Why do I enjoy the overturning of conventional wisdom? I guess I have a form of schadenfreude. Here goes another one – Aspirin 'only for heart patients'
Low-dose aspirin is widely used to prevent further episodes of cardiovascular disease in people who have already had problems such as a heart attack or stroke.
This approach – known as secondary prevention – is well-established and has confirmed benefits.
But many thousands of people in the UK are believed to be taking aspirin as a protective measure before they have any heart symptoms.
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Between 2005 and 2008, the DTB said four sets of guidelines were published recommending aspirin for the "primary prevention" of cardiovascular disease – in patients who had shown no sign of the disease.
These included people aged 50 and older with type 2 diabetes and those with high blood pressure.
But the DTB said a recent analysis of six controlled trials involving a total of 95,000 patients published in the journal the Lancet does not back up the routine use of aspirin in these patients because of the risk of serious gastrointestinal bleeds and the negligible impact it has on curbing death rates.
This represents a classic example of the risks exceeding the benefits. We thought of low dose aspirin as a benign method to decrease coronary thrombi. We were wrong – even 1 low dose aspirin each day provides a high bleeding risk. I was wrong, and so were the experts.
I stopped taking aspirin after the first of these studies reached print. Now I must modify my teaching.
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This will be a tough change. I fight this battle regularly in clinic with rather modest success. I was an "early adopter" of this, but was routinely overruled by attendings. Still am.