Why We Still Use Aspirin 33 years Later

November 12, 2016

On the Shoulders of Giants

The wonder drug that works wonders
There was an early understanding that platelet plugs may be responsible for angina and MI.  Turns out that was correct!  This RCT in 1983 with ~1200 veterans, half with placebo and half with aspirin (ASA) 324mg daily, found a 51% reduction in the incidence of death or MI and is the reason ASA use is the cornerstone of treatment for acute coronary syndromes.

Spoon Feed
ASA is still, 33 years later, one of the most effective treatments in patients with acute coronary syndrome.  Wiki Journal Club has a great summary.

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Abstract

N Engl J Med. 1983 Aug 18;309(7):396-403.

Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina. Results of a Veterans Administration Cooperative Study.

Lewis HD Jr, Davis JW, Archibald DG, Steinke WE, Smitherman TC, Doherty JE 3rd, Schnaper HW, LeWinter MM, Linares E, Pouget JM, Sabharwal SC, Chesler E, DeMots H.

Abstract

We conducted a multicenter, double-blind, placebo-controlled randomized trial of aspirin treatment (324 mg in buffered solution daily) for 12 weeks in 1266 men with unstable angina (625 taking aspirin and 641 placebo). The principal end points were death and acute myocardial infarction diagnosed by the presence of creatine kinase MB or pathologic Q-wave changes on electrocardiograms. The incidence of death or acute myocardial infarction was 51 per cent lower in the aspirin group than in the placebo group: 31 patients (5.0 per cent) as compared with 65 (10.1 per cent); P = 0.0005. Nonfatal acute myocardial infarction was 51 per cent lower in the aspirin group: 21 patients (3.4 per cent) as compared with 44 (6.9 per cent); P = 0.005. The reduction in mortality in the aspirin group was also 51 per cent–10 patients (1.6 per cent) as compared with 21 (3.3 per cent)–although it was not statistically significant; P = 0.054. There was no difference in gastrointestinal symptoms or evidence of blood loss between the treatment and control groups. Our data show that aspirin has a protective effect against acute myocardial infarction in men with unstable angina, and they suggest a similar effect on mortality.

PMID: 6135989 [PubMed – indexed for MEDLINE]