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Aspirin

Aspirin or acetylsalicylic acid is a drug in the family of salicylates, often used as an analgesic (against minor pains and aches), antipyretic (against fever), and anti-inflammatory. It has also an anticoagulant (blood-thinning) effect and is used in long-term low-doses to prevent heart attacks. more...

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Low-dose long-term aspirin irreversibly blocks formation of thromboxane A2 in platelets, producing an inhibitory effect on platelet aggregation, and this blood-thinning property makes it useful for reducing the incidence of heart attacks. Aspirin produced for this purpose often comes in 75 or 81 mg dispersible tablets and is sometimes called "Junior aspirin." High doses of aspirin are also given immediately after an acute heart attack. These doses may also inhibit the synthesis of prothrombin and may therefore produce a second and different anticoagulant effect.

Several hundred fatal overdoses of aspirin occur annually, but the vast majority of its uses are beneficial. Its primary undesirable side effects, especially in stronger doses, are gastrointestinal distress (including ulcers and stomach bleeding) and tinnitus. Another side effect, due to its anticoagulant properties, is increased bleeding in menstruating women. Because there appears to be a connection between aspirin and Reye's syndrome, aspirin is no longer used to control flu-like symptoms in minors.

Aspirin was the first discovered member of the class of drugs known as non-steroidal anti-inflammatory drugs (NSAIDs), not all of which are salicylates, though they all have similar effects and a similar action mechanism.

ASPIRIN

The brand name Aspirin was coined by the Bayer company of Germany. In some countries the name is used as a generic term for the drug rather than the manufacturer's trademark. In countries in which Aspirin remains a trademark, the initialism ASA is used as a generic term (ASS in German-language countries, for Acetylsalicylsäure; AAS in Spanish- and Portuguese-language countries, for ácido acetilsalicílico).

The name "aspirin" is composed of a- (from the acetyl group) -spir- (from the spiraea flower) and -in (a common ending for drugs at the time). Bayer registered it as a trademark on March 6, 1899.

However, the German company lost the right to use the trademark in many countries as the Allies seized and resold its foreign assets after World War I. The right to use "Aspirin" in the United States (along with all other Bayer trademarks) was purchased from the U.S. government by Sterling Drug, Inc. in 1918. Even before the patent for the drug expired in 1917, Bayer had been unable to stop competitors from copying the formula and using the name elsewhere, and so, with a flooded market, the public was unable to recognize "Aspirin" as coming from only one manufacturer. Sterling was subsequently unable to prevent "Aspirin" from being ruled a genericized trademark in a U.S. federal court in 1921. Sterling was ultimately acquired by Bayer in 1994, but this did not restore the U.S. trademark. Other countries (such as Canada) still consider "Aspirin" a protected trademark.

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Aspirin prevents stroke, but not cardiovascular disease, in women
From American Family Physician, 8/1/05 by Mark Ebell

Clinical Question: Does aspirin prevent cardiovascular disease in women?

Setting: Population-based

Study Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: Most of the data on the use of aspirin for the prevention of cardiovascular events come from studies in men. The current study represents the largest and best evidence to date for women. Women older than 45 years without a history of coronary artery disease, cerebrovascular disease, or cancer were initially enrolled in a three-month placebo run-in period to establish compliance with the study protocol. Women who complied throughout the run-in period (n = 39,876) were randomized to receive 100 mg of aspirin daily or matching placebo. They were followed for a mean of 10 years, with 97 percent complete data on morbidity and 99 percent complete data on mortality.

The mean age of participants was 55 years, and the 10-year risk of heart disease was less than 5 percent in 85 percent of the women. Groups were balanced at the start of the study, outcomes were assessed blindly, and analysis was by intention to treat. Women taking aspirin were less likely to have a stroke (1.1 versus 1.3 percent; P = .04; number needed to treat [NNT] = 444 for 10 years) or transient ischemic attack (0.9 versus 1.2 percent; P = .01; NNT = 384 for 10 years) than women taking placebo. However, there were no differences between groups in the likelihood of myocardial infarction (0.99 percent for aspirin and 0.97 percent for placebo) or death from cardiovascular causes (0.60 versus 0.63 percent), any major cardiovascular event (2.4 versus 2.6 percent), or death from any cause (3.1 versus 3.2 percent). Gastrointestinal bleeds requiring transfusion were more common in the aspirin group (0.64 versus 0.46 percent; P = .02; number needed to treat to harm [NNH] = 553 for 10 years).

The study was powered to have an 86 percent chance to detect a 25 percent reduction in the primary outcome of any major cardiovascular event. Review of the survival curve reveals a steady but small trend in favor of aspirin regarding the primary outcome. This apparent benefit, equivalent to a 5 to 10 percent relative reduction in the rate of all-cause mortality, was not statistically significant despite the large size of the study.

Bottom Line: Aspirin reduces the risk of stroke and transient ischemic attack in women, but does not reduce the risk of myocardial infarction or cardiovascular death. The reduction in strokes over 10 years (NNT = 444) must be balanced against an increase in serious gastrointestinal bleeding (NNH = 553). No change regarding all-cause mortality was seen in this large, long study. (Level of Evidence: 1b)

Study Reference: Ridker PM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med March 31, 2005;352:1293-304.

Used with permission from Ebell M. ASA prevents stroke, not MI, in women. Accessed online June 1, 2005, at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2005 Gale Group

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