ASPIRIN















The Women's Health Study - Aspirin vs Placebo in Cancer Prevention, JAMA (2005) [PubMed abstract]
  • The Women's Health Study enrolled 39,876 female healthcare professionals
Main inclusion criteria
  • Female ≥ 45 years old
  • No history of cancer (except nonmelanoma skin cancer), cardiovascular disease, or major chronic illness
Main exclusion criteria
  • Taking aspirin or NSAIDs more than once a week
  • Taking anticoagulants or corticosteroids
Baseline characteristics
  • Average age 55 years
  • Average BMI - 26
  • Current smoker - 13%
  • First-degree relative with breast, colorectal, or ovarian cancer - 18%
Randomized treatment groups
  • Group 1 (19,934 patients) - Aspirin 100 mg every other day
  • Group 2 (19,942 patients) - Placebo every other day
Primary outcome: Any cancer (excluding nonmelanoma skin cancer)
Results

Duration: 10 years
Outcome Aspirin Placebo Comparisons
Primary outcome (any cancer) 7.2% 7.15% HR 1.01, 95%CI [0.94 - 1.08], p=0.87
Colorectal cancer 0.67% 0.68% HR 0.97, 95%CI [0.77 - 1.24], p=0.83
Lung cancer 0.45% 0.58% HR 0.78, 95%CI [0.59 - 1.03], p=0.08
Leukemia 0.19% 0.12% HR 1.54, 95%CI [0.92 - 2.57], p=0.10
Overall mortality 3.1% 3.2% HR 0.95, 95%CI [0.85 - 1.06], p=0.32
  • Aspirin did not significantly reduce the risk of any specific cancer
  • During the study, about 73% of patients were compliant with their assigned treatment [2]

Findings: Results from this large-scale, long-term trial suggest that alternate day use of low-dose aspirin (100 mg) for an average 10 years of treatment does not lower risk of total, breast, colorectal, or other site-specific cancers. A protective effect on lung cancer or a benefit of higher doses of aspirin cannot be ruled out.

















  • Reference [15]
AHA recommendations for daily low-dose aspirin in patients with a history of GI bleed/PUD
STEP 1 - Determine if patient has major risk factor for GI bleeding
  • Major risk factors include:
    • History of GI ulcers
    • History of GI ulcer complications (ex. bleeding)
      • If yes then patient should be tested for H. pylori infection and treated if indicated
    • History of GI bleeding
    • Patient taking dual antiplatelet therapy (Ex. aspirin + clopidogrel)
    • Patient also taking an anticoagulant (e.g. aspirin + warfarin)
STEP 2 - If any of the above are present, prescribe PPI with aspirin
  • Dose of aspirin should not exceed 81 mg a day
  • Enteric and buffered aspirin does not help (See enteric coated aspirin below)
STEP 3 - If none of the above are present, determine if other risk factors are present
  • Other risk factors include:
    • Age ≥ 60 years
    • Corticosteroid use
    • Stomach upset (dyspepsia) or GERD symptoms
STEP 4 - If two or more other risk factors are present, prescribe a PPI with aspirin
  • Dose of aspirin should not exceed 81 mg a day
  • Enteric and buffered aspirin does not help (See enteric coated aspirin below) [15]