Boston—Which patients who have not already had a heart attack or stroke should take a low-dose aspirin as a preventative measure?
That is a difficult question that usually requires an individualized answer, according to a new study in JAMA Internal Medicine. It emphasizes that the risk of taking low-dose aspirin to prevent or delay a first heart attack or stroke must be balanced with the increased risk of gastrointestinal or other bleeding.
Now, in an effort to help healthcare professionals and patients make informed decisions about aspirin use, researchers at Brigham and Women’s Hospital developed a new, free, mobile app, “Aspirin-Guide” that calculates both the cardiovascular disease (CVD) risk score and the bleeding risk score for the individual patient. Clinicians can use it to help decide which patients are appropriate candidates for the use of low-dose aspirin (75 to 81 mg daily).
“We developed the Aspirin-Guide app because we realized that weighing the risks and benefits of aspirin for individuals who have not had a heart attack or stroke is a complex process,” lead author Samia Mora, MD, said in a Brigham and Women’s press release. “The new mobile app enables individualized benefit to risk assessment in a matter of seconds while the patient is with the physician.”
After a review of 11 trials involving more than 118,000 patients, results indicate that both the net ASCVD benefit and the bleeding risk of aspirin therapy increased as the absolute ASCVD risk increased, although benefits generally exceeded risks at higher baseline ASCVD risk scores such as 10% or greater over a decade.
“Balancing the benefit of ASCVD reduction with the risk of bleeding from low-dose aspirin is difficult but essential for informed decision making and achieving a net clinical benefit from aspirin for primary prevention,” Mora and co-author JoAnn Manson, MD, cardiovascular epidemiologist and Chief of Preventive Medicine, conclude.
In addition to the CVD and bleeding risk score information, the mobile app does the following:
• uses evidence from the literature, together with the risk scores, to compare the number needed to treat versus the number needed to harm;
• helps clinicians to implement current clinical guidelines for low-dose aspirin in primary prevention;
• provides the ability to email a summary of the decision-making process to the patient and/or to the clinician for the patient’s record.
“Aspirin-Guide is a user-friendly clinical decision support tool that will facilitate informed and personalized decision-making about the use of aspirin in primary prevention of CVD. Patients should discuss the pros and cons of aspirin treatment with their healthcare provider,” Manson said.
The free Aspirin-Guide mobile app, developed for iPhones and iPads, became available at the Apple app store on June 20.
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