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Low-dose aspirin for PCI
Patients with acute coronary artery syndrome and those undergoing percutaneous coronary intervention should be maintained on low-dose aspirin therapy, a recent study demonstrates.
Patients with acute coronary artery syndrome and those undergoing percutaneous coronary intervention (PCI) should be maintained on low-dose aspirin therapy, a recent study demonstrates.
The effect of dosing is of significant interest given the requirement for dual antiplatelet therapy following PCI, the increased risk of bleeding associated with newer, more potent adenosine diphosphate antagonists, and the potential for drug-to-drug interactions, wrote Roxana Mehran, MD, of Mount Sinai School of Medicine in New York, NY, and colleagues.
The article, published in the December issue of JACC: Cardiovascular Interventions, found that patients who were discharged on and maintained on high-dose aspirin were more likely to have major bleeding than patients on low-dose aspirin. However, the authors reported no difference in ischemic end points between high- and low-dose aspirin used in combination with clopidogrel.
The researchers examined the impact of aspirin dose on late outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The authors assessed 3-year outcomes from the HORIZONS-AMI (Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction).
The study assessed the end points for 2,851 patients with STEMI who underwent primary PCI and were discharged on high-dose aspirin (>200 mg daily) versus low-dose aspirin (≤200 mg daily). After propensity score-adjusted multivariable analysis, the authors found high-dose aspirin was an independent predictor for non-coronary artery bypass graft-related major bleeding (HR, 2.80; 95% CI: 1.31 to 5.99; P=.008). Further, the authors noted that the increase in major bleeding events occurred in the first 2 months after hospital discharge and continued to accrue in the high-dose group over the entire 3-year follow-up period.
“Absent a demonstrated benefit of high-dose aspirin in patients on dual antiplatelet therapy with clopidogrel following PCI, and given the concern of potential harm of high-dose aspirin used with more potent P2Y12 inhibitors, these data support the routine use of low-dose aspirin (<200 mg daily) at discharge following primary PCI in STEMI,” the authors concluded.
Coalition promotes important acetaminophen dosing reminders
November 18th 2014It may come as a surprise that each year Americans catch approximately 1 billion colds, and the Centers for Disease Control and Prevention estimates that as many as 20% get the flu. This cold and flu season, 7 in 10 patients will reach for an over-the-counter (OTC) medicine to treat their coughs, stuffy noses, and sniffles. It’s an important time of the year to remind patients to double check their medicine labels so they don’t double up on medicines containing acetaminophen.
Support consumer access to specialty medications through value-based insurance design
June 30th 2014The driving force behind consumer cost-sharing provisions for specialty medications is the acquisition cost and not clinical value. This appears to be true for almost all public and private health plans, says a new report from researchers at the University of Michigan Center for Value-Based Insurance Design (V-BID Center) and the National Pharmaceutical Council (NPC).
Management of antipsychotic medication polypharmacy
June 13th 2013Within our healthcare-driven society, the increase in the identification and diagnosis of mental illnesses has led to a proportional increase in the prescribing of psychotropic medications. The prevalence of mental illnesses and subsequent treatment approaches may employ monotherapy as first-line treatment, but in many cases the use of combination of therapy can occur, leading to polypharmacy.1 Polypharmacy can be defined in several ways but it generally recognized as the use of multiple medications by one patient and the most common definition is the concurrent use of five more medications. The presence of polyharmacy has the potential to contribute to non-compliance, drug-drug interactions, medication errors, adverse events, or poor quality of life.
Medical innovation improves outcomes
June 12th 2013I have been diagnosed with stage 4 cancer of the pancreas, a disease that’s long been considered not just incurable, but almost impossible to treat-a recalcitrant disease that some practitioners feel has given oncology a bad name. I was told my life would be measured in weeks.
