefore, either a heart attack occurs (complete blockage of blood flow through the coronary artery), or an episode of unstable angina pain (a high degree of partial blockage of blood flow through the coronary artery) .

Platelets can also form blood clots around stents that are installed inside the arteries to treat stenosis (PCI), or on the surface of artificial heart valves, or other devices that are placed inside the heart or blood vessels.

Therefore, antiplatelet agents are given as “treatment” during and after coronary artery bypass grafting (PCI) and after coronary artery bypass grafting (CABG). In addition to preventing the formation of blood clots inside the heart in some cases of patients suffering from atrial fibrillation or some heart valve diseases.

“Advanced prevention” medication.

In these cases, aspirin is the first drug, if there are no reasons to use other antiplatelet drugs.

On the other hand, antiplatelet drugs are useful in “advanced prevention” to prevent clot formation in patients with arterial diseases. Therefore, medical treatment advice for patients with cardiovascular disease includes giving them antiplatelet agents as “advanced prevention” if there is a history of coronary artery disease (CAD), heart attack, angina, stroke, or transient ischemic attacks (TIAs). more than 24 hours) or peripheral vascular disease (PVD).

Mayo Clinic cardiologists say: “Advanced prevention means you’ve had a heart attack or stroke before, or you currently have heart or blood vessel disease. In this case, you take aspirin every day to prevent a heart attack or stroke. The benefit of daily aspirin therapy in this case is proven. “

On the other hand, it may not be appropriate for “healthy” people to take aspirin daily to reduce the risk of heart attacks and strokes, that is, for “primary prevention.” Instead, it depends on age, general health condition, history of heart disease, and the level of risk of a healthy person suffering from heart attacks or strokes.

“Primary prevention”

To clarify, cardiologists from the Mayo Clinic say that “daily aspirin therapy can be used for primary prevention. This means you have never had a heart attack or stroke. You have never had coronary bypass surgery or coronary angioplasty with stenting. She did not suffer from clogged arteries in the neck, legs, or other parts of the body. But you take aspirin daily to prevent such heart diseases. However, the benefits of aspirin in this case are controversial.

They say, explaining: “This is why you shouldn’t start taking aspirin every day without talking to your doctor. It is safe for most adults to take aspirin occasionally for a headache, body ache, or fever. But daily use of aspirin can cause serious side effects, including gastrointestinal bleeding. So talk to your doctor about the pros and cons of daily aspirin therapy. Together, you can discuss whether taking a daily aspirin would help prevent a heart attack or stroke.

In general, the risk of heart attack and stroke increases with age. “But also with age, the risk of bleeding due to aspirin increases even more.”

Benefits and warnings of taking aspirin

In this regard, many medical sources related to heart health summarize the following points about taking aspirin:

– For people at low risk of heart attack, the benefits of taking a daily aspirin do not outweigh the bleeding risks.

The higher the risk of heart attack, the more likely the benefits of daily aspirin therapy outweigh the risks of bleeding.

Because of the risk of bleeding, some guidelines recommend that people age 60 and older who have never had heart or blood vessel disease should not start taking aspirin daily to prevent a heart attack or stroke. for the first time. Other recommendations suggest avoiding daily aspirin therapy after age 70.

– If you are between 60 and 69 years old, ask your doctor about the effect of daily aspirin therapy on your condition.

– Your doctor may recommend that you take a low-dose aspirin daily for primary prevention of heart attack or stroke if you are between the ages of 40 and 59 and are at high risk of having a heart attack or stroke for the first time once within the next step. 10 years. The most vulnerable means that the risk of infection is 10 percent or more.

Your doctor may recommend that you take a low-dose aspirin daily for primary prevention of heart attack or stroke if you are under the age of 60, have diabetes and have at least one heart disease risk factor other conditions, such as smoking or high blood pressure.

Types of antiplatelet and anticoagulant medications

There is a difference between anticoagulants and antiplatelet agents. It is true that both anticoagulants and antiplatelet agents reduce or prevent clotting, but they work in completely different ways.

Antiplatelets are aimed at preventing and inhibiting platelet adhesion. While anticoagulation, or drugs that increase blood fluidity, inhibit the proteins in the blood that participate in the clotting process by stabilizing the aggregation of platelets that formed the blood clot in the first place .

Examples of anticoagulants include heparin (received as an injection under the skin or into a vein). In addition to warfarin, there is Apixaban (Eliquis), and Rivaroxaban (Xarelto).

In contrast, there are many types of antiplatelet medications. Although each type works differently, all antiplatelet medications help prevent plaques from sticking together and forming blood clots. Among the most important and widely used medically at this time are:

– Aspirin. This is the most common type of antiplatelet medication. Low-dose aspirin (sometimes called baby aspirin) is usually given daily to prevent heart attacks and strokes. It should be noted that “baby aspirin” means “low dose” aspirin. It literally translates to “baby aspirin.” The mistake is that it is not recommended to give aspirin to children under the age of 12, because they have serious harmful effects on them. Therefore, there is no aspirin specifically for children that they can take only in a very narrow medical context.

– Adenosine diphosphate receptors (ADP Receptor Inhibitors). It is usually given to patients who have recently had a heart attack or stroke, as these patients have a higher risk of having another heart attack or stroke. Doctors may also prescribe this medication to patients with mitral valve disease or those who have undergone heart valve replacement. Some patients with peripheral vascular disease (PVD) may also be good candidates for ADP receptor blockers, as poor circulation in the legs can lead to blood clots. It is taken orally. Notable examples include clopidogrel (Plavix), ticagrelor (Brilinta), and prasugrel (Effective).

– Adenosine reuptake inhibitors. Currently, it is given to patients as a treatment in a few cases. Examples include Dipyridamole (Persantine).

– Glycoprotein IIB-IIIA inhibitors. It is given through an intravenous needle directly into the bloodstream, so patients must be in the hospital to receive it. Patients are usually given this type of antiplatelet medication to prevent blood clots that sometimes form during angioplasty and PCI procedures, and it is also used in patients with angina who undergo angioplasty or stenting. Examples include Abciximab and ReoPro.

– Phosphodiesterase inhibitors. They are often used in patients with PVD to reduce leg pain that comes with walking (called intermittent claudication). Patients with peripheral vascular disease (PVD) are more likely to develop blood clots in their legs, so some PVD patients need to take antiplatelet medications. But patients with heart failure should not take this type of antiplatelet medication. An example is Cilostazol.