Prescribing Advice for GPs

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BMJ Change Page targets aspirin

The British Medical Journal has published a 'Change Page' that reviews the current evidence for aspirin in the prevention of primary cardiovascular events. Change Page articles highlight areas of practice where there is an immediate need for a change in practice to make it consistent with current evidence.

This article notes that recent systematic reviews and meta-analyses have identified that the benefit of using aspirin for primary prevention is much lower than previously assumed and does not appear to outweigh the harms associated with the treatment.

This article also draws attention to the disparate recommendations in current guidelines. For example, a recent update to the Scottish Intercollegiate Guidelines Network (SIGN) Diabetes guideline has stated that "low-dose aspirin is not recommended for the primary prevention of vascular disease in patient with diabetes" while the British Hypertension Society (BHS) has reaffirmed it's recommendation for "low dose aspirin for primary prevention of cardiovascular disease in those for whom the balance of benefit outweighs the risk of harm".

This article urges a review of therapy for all patients taking aspirin for primary prevention and recommends that "the decision to stop or continue treatment should be made with these patients after fully informing them of the available evidence".

Action: Clinicians should not routinely start aspirin for the primary prevention of cardiovascular disease. Patients on current treatment should be reviewed to assess whether continued therapy is justified.

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