More than 10 percent of patients received inappropriate aspirin therapy for the primary prevention of cardiovascular disease, according to a study published Jan. 12 in the Journal of the American College of Cardiology. Among patients without cardiovascular disease risk, the risk of gastrointestinal bleeding and hemorrhagic strokes from aspirin use can outweigh the potential benefits.

Using data from the ACC’s PINNACLE Registry, researchers evaluated aspirin use for primary prevention in 68,808 patients and 119 different U.S. practices between January 2008 and June 2013. Patients receiving aspirin for secondary prevention – such as for a history of myocardial infarction, percutaneous coronary intervention or coronary artery disease – were excluded from the study. Researchers defined inappropriate aspirin use as that in patients who received aspirin and also had a 10 year risk of a cardiovascular disease event lower than 6 percent.

The results of the study showed that 12 percent of patients (7,972) were receiving inappropriate aspirin therapy. Researchers found that the frequency of inappropriate aspirin use was 17 percent among women and 5 percent among men. Overall, the patients receiving aspirin inappropriately were younger than those receiving appropriate therapy (50 years of age vs. 66).

Further, researchers found that, when examining variations of aspirin therapy use among practices, a patient was “63 percent more likely to receive aspirin inappropriately than another patient with similar characteristics because of the practice where they were receiving care.” However, no correlation was found between a practice’s frequency of inappropriate aspirin use for primary prevention of cardiovascular disease and the overall frequency of aspirin use at that practice.

“Medical providers must consider whether the potential for bleeding outweigh[s] the potential benefits of aspirin therapy in patients who don’t yet meet the guidelines for prescribing aspirin therapy,” said the study’s lead and senior authors, Ravi S. Hira, MD, and Salim S. Virani, MD, FACC, of the Baylor College of Medicine in Houston, TX. “Since aspirin is available over the counter, patient and public education against using aspirin without a medical provider’s recommendation will also play a key role in avoiding inappropriate use.”

In an accompanying editorial, Freek W.A. Verheugt, MD, FACC, of Onza Lieve Vrouwe Gasthuis Radboud University Nijmegen Medical Centre in Amsterdam remarked that “major coronary events are reduced [by] 18 percent [with aspirin use], but at the cost of an increase of 54 percent of major extracranial bleeding. Each two major coronary events have shown to be prevented by prophylactic aspirin at the cost of one major extracranial bleed. Yet, primary prevention with aspirin is widely applied…When [it is] applied, other strategies should be [employed] as well.”

Keywords: Aspirin, Coronary Artery Disease, Hemorrhage, Myocardial Infarction, Percutaneous Coronary Intervention, Primary Prevention, Registries, National Cardiovascular Data Registries

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