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CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
1. For which of the following conditions
does low-dose aspirin use have the
a) Peripheral oedema.
b) Primary prevention of heart disease.
c) Atrial fibrillation.
d) Transient ischaemic attack (TIA).
2. Which of the following is NOT an
absolute contraindication for use of
c) Peptic ulceration.
d) Aspirin-sensitive asthma.
3. Based on available evidence, what is
the MOST appropriate dose of aspirin
for the secondary prevention of CVD?
a) 30–75 mg once daily.
b) 75–150 mg once daily.
c) 160–325 mg once daily.
d) 150–300 mg on alternate days.
4. Which of the following have clinically
important drug-drug interactions
with low-dose aspirin?
a) Sodium valproate.
5. Which of the following statements
a) Low-dose aspirin reduces the
proportional risk of heart disease by
b) The rate of excess bleeding incurred
through aspirin use is about 1–2 bleeds
per year for every 1,000 patients.
c) Part of the efficacy of low-dose aspirin is
through the inhibition of prostacyclin.
d) None of the above.
It is equally important to make sure
that patients tell their GPs if they are
taking OTC aspirin. As mentioned
above, there is a range of drugs that can
interfere with the efficacy and bleeding
risk associated with aspirin. The current
uncertainty around the need for aspirin
therapy in primary prevention might also
result in conflicting messages to patients
if prescribers are not involved with the
discussion. If a patient has been advised
by their GP to take aspirin, it is likely due
to a high risk of CVD. Some patients who
may currently be taking aspirin, but have
no history of CVD, should be advised to
review the need for this therapy with
their doctor in light of recent debates.
In the scenario above, it turned out
that the patient in question did not
have a history of heart disease. He was
interested because his wife had just had
a heart attack and had been prescribed
low-dose aspirin. You explain that
aspirin is probably not appropriate in
his case, but advise him he can improve
his cardiovascular health in other ways.
You offer to conduct a ‘heart health’
screening program and communicate
results to his GP, provide some
educational materials and work with him
to develop practical strategies to help
him and his wife improve their health
TAKE HOME MESSAGES
• The optimal dose of aspirin for
long-term CVD prevention is between
75 mg and 150 mg daily.
• The evidence for aspirin use in
secondary prevention of CVD is
extensive. Justification for use in
primary prevention is very uncertain.
• Enteric coated aspirin tablets and
capsules may not offer additional
protection from bleeding. Hence it is
important to continue monitoring for
signs of bleeding.
• Regular NSAID use may reduce the
antiplatelet effect of low-dose aspirin
and increase CVD risk.
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