Aspirin is pointless for a quarter of patients and hundreds could be needlessly dying as a result, doctors have warned.
They say that 16million Britons may not gain any benefit at all from taking a daily dose of the drug, which is mainly used to thin the blood.
54. When those who believe
in Our Ayat (proofs, evidences, verses,
lessons, signs, revelations, etc.) come to you, say: "Salamun 'Alaikum" (peace be on you); your Lord has
written Mercy for Himself, so that, if any of you does evil in ignorance, and
thereafter repents and does righteous good deeds (by obeying Allah), then
surely, He is Oft-Forgiving, Most Merciful.
55. And thus do We explain
the Ayat (proofs, evidences, verses,
lessons, signs, revelations, etc.) in detail, that the way of the Mujrimun (criminals, polytheists, sinners),
may become manifest.
56. Say (O Muhammad ): "I have been forbidden to
worship those whom you invoke (worship) besides Allah." Say: "I will
not follow your vain desires. If I did, I would go astray, and I would not
be one of the rightly guided."
59. And with Him are the
keys of the Ghaib (all that is hidden), none knows
them but He. And He knows whatever there is in (or on) the earth and in
the sea; not a leaf falls, but he knows it. There is not a grain in the
darkness of the earth nor anything fresh or dry, but is written in a Clear
Record. 6. Surah Al-An'am (The Cattle)
Those at risk of heart attacks and strokes are also thought to be around four times more likely to suffer a fatal attack than those for whom aspirin is effective.
Scientists have now developed a £10 urine test that can tell whether the drug is effective for individual patients.
Doctors want patients to be tested for aspirin resistance before they are prescribed the drug.
Dr Paul Ames, a consultant at St George's Hospital, London, believes the new test could have a significant impact on the health of hundreds of thousands of patients.
He told The Daily Telegraph: 'Doctors need to realise that aspirin, the cornerstone of much cardiac therapy, is not working for up to 25 per cent of those taking it.
'Then there are the side effects, such as ulcers, to consider.'
He added that aspirin-resistant patients are twice as likely to suffer a heart attack and almost four times more likely to suffer cardiovascular death
He said it was imperative that there should be testing for aspirin resistance, so patients can be given alternative treatments.
Aspirin, known as acetylsalicylic acid, has been used for many years as a painkiller because it is an anti-inflammatory.
Low doses of up to 75mg are recommended for people with known cardiovascular disease because it thins the blood.
Medics say that, in aspirin-resistant patients, blood thinning is poor. It means there a greater likelihood of clots forming in arteries, resulting in heart attacks and strokes.
People who are "resistant" to aspirin may be at risk for larger, more severe strokes, South Korean researchers report.
Doctors often prescribe low-dose aspirin to people at high risk of stroke because the drug helps prevent blood clots. But for about 28 percent of stroke patients in a new study, aspirin didn't keep blood from clotting. And their strokes were worse than strokes suffered by aspirin-users who weren't resistant to the drug.
"Aspirin resistance is an important predictor of severe stroke and large stroke size in patients taking aspirin before having a stroke," said lead researcher Dr. Mi Sun Oh, of the department of neurology at Hallym University College of Medicine in Seoul.
What causes aspirin resistance isn't known. Other studies have found that between 5 percent and 45 percent of patients have this problem, but doctors do not routinely test for it.
Clots that break loose can travel to the brain and cause "ischemic" strokes -- the most common type of stroke. This study suggests that people who are aspirin-resistant might need a different drug to prevent dangerous clotting, Oh said.
"In patients at high risk for stroke with aspirin resistance, different anti-clotting drugs -- such as clopidogrel (Plavix) -- can be considered as alternatives to prevent another stroke or decrease stroke severity," Oh said.
The findings of the study were released Feb. 23, ahead of its official presentation in April at the annual meeting of the American Academy of Neurology in Washington, D.C. Data and conclusions presented at meetings are usually considered preliminary until published in a peer-reviewed medical journal.
Dr. Ralph Sacco, chairman of neurology at the University of Miami Miller School of Medicine, said the new research sheds light on the aspirin-stroke relationship. Prior studies have suggested that patients taking aspirin at the time of their stroke may have smaller and less severe strokes. This would indicate that these people aren't resistant to aspirin.
"This study fits with this premise," Sacco said.
Why this happens isn't known, he added.
"One way aspirin works is to prevent platelets [particles that form clots in the blood] from clumping, and this could mean that clots that are released and block brain arteries are smaller and lead to smaller areas of brain injury," Sacco speculated.
"Although we do not routinely test for aspirin resistance, in the future era of targeted medicine we may improve the ability to assess whether someone is aspirin-resistant and choose medicines more accurately," he said.
For the study, Oh and colleagues studied 310 patients who had been taking aspirin for at least seven days before they suffered an ischemic stroke. Aspirin resistance was checked within 24 hours of hospital admission.
The researchers found that nearly 28 percent of the patients were resistant to aspirin. Their strokes ranged from 3 to 11 on a stroke severity score, compared with scores of 1 to 6 among aspirin responders.
Moreover, strokes of patients resistant to aspirin affected about twice the brain area as the strokes of those who responded to aspirin, the study found.
Hundreds of people may be needlessly dying each year because they are resistant to aspirin, doctors have claimed.
The over-the-counter painkiller is not affective for up to 16 million people in Britain, yet few are aware that it will not work.
However for those at risk of heart attacks and strokes, who are relying on aspirin to thin their blood, the problem could be deadly. They are around four times more likely to suffer a fatal attack.
Now doctors are calling for patients to be tested for aspirin resistance before they are put on daily regimes.
And scientists have developed a new simple £10 urine test can tell whether the drug is being metabolised properly by the body.
A daily dose of aspirin is taken by millions across Britain and around the world to thin
Dr Paul RJ Ames, Consultant in Haemostasis & Thrombosis at St George’s Hospital, London, who has been working with the new test, believes it could have a significant impact on the health of hundreds of thousands of patients in the UK and is calling for doctors to take aspirin resistance seriously:
“Doctors need to realise that aspirin, the cornerstone of much cardiac therapy is not working for up to 25 per cent of those taking it.
“Then there are the side effects such as ulcers to consider. Why should you continue to take something that actually isn’t doing any good?”
“It is also worrying that aspirin resistant patients are twice as likely to suffer a heart attack and almost four times more likely to suffer cardiovascular death than those who are responsive.
“We need to begin testing for aspirin resistance, so that we can identify patients who need alternative treatments, ultimately reducing their risk of heart attack and stroke.”
Aspirin (acetylsalicylic acid) has been used for many years as a painkiller. It has an anti-inflammatory action
Low-dose (75mg) aspirin is already recommended for people with known cardiovascular disease.
Aspirin works to thin the blood by inhibiting the production of a blood clotting chemical called thromboxane.
However come people are genetically predisposed to resist the drug. Conditions like high cholesterol and diabetes can increase the risk of resistance.
In aspirin resistant patients, blood thinning is poor, therefore there is a greater likelihood of clots forming in arteries which are narrowed by fatty and fibrous plaques resulting in heart attack and stroke.
Dr Peter FitzGerald of biotech company Randox, has developed the new urine test.
“We are faced with the fact that thousands of patients are at increased risk because they are not getting the benefits from their aspirin treatment.
“Some people have genetic resistance to aspirin, but high cholesterol, diabetes and pre-diabetes (affecting an estimated 1-in-3 people In England) may significantly contribute to the poor aspirin response.”
A recent study of 3,000 people with heart disease found that 20 per cent were resistant to aspirin. In the follow period 41 per cent had a cardiovascular attack and nearly 6 per cent died, four times greater than those who could metabolise the drug.
According to the British Heart Foundation, there are more than a quarter of a million heart attacks and strokes in the UK each year, it is not yet known how many of these were suffered by aspirin resistant patients, but it is evident that aspirin, the basis of treatment for millions at cardiovascular risk, is not a one-pill-wonder.
For the first time, a test is available which can rapidly and accurately identify aspirin resistance, a breakthrough in individual patient management; with the potential to revolutionise health care for those with cardiovascular risk
.
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What are the side effects of aspirin?
The most common side effects of aspirin are:
- Irritation of the stomach or gut
- Indigestion
- Nausea.
The following side effects are possible, but less common:
- Asthma symptoms may worsen
- Vomiting
- Inflammation of the stomach
- Stomach bleeding
- Bruising.
An extremely rare side-effect of low-dose aspirin is hemorrhagic stroke.
Aspirin and children
Acetaminophen (paracetamol, Tylenol) and ibuprofen are generally used for children; not aspirin. Aspirin and salicylate NSAID usage in children raises the risk of developing Reye's Syndrome. In some countries, such as the UK, aspirin is only occasionally used in children under specialist supervision for Kawasaki disease and to prevent blood clot formation after heart surgery.
Low-dose aspirin (75mg per day) is used as an antiplatelet medication - to prevent the formation of clots in the blood.
Low-dose aspirin may be given to patients who had:
Low-dose aspirin may be given to patients who had:
- A coronary artery bypass graft operation
- A heart attack
- A stroke
- Atrial fibrillation
- Acute coronary syndrome.
The following people may also be given low-dose aspirin if the doctor believes they are at risk of heart attack or stroke:
- Patients with high blood cholesterol levels
- Patients with hypertension (high blood pressure)
- Patients with diabetes
- Some smokers.
The following patients may also be advised to take low-dose aspirin:
- Those with damage to the retina (retinopathy)
- Those with kidney damage (nephropathy)
- Some patients who have had diabetes for over ten years
- Some patients who are taking antihypertensive medications.
In all these cases, low-dose aspirin will be taken daily for the rest of the patient's life.
Precautions
Aspirin is not recommended for the following patients:
- People who have a peptic ulcer
- Patients with hemophilia or any other bleeding disorder
- People with a known allergy to aspirin
- People who are allergic to any NSAIDs, such as ibuprofen
- Children under 16 years of age (unless under specialist medical supervision).
The following people should be cautious about taking aspirin, and should only do so if the doctor agrees:
- Patients with asthma
- Patients with uncontrolled hypertension
- People who have had a peptic ulcer (even though they don't now)
- Patients with liver problems
- Patients with kidney problems.
If you are planning to have a surgical operation you should tell your doctor if you are taking regular aspirin. In many cases patients will be asked to stop taking the aspirin for seven days before the operation.
Pregnant or breastfeeding patients may take low-dose aspirin, but only under their doctor's supervision. High-dose aspirin is not recommended.
Pregnant or breastfeeding patients may take low-dose aspirin, but only under their doctor's supervision. High-dose aspirin is not recommended.
Drug interactions
Sometimes one medication can undermine the efficacy of another medication - this is calleddrug interaction. Below is a list of the most common drugs that aspirin interacts with (there are more):
- Anti-inflammatory painkillers - such as diclofenac, ibuprofen, indometacin, and naproxen increase the risk of stomach bleeding if taken in combination with aspirin.
- Methotrexate - used in the treatment of cancer and some auto-immune diseases. Aspirin can make it harder for the body to eliminate methotrexate, resulting in high and potentially dangerous levels of methotrexate in the body.
- SSRI (selective serotonin reuptake inhibitors) antidepressants - drugs, such as citalopram, fluoxetine, paroxetine, venlafaxine and sertraline, taken with aspirin can increase the risk of bleeding.
- Warfarin - this is an anticoagulant drug (a blood thinner); it stops the blood from clotting. Aspirin taken with warfarin can reduce the drug's anticoagulant effects, increasing the risk of bleeding. In some situations, however, a doctor may prescribe aspirin together with warfarin.
Aspirin has also become increasingly popular as an anti-platelet - used to prevent blood clot formation - in long-term low doses to prevent heart attacks and strokes in high risk patients. Nowadays, aspirin is often given to patients immediately after a heart attack to prevent recurrence or cardiac tissue death.
Aspirin is a non-steroidal anti-inflammatory drug (NSAID). NSAIDs are medications with analgesic, antipyretic (something that reduces a fever), and in higher doses anti-inflammatory effects. Non-steroidal means they are not steroids, which often have similar effects. As analgesics, NSAIDs are generally non-narcotic (do not cause insensibility or stupor). The most prominent NSAIDs are aspirin, ibuprofen and naproxen - mainly because most of them are OTC (over-the-counter, no prescription required) medications. Aspirin was the first discovered NSAID.
Aspirin in its present form has been around for over 100 years and is still one of the most widely used medications in the world. It is estimated that approximately 40,000 metric tons of it is consumed annually. Aspirin is a trademark owned by German pharmaceutical company Bayer; the generic term is acetylsalicylic acid (ASA).
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