If Aspirin was to be discovered today, the discoverer will be a nominee for Nobel prize and the drug will be sold in the market fifty times of its current price. This has been one of the most ‘wonderful’ discoveries in the world of science but the credit goes to the ‘rediscovery’ of its many ‘potentials’. The story of Aspirin is that of ‘rags to riches’ starting from a very humble background, it has become one of the most widely prescribed drugs. To start with, it was used only as a pain killer and now it has an application in almost all the fields of medicine directly and indirectly.
The strongest effects have been felt in the field of cardiology. Anyone with the diagnosis of a heart ailment has to have Aspirin. There was a time when ‘digoxin’ was synonymous with cardiac problems and every one with the ‘possibility’ of a heart problem would be prescribed the drug, the same is now true for aspirin. More than that we have entered in an era where it is being ‘over prescribed’ and we have to make special efforts to rationalize its usage to the ones who really need to have it.
The utility of Aspirin has been proven in the courts of statistics – the world of numbers by conducting large clinical trials where it was tested in a ‘blind’ fashion again placebo and other drugs. The results are very impressive and highly significant. The essential role of Aspirin is to reduce the aggregability or stickiness of an important constituent of blood called platelets. Platelets stick together and form a plug which blocks the tubes carrying the nutrition – blood. Hence they reduce or in many cases totally block the blood supply to a part of body which may happen to be heart, brain or kidney.
There is an elaborate system of blood supply, operating in the body which ensures optimal nutrition/blood to each and every part of body and at the same time same medium is used for getting rid of toxic material. Any blockage in the system causes reduction of blood supply to that particular part of body which results in impairment of function of that part or system. Some of the blockages may be due to inborn problems but mostly they are due to the process of atherosclerosis (athero – cheesy and sclerosis-hardening). This is a process by which cheesy material is deposited inside the tube or vessels. This process starts early in life and is progressive. Known risk factors like diabetes, high blood pressure, high cholesterol and smoking predispose to this process and accelerate it. On top of these blockages blood supply may be further reduced with the formation of platelets plugs. Aspirin prevents formation of these plugs hence it has its application in preserving the blood supply to all the systems of the body.
The major advantage is found in preventing the blockage in the blood supply system to heart and brain. It is an important player in ischaemic heart disease presenting as angina, acute coronary syndrome and heart attack. The most convincing effects are seen in the setting of acute myocardial infarction where Aspirin is recommended to be chewed for quick action as soon as possible. Very few treatment modalities have been so well and widely received and practiced as aspirin in heart attack. Aspirin in does of 40 mg can acetylate all the platelet cyclo-oxycenase hence reducing the aggregation property of platelets. In a summary of 33 trials conducted in heart attack, mortalilty in patients on aspirin was reduced from 25% to 11%. The effects are comparable to the use of clot dissolving drugs like streptokinase. It is mandatory for all doctors and paramedical staff to administer a tablet of Aspirin to anyone who presents with chest pain and is suspected to have a heart attack. In the setting of CCU first thing to be given to the patient should be Aspirin. Many doctors carry Aspirin with them, to be taken in case of an emergency.
In patients presenting with unstable angina or acute coronary syndrome Aspirin has been shown to be highly effective in reducing platelets stickiness and restoring blood supply to heart. The usage has been shown to reduce the complications and further progress of disease. Similar salutary effects are seen in patients labeled as stable angina experiencing chest pain on exertion. Every patient with suspicion of heart attack, unstable angina or stable angina should take Aspirin and continue indefinitely in dosage of 75mg per day. Various enteric coated brands are available in the market to reduce hyperacidity.
As a step further, Aspirin is being recommended for patients who have risk factors for developing heart problems. In patients who are diabetic, have high blood pressure or elevated cholesterol, the introduction of Aspirin has been shown to decrease the risks for further problems. Many doctors recommend Aspirin to all the patients above forty years of age, regardless of other risk factors. The evidence to support such treatment is not very robust. In the present day scenario Aspirin is being used in all the presentations and even for the prevention of Ishaemic heart disease.
Aspirin has been used for ages as a first choice in a disease which afflicts the joints and heart at the same time called rheumatic fever. This is a disease, still quite prevalent in the developing countries, in the lower social strata and in childhood. This results in damaging the valves-doors of heart causing heart failure in young children. Many of these children require operation of the valve and some succumb to it. The response to Aspirin is dramatic and quick. The response is taken as evidence of the validity of the diagnosis.
The usage has increased in other cardiovascular diseases where platelets are discouraged to stick together and form clumps. Patients with irregular beating of heart called a trial fibrillation have the propensity of clot formation due to whirling of blood in left storing chamber. These clots can get dislodged and find their way into different circulations. Aspirin is indicated in such situations to prevent clump formation and prevention of stroke.
Aspirin is being used for the prevention of stroke and in patients of transient ischaemic attacks (TIA) enthusiastically in the light of over whelming evidence provided by many large well conducted trials. An analogy can be drawn between stroke and TIA to heart attack and acute coronary syndrome respectively. Blockages in blood supply produce symptoms and these blockages can be prevented by Aspirin. Same as ischaemic heart disease, people at a higher risk of developing stroke are treated with Aspirin for the prevention. Same risk factors as for heart attack are taken into account and treated aggressively.
A unique role for Aspirin has been discovered in pregnancy. Certain patients go into premature labour before their due time. Aspirin plays an important role in preventing that through its action on arachidonic acid. This has been a new tool in the hands of Obstetricians with very good response.
Aspirin can potentially cause gastric erosions and ulcers beside hyperacidity. Paitnets with proven ulcer on endoscopy or barium meal, history of gastrointestinal bleeding or thos receiving antiulcer treatment should not be given aspirin. Patients with known allergy should not be given aspirin. Other platelet inhibitors may be considered in patients who have allergy or who cannot tolerate aspirin.
___________________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
The strongest effects have been felt in the field of cardiology. Anyone with the diagnosis of a heart ailment has to have Aspirin. There was a time when ‘digoxin’ was synonymous with cardiac problems and every one with the ‘possibility’ of a heart problem would be prescribed the drug, the same is now true for aspirin. More than that we have entered in an era where it is being ‘over prescribed’ and we have to make special efforts to rationalize its usage to the ones who really need to have it.
The utility of Aspirin has been proven in the courts of statistics – the world of numbers by conducting large clinical trials where it was tested in a ‘blind’ fashion again placebo and other drugs. The results are very impressive and highly significant. The essential role of Aspirin is to reduce the aggregability or stickiness of an important constituent of blood called platelets. Platelets stick together and form a plug which blocks the tubes carrying the nutrition – blood. Hence they reduce or in many cases totally block the blood supply to a part of body which may happen to be heart, brain or kidney.
There is an elaborate system of blood supply, operating in the body which ensures optimal nutrition/blood to each and every part of body and at the same time same medium is used for getting rid of toxic material. Any blockage in the system causes reduction of blood supply to that particular part of body which results in impairment of function of that part or system. Some of the blockages may be due to inborn problems but mostly they are due to the process of atherosclerosis (athero – cheesy and sclerosis-hardening). This is a process by which cheesy material is deposited inside the tube or vessels. This process starts early in life and is progressive. Known risk factors like diabetes, high blood pressure, high cholesterol and smoking predispose to this process and accelerate it. On top of these blockages blood supply may be further reduced with the formation of platelets plugs. Aspirin prevents formation of these plugs hence it has its application in preserving the blood supply to all the systems of the body.
The major advantage is found in preventing the blockage in the blood supply system to heart and brain. It is an important player in ischaemic heart disease presenting as angina, acute coronary syndrome and heart attack. The most convincing effects are seen in the setting of acute myocardial infarction where Aspirin is recommended to be chewed for quick action as soon as possible. Very few treatment modalities have been so well and widely received and practiced as aspirin in heart attack. Aspirin in does of 40 mg can acetylate all the platelet cyclo-oxycenase hence reducing the aggregation property of platelets. In a summary of 33 trials conducted in heart attack, mortalilty in patients on aspirin was reduced from 25% to 11%. The effects are comparable to the use of clot dissolving drugs like streptokinase. It is mandatory for all doctors and paramedical staff to administer a tablet of Aspirin to anyone who presents with chest pain and is suspected to have a heart attack. In the setting of CCU first thing to be given to the patient should be Aspirin. Many doctors carry Aspirin with them, to be taken in case of an emergency.
In patients presenting with unstable angina or acute coronary syndrome Aspirin has been shown to be highly effective in reducing platelets stickiness and restoring blood supply to heart. The usage has been shown to reduce the complications and further progress of disease. Similar salutary effects are seen in patients labeled as stable angina experiencing chest pain on exertion. Every patient with suspicion of heart attack, unstable angina or stable angina should take Aspirin and continue indefinitely in dosage of 75mg per day. Various enteric coated brands are available in the market to reduce hyperacidity.
As a step further, Aspirin is being recommended for patients who have risk factors for developing heart problems. In patients who are diabetic, have high blood pressure or elevated cholesterol, the introduction of Aspirin has been shown to decrease the risks for further problems. Many doctors recommend Aspirin to all the patients above forty years of age, regardless of other risk factors. The evidence to support such treatment is not very robust. In the present day scenario Aspirin is being used in all the presentations and even for the prevention of Ishaemic heart disease.
Aspirin has been used for ages as a first choice in a disease which afflicts the joints and heart at the same time called rheumatic fever. This is a disease, still quite prevalent in the developing countries, in the lower social strata and in childhood. This results in damaging the valves-doors of heart causing heart failure in young children. Many of these children require operation of the valve and some succumb to it. The response to Aspirin is dramatic and quick. The response is taken as evidence of the validity of the diagnosis.
The usage has increased in other cardiovascular diseases where platelets are discouraged to stick together and form clumps. Patients with irregular beating of heart called a trial fibrillation have the propensity of clot formation due to whirling of blood in left storing chamber. These clots can get dislodged and find their way into different circulations. Aspirin is indicated in such situations to prevent clump formation and prevention of stroke.
Aspirin is being used for the prevention of stroke and in patients of transient ischaemic attacks (TIA) enthusiastically in the light of over whelming evidence provided by many large well conducted trials. An analogy can be drawn between stroke and TIA to heart attack and acute coronary syndrome respectively. Blockages in blood supply produce symptoms and these blockages can be prevented by Aspirin. Same as ischaemic heart disease, people at a higher risk of developing stroke are treated with Aspirin for the prevention. Same risk factors as for heart attack are taken into account and treated aggressively.
A unique role for Aspirin has been discovered in pregnancy. Certain patients go into premature labour before their due time. Aspirin plays an important role in preventing that through its action on arachidonic acid. This has been a new tool in the hands of Obstetricians with very good response.
Aspirin can potentially cause gastric erosions and ulcers beside hyperacidity. Paitnets with proven ulcer on endoscopy or barium meal, history of gastrointestinal bleeding or thos receiving antiulcer treatment should not be given aspirin. Patients with known allergy should not be given aspirin. Other platelet inhibitors may be considered in patients who have allergy or who cannot tolerate aspirin.
___________________________________________________
Ref: Heal Thy Heart written by Prof: Dr. Muhammad Hafizullah
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