Güncel Kılavuzlara Göre Aspirinin Birincil Korunmadaki Rolü: Aile Hekimleri için Öneriler

Öz

Hastaların kolaylıkla ulaşabileceği birinci basamak sağlık kuruluşlarının öncüsü olan aile hekimleri, "Primum non nocere" ilkesi ile yarar-zarar ilişkisini değerlendirerek birincil veya ikincil koruma için uygun endikasyonu olan hastalara aspirin önermelidir. Türkiye'de birinci basamakta yapılan çalışmalarda aterosklerotik kardiyovasküler hastalıkların birincil korunmasında aspirinin akılcı olmayan ve uygunsuz kullanımı söz konusudur. Aspirinin kardiyovasküler hastalıkların primer önlenmesinde, kolorektal kanser insidansının azaltılmasında, bazı onkoloji ilaçlarının tromboz riskini artırmasına bağlı korunmada ve gebelik komplikasyonlarından korunmada rolü vardır. Güncel kılavuzlara ait öneriler, birincil korunmada aspirin kullanımı konusunda aile hekimlerine rehber olacaktır.

Anahtar Kelimeler

• aspirin
• primer korunma
• aile hekimliği
• rehber

The Role of Aspirin in Primary Prevention According to Current Guidelines: Recommendations for Family Physicians

Öz

Family physicians, who are the leaders of primary health care institutions that patients can access easily, should recommend aspirin to patients with suitable indications for primary or secondary protection by evaluating the benefit-harm relationship via the principle of "Primum non nocere". Studies which were conducted in Turkish primary care settings mentioned that there is an irrational and inappropriate use of aspirin in the primary prevention of atherosclerotic cardiovascular diseases. Aspirin has a role in the primary prevention of cardiovascular diseases, in reducing the incidence of colorectal cancer, in protection related to increased thrombosis risk by some oncology drugs, and in protection from pregnancy complications. Recommendations from current guidelines will lead the way to family physicians regarding the use of aspirin.

Anahtar Kelimeler

• aspirin
• primary prevention
• family practice
• guideline

Kaynakça

1. 1. The European Definition of General Practice / Family Medicine, WONCA EUROPE 2023 Edition [Internet]. Available from: https://www.woncaeurope.org/file/41f61fb9-47d5-472184e603f4afa6588/WONCA_ European_Definitions_2_v7.pdf [Cited 09 Jan 2024] 2. Kisling LA, M Das J. Prevention strategies. Treasure Island (FL): StatPearls [Internet]. Publishing; 2023 Jan. [Updated 2023 Aug 1]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537222/ [Cited 09 Jan 2024]
2. 3. Çelik O, Çil C. Aterosklerotik hastalığın primer korumasında aspirin kullanımının uygunluğu: ASSOS çalışmasının altgrup analizi. Medical Journal of Mugla Sitki Kocman University 2021 Apr;8(1):43-46. doi:10.47572/muskutd.857550 [In Turkish]
3. 4. Bulca Acar A, Özen M. Aile hekimliği polikliniğine başvuran hastalarda aspirin kullanımının değerlendirilmesi. Cukurova Medical Journal 2021 Sep;46(3):1026-1032. doi:10.17826/cumj.907395. [In Turkish]
4. 5. Ponir C, Seals A, Caldarera T, Ip EH, German CA, Taylor Y, et al. Specialty preference for cardiovascular prevention practice in the Southeast US and role of a preventive cardiologist. Postgrad Med J. 2023;100(1179):42-49. doi:10.1093/postmj/qgad082
5. 6. Hira RS, Gosch KL, Kazi DS, Yeh RW, Kataruka A, Maddox TM, et al. Potential impact of the 2019 ACC/AHA guidelines on the primary prevention of cardiovascular disease recommendations on the inappropriate routine use of aspirin and aspirin use without a recommended indication for primary prevention of cardiovascular disease in cardiology practices: insights from the NCDR PINNACLE registry. Circ Cardiovasc Qual Outcomes. 2022;15(3):e007979. doi:10.1161/CIRCOUTCOMES.121.007979
6. 7. Christensen MB, Jimenez-Solem E, Ernst MT, Schmidt M, Pottegård A, Grove EL. Low-dose aspirin for primary and secondary prevention of cardiovascular events in Denmark 1998-2018. Sci Rep. 2021;11(1):13603. Published 2021 Jun 30. doi:10.1038/s41598-021-93179-8
7. 8. Ong SY, Chui P, Bhargava A, Justice A, Hauser RG. Estimating Aspirin Overuse for Primary Prevention of Atherosclerotic Cardiovascular Disease (from a Nationwide Healthcare System). Am J Cardiol. 2020;137:25-30. doi:10.1016/j.amjcard.2020.09.042
8. 9. Vane JR, Botting RM. The mechanism of action of aspirin. Thromb Res 2003 June;110(5-6):255-258.

9. 10. Jack DB. One hundred years of aspirin. Lancet 1997 Aug;350(9075):437-439.
10. 11. Gibson PC. Aspirin in the treatment of vascular diseases. Lancet 1949 Dec;2(6591):1172-1174.
11. 12. Arif H, Aggarwal S. Salicylic Acid (Aspirin). Treasure Island (FL): StatPearls [Internet]. Publishing; 2023 Jan. [Updated 2023 Jul 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519032/ [Cited 30 Oct 2023]
12. 13. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA Guideline on the primary prevention of cardiovascular disease: A report of the american college of cardiology/american heart association task force on clinical practice guidelines. Circulation, 140(11), e596–e646. doi:10.1161/CIR.0000000000000678
13. 14. Pearson TA, Blair SN, Daniels SR, Eckel RH, Fair JM, Fortmann SP, et al. AHA Guidelines for primary prevention of cardiovascular disease and stroke: 2002 update: consensus panel guide to comprehensive risk reduction for adult patients without coronary or other atherosclerotic vascular diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation. 2002;106(3):388-391. doi:10.1161/01.cir.0000020190.45892.75
14. 15. Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation. 2010;121(24):2694-2701. doi:10.1161/CIR.0b013e3181e3b133
15. 16. Halvorsen S, Andreotti F, ten Berg JM, Cattaneo M, Coccheri S, Marchioli R, et al. Aspirin therapy in primary cardiovascular disease prevention: a position paper of the European Society of Cardiology working group on thrombosis [published correction appears in J Am Coll Cardiol. 2014 Nov 4;64(18):1970]. J Am Coll Cardiol. 2014;64(3):319-327. doi:10.1016/j.jacc.2014.03.049
16. 17. McNeil JJ, Wolfe R, Woods RL, Tonkin AM, Donnan GA, Nelson MR, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509-1518. doi:10.1056/NEJMoa1805819
17. 18. Visseren FLJ, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European heart journal, 42(34), 3227–3337. doi:10.1093/eurheartj/ehab484
18. 19. Abdelaziz HK, Saad M, Pothineni NVK, Megaly M, Potluri R, Saleh M, et al. Aspirin for primary prevention of cardiovascular events. J Am Coll Cardiol. 2019;73(23):2915-2929. doi:10.1016/j.jacc.2019.03.501
19. 20. Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis JAMA, 321(3), 277–287. doi:10.1001/jama.2018.20578
20. 21. Mahmoud AN, Gad MM, Elgendy AY, Elgendy IY, Bavry AA. Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials. Eur Heart J. 2019;40(7):607-617. doi:10.1093/eurheartj/ehy813
21. 22. Davidson KW, Barry MJ, Mangione CM, Cabana M, Chelmow D, Coker TR, et al. Aspirin use to prevent cardiovascular disease: US preventive services task force recommendation statement. JAMA 2022 Apr;327(16):1577-1584. doi:10.1001/jama.2022.4983
22. 23. ASCEND Study Collaborative Group, Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, Barton J, et al. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379(16):1529-1539. doi:10.1056/NEJMoa1804988
23. 24. American diabetes association professional practice committee (2022). 10. Cardiovascular disease and risk management: standards of medical care in diabetes-2022. Diabetes care, 45(Suppl 1), S144–S174. doi:10.2337/dc22-S010
24. 25. Belch J, MacCuish A, Campbell I, Cobbe S, Taylor R, Prescott R, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ. 2008;337:a1840. Published 2008 Oct 16. doi:10.1136/bmj.a1840
25. 26. De Berardis G, Sacco M, Strippoli GF, Pellegrini F, Graziano G, Tognoni G, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomised controlled trials [published correction appears in BMJ. 2010;340:c374]. BMJ. 2009;339:b4531. Published 2009 Nov 6. doi:10.1136/bmj.b4531
26. 27. Türkiye Endokrinoloji ve Metabolizma Derneği. Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu 2022. (Türkiye Endokrinoloji ve Metabolizma Derneği, Ed.) (15. baskı). Ankara: Türkiye Endokrinoloji ve Metabolizma Derneği. Retrieved from https://file.temd.org.tr/Uploads/publications/guides/documents/diabetesmellitus_2022.pdf [Cited 30 Oct 2023] [In Turkish]
27. 28. Guo C, Ma W, Drew DA, et al. Aspirin use and risk of colorectal cancer among older adults. JAMA Oncol 2021 Jan.;7(3):428–435.
28. 29. Guirguis-Blake JM, Evans CV, Perdue LA, Bean SI, Senger CA. Aspirin use to prevent cardiovascular disease and colorectal cancer: updated evidence report and systematic review for the US preventive services task force. JAMA 2022 April;327(16):1585–1597.
29. 30. Shah D, Di Re A, Toh JWT. Aspirin chemoprevention in colorectal cancer: network meta-analysis of low, moderate, and high doses. Br J Surg 2023 Jul; znad231. doi:10.1093/bjs/znad231
30. 31. Monahan KJ, Bradshaw N, Dolwani S, Desouza B, Dunlop MG, East JE, et al. Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/UK Cancer Genetics Group (UKCGG). Gut 2020 Mar;69(3):411–444.
31. 32. Seppälä TT, Latchford A, Negoi I, Sampaio Soares A, Jimenez-Rodriguez R, Sánchez-Guillén L et al. European Guidelines from the EHTG and ESCP for Lynch syndrome: an updated third edition of the Mallorca guidelines based on gene and gender. Br J Surg 2021 May;108:484–498.
32. 33. Beavers CJ, Rodgers JE, Bagnola AJ, Beckie TM, Campia U, Di Palo KE, et al. Cardio-Oncology Drug Interactions: A scientific statement from the American Heart Association. Circulation 2022 April;145(15):e811-e838. doi:10.1161/CIR.0000000000001056
33. 34. ACOG committee opinion no. 743 summary: low-dose aspirin use during pregnancy. Obstet Gynecol 2018 Jul;132(1):254-256.
34. 35. Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, et al. Aspirin use to prevent preeclampsia and related morbidity and mortality: US preventive services task force recommendation statement. JAMA 2021 Sep;326(12):1186-1191.
35. 36. Miser WF. Appropriate aspirin use for primary prevention of cardiovascular disease. Am Fam Physician 2011 Jun;83(12):1380-1386.