Before many operations, ASA must therefore be discontinued in good time so that uncontrollable bleeding does not occur on the operating table. Nevertheless, patients should not simply omit the tablets on their own initiative. This, in turn, reports Hamburg researchers led by the anesthesiologist Lili Plümer, can trigger a rebound effect that suddenly increases the risk of a heart attack by more than 60 percent.
Healthy seniors should not be treated preventively with ASA
Most of them didn’t seem to know this and were all too careless about ASD, write internist Alan Jacobsen and his team in the journal “Journal of the American Heart Association”: “Many patients can hardly estimate their ten-year cardiovascular risk and know it Risks, advantages and the role of ASA in prevention.« Nevertheless, almost half of those surveyed took the drug for primary prophylaxis.
»A fit pensioner who does sport regularly, eats healthily and has no family problems does not have to take ASS«(Sven Poli, neurologist)
Although an estimated one billion people around the world regularly take ASA: in Germany there is restraint. “If the risk of a heart attack is high, it can make sense to take a platelet inhibitor to prevent it,” says Sven Poli, Deputy Medical Director of the Neurological Clinic with a focus on neurovascular diseases at the University Hospital in Tübingen. The neurologist is co-author of the guideline for secondary prophylaxis, but cannot recommend comprehensive primary prophylaxis with ASA: “We always have to weigh up the risks and benefits. Because ASA inhibits clotting, it can prevent heart attacks, that’s true. But to prevent just one case, you have to treat more than 300 patients in purely mathematical terms.« The risk of internal bleeding, which increases with age, is not worth treating healthy seniors without previous illnesses with ASA as a preventive measure: »A fit pensioner who does sports regularly, eats healthily and has no family history does not have to take ASS. His risk of a heart attack is lower than the risk of bleeding.«
What was not clear for a long time: The protective effect of the standard dose decreases drastically from a body weight of 70 kilograms, as a study by Peter Rothwell and others from Oxford shows. Armin Grau, first chairman of the German Stroke Society, said in a press release: »Around 80 percent of all men and half of all women weigh more. We have to assume that a great many people are underserved in terms of primary and secondary prophylaxis.«
ASA does not prolong a healthy life
The fact that preventive ASA consumption is viewed critically today is thanks to various larger studies that have downright disenchanted the myth of the prophylactic pill in recent years: In 2014, Japanese scientists led by internist Yasuo Ikeda stopped their investigation of 15,000 older people prematurely, because those who took ASA hardly had fewer heart attacks, but more bleeding.
The two large studies ASCEND and ARRIVE also confirmed only a marginal effect of ASA for prophylaxis. And the ASPREE study, for which a large research team led by epidemiologist John McNeil examined more than 19,000 people from Australia and the USA, showed that ASA does not prolong a healthy life. “There were only very slight differences between the test groups with aspirin and those with placebo.” What’s more: the risk of death even rose slightly under ASA, which according to the German Society for Cardiology – Heart and Circulatory Research “a debacle”.