From the Guidelines
For a 65-year-old patient with diabetes (A1c of 7), hypertension, and a potential Q wave on EKG without known history of myocardial infarction, daily low-dose aspirin (75-162 mg) is generally recommended. This patient has multiple cardiovascular risk factors, including age, diabetes, and hypertension, which place them at elevated risk for cardiovascular events 1. Aspirin provides antiplatelet effects that can help prevent clot formation in coronary arteries. The combination of diabetes, hypertension, and possible previous silent cardiac damage (suggested by the Q wave) creates a risk profile where the benefits of aspirin therapy likely outweigh the bleeding risks.
Some key points to consider when recommending aspirin therapy for this patient include:
- The patient's age and presence of diabetes and hypertension put them at increased cardiovascular risk 1
- Aspirin has been shown to be effective in reducing cardiovascular morbidity and mortality in high-risk patients with diabetes 1
- The potential adverse effects from bleeding should be weighed against the potential benefits of aspirin therapy, and the patient should be monitored regularly for any signs of bleeding 1
- The patient should take aspirin with food to minimize gastrointestinal irritation
It is essential to note that the patient's physician should perform a comprehensive cardiovascular risk assessment and consider other factors such as bleeding risk, other medications, and overall health status before initiating aspirin therapy 1. If prescribed, this preventive therapy should be continued indefinitely unless complications develop or medical circumstances change.
From the FDA Drug Label
Ask a doctor or pharmacist before use if you are taking a prescription drug for: Gout, Diabetes, Arthritis The patient is taking diabetic medication, so according to the label, they should ask a doctor or pharmacist before use of aspirin.
- The patient's age, a1c level, hypertension, and potential q wave EKG are not directly addressed in the label.
- There is no direct information in the label to support a decision to take daily aspirin in this case. The FDA drug label does not answer the question.
From the Research
Patient Profile
- Age: 65 years
- A1c: 7
- Diabetic medication: yes
- Hypertension: yes
- Potential Q wave EKG: yes
- No known MI history: yes
Aspirin Therapy Considerations
- The decision to recommend aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) should be based on the patient's ASCVD risk level 2
- The American College of Cardiology and the American Heart Association recommend low-dose aspirin for primary prevention of ASCVD among select adults aged 40 to 70 years who are at higher ASCVD risk but not at increased risk for bleeding 2
- Patients with advanced subclinical atherosclerosis may benefit from preventive aspirin therapy, especially if they do not have significant bleeding risks 3
- The benefit-to-risk ratio of aspirin use in primary prevention is debated, and the decision to prescribe aspirin should be based on an individualized assessment of both benefits and harm 4
Bleeding Risks
- Dual antiplatelet therapy is associated with a significantly increased risk of major and minor bleeding events compared to single agent therapy 5
- The use of prasugrel versus clopidogrel and a low baseline hemoglobin are risk factors associated with bleeding in patients on triple antithrombotic therapy 6
- The choice of oral anticoagulant does not impact bleeding rates in patients on triple antithrombotic therapy 6
Recommendations
- Assess the patient's ASCVD risk level and consider their individual characteristics, such as age, diabetes status, and hypertension 2, 3
- Evaluate the patient's bleeding risk and consider their individual characteristics, such as hemoglobin level and use of other antithrombotic agents 5, 6
- Consider the patient's preferences and values when making a decision about aspirin therapy 2, 4