Chronic stable angina treatment aspirin: Difference between revisions

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(New page: __NOTOC__ {{Chronic stable angina}} '''Editors-In-Chief:''' C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[J...)
 
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{{Chronic stable angina}}
{{Chronic stable angina}}
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[John Fani Srour, M.D.]]; Jinhui Wu, MD
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[John Fani Srour, M.D.]]; Jinhui Wu, MD
==Overview==


'''Mechanism of benefit:'''
'''Mechanism of benefit:'''
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'''Supportive trial data:'''
'''Supportive trial data:'''
*Meta-analysis of 140,000 patients from the Antiplatelet Trialists’ Collaboration showed that aspirin (75-325 mg/day) reduced the rate of subsequent [[myocardial infarction]], [[stroke]], and death in patients with history of [[angina]] pectoris, myocardial infarction, [[CABG]], and stroke.  
*'''Meta-analysis''' of 140,000 patients from the Antiplatelet Trialists’ Collaboration showed that aspirin (75-325 mg/day) reduced the rate of subsequent [[myocardial infarction]], [[stroke]], and death in patients with history of [[angina]] pectoris, myocardial infarction, [[CABG]], and stroke.
 
*In the Swedish Angina Pectoris Aspirin Trial ('''SAPAT'''), aspirin (75 mg/day) in conjunction with the [[beta blocker]] sotalol conferred an additional 34% reduction in acute [[myocardial infarction]] and [[sudden cardiac death]] among men and women with chronic stable angina.


*In the Swedish Angina Pectoris Aspirin Trial (SAPAT), aspirin (75 mg/day) in conjunction with the [[beta blocker]] sotalol conferred an additional 34% reduction in acute [[myocardial infarction]] and [[sudden cardiac death]] among men and women with chronic stable angina.


==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).]''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref>==
==ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)<ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).]''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref><ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref>==
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'''1.''' [[Aspirin]] should be started at 75 to 162 mg per day and continued indefinitely in all patients unless contraindicated. ''(Level of Evidence: A)''
'''1.''' [[Aspirin]] should be started at 75 to 162 mg per day and continued indefinitely in all patients unless contraindicated. ''(Level of Evidence: A)''


'''2.''' Use of [[warfarin]] in conjunction with [[aspirin]] and/or [[clopidogrel]] is associated with an increased risk of bleeding and should be monitored closely. ''(Level of Evidence: B)''
===Class IIa===
'''1.''' [[Clopidogrel]] when [[aspirin]] is absolutely contraindicated. ''(Level of Evidence: B)''


===Class IIa===
===Class IIb===
'''1.''' [[Clopidogrel]] when [[aspirin]] is absolutely contraindicated. ''(Level of Evidence: B)''}}
'''1.''' Low-intensity anticoagulation with [[warfarin]] in addition to [[aspirin]]. ''(Level of Evidence: B)''}}


==See Also==
==See Also==

Revision as of 17:24, 19 July 2011

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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [2]; Associate Editors-In-Chief: John Fani Srour, M.D.; Jinhui Wu, MD

Overview

Mechanism of benefit:

  • Aspirin inhibits cyclo oxygenase and the subsequent suppression of thromboxane A2, the key moderator of irreversible platelet aggregation.
  • Aspirin is a potent anti platelet agent and has been shown to improve survival and to prevent infarction in patients with unstable angina or after myocardial infarction.

Aspirin dosing:

  • A 75-mg dose has been shown to be effective and causes less gastrointestinal bleeding than the commonly prescribed 325 mg dose.
  • Aspirin also improves endothelial function and, when used in high dose (300 mg/day), has been shown to reduce circulating levels of C-reactive protein. Therefore, it should be started at 75 to 162 mg/day and continued indefinitely in all patients with chronic stable angina pectoris, unless contraindicated.
  • 75 to 162 mg/day aspirin dosing range appears to have comparable efficacy for secondary prevention compared to dosing at 160-325 mg/day and also reduces bleeding risk.
  • Use of warfarin in conjunction with aspirin and/or clopidogrel is associated with an increased risk of bleeding and should be monitored closely.

Supportive trial data:

  • Meta-analysis of 140,000 patients from the Antiplatelet Trialists’ Collaboration showed that aspirin (75-325 mg/day) reduced the rate of subsequent myocardial infarction, stroke, and death in patients with history of angina pectoris, myocardial infarction, CABG, and stroke.


ACC/AHA Guidelines- Pharmacotherapy to Prevent MI and Death and Reduce Symptoms (DO NOT EDIT)[1][2]

Class I

1. Aspirin should be started at 75 to 162 mg per day and continued indefinitely in all patients unless contraindicated. (Level of Evidence: A)

Class IIa

1. Clopidogrel when aspirin is absolutely contraindicated. (Level of Evidence: B)

Class IIb

1. Low-intensity anticoagulation with warfarin in addition to aspirin. (Level of Evidence: B)

See Also

Sources

  • The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [1]
  • TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [2]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [3]

References


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