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Should Senior Citizens Take Aspirin Daily to Prevent Heart Attacks or Strokes?
More than one-half of Americans age 45 to 75 years take aspirin daily to prevent a stroke or a heart attack.1 Nearly half of US adults 75 years and older take daily aspirin even though they do not have a history of stroke or heart attack; they take it for the primary prevention of cardiovascular disease.2 Half of these individuals had discussed this with a physician.1 IS this a good or a bad idea? And how did the controversy surrounding the use of aspirin to prevent cardiovascular disease get started?
Source: The American Journal of Medicine - April 13, 2021 Category: General Medicine Authors: James E. Dalen, Robert J. Goldberg, Anna Waterbrook, Laura Wylie, Joseph S. Alpert Tags: Commentary Source Type: research

Should Senior Citizens Take Aspirin Daily to Prevent Heart Attacks or Strokes??
More than one-half of Americans aged 45 to 75 years take aspirin daily to prevent a stroke or a heart attack.1 Nearly half of American adults 75 years and older take daily aspirin even though they do not have a history of stroke or heart attack; they take it for the primary prevention of cardiovascular disease.2 Half of these individuals had discussed this with a physician.1 Was this a good or a bad idea? And how did the controversy surrounding the use of aspirin to prevent cardiovascular disease get started?
Source: The American Journal of Medicine - April 13, 2021 Category: General Medicine Authors: James E. Dalen, Robert Goldberg, Anna Waterbrook, Laura Wylie, Joseph S. Alpert Tags: COMMENTARY Source Type: research

Embolic stroke of undetermined source: Gateway to a new stroke entity?
Embolic stroke of unknown source is currently thought to represent a subpopulation of cryptogenic strokes defined by its embolic stroke pattern on imaging and if after a carefully performed diagnostic evaluation, a specific, well recognized cause of stroke has not been identified. The concept was primarily established to justify and enable the conduct of the Embolic Stroke of Unknown Source (ESUS)-trials, such as RESPECT-ESUS (Randomized, Double-Blind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate versus Acetylsalicylic Acid in Patients with ...
Source: The American Journal of Medicine - April 1, 2020 Category: General Medicine Authors: Wolf-R üdiger Schäbitz, Martin Köhrmann, Peter D. Schellinger, Jens Minnerup, Marc Fisher Tags: Review Source Type: research

Cholangiocarcinoma manifesting as non-bacterial thrombotic endocarditis in a young patient
A 41-year-old female with steroid-dependent rheumatoid arthritis and a recent (four months prior) cerebellar stroke presented with complaints of constant headache and right eye blindness of one day.  At the time of the cerebellar stroke, she had presented with persistent headaches, dizziness and gait instability. That workup, including hypercoagulability evaluation, was unremarkable apart from the radiographic abnormalities diagnosing her left medial cerebellar hemisphere infarct. She was disc harged with a plan for outpatient loop recorder placement and aspirin for secondary stroke prevention.
Source: The American Journal of Medicine - January 23, 2020 Category: General Medicine Authors: Ninad Nadkarni, Young Ju Lee, Ryan Hoefen, Richard Alweis Tags: Diagnostic Dilemma Source Type: research

The Anti-Platelet Anomaly: Aspirin/Dipyridamole-Induced Acute Pancreatitis
We present a case of aspirin/dipyridamole-induced pancreatitis in an elderly patient. There was no other evidence suggesting any other etiology of pancreatitis for this patient. According to the Naranjo Adverse Drug Reaction Probability Scale, the association of pancreatitis is a probable reaction due to aspirin/dipyridamole.2 Although rare, this severe complication illustrates how physicians and clinical pharmacists should be aware of the risk of pancreatitis with aspirin/dipyridamole and the consequences regarding secondary stroke prevention after it occurs.
Source: The American Journal of Medicine - November 17, 2019 Category: General Medicine Authors: Daniel J. DeSantis, Punam B. Patel, Ludmila Gerova, Derek W. Grady Tags: Diagnostic Dilemma Source Type: research

Novel Oral Anticoagulants
Abstract: Warfarin has a proven record as an oral anticoagulant; almost every study, however, has found that it is not prescribed for 40–60% of patients who are eligible and should receive it, and of those who do receive it, serum warfarin levels only achieved a time in therapeutic range (TTR) equal to INR 2–3 about 55–60% of the time (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). This means that only about 1 in 4 patients are adequately anticoagulated with warfarin, and thus there is a large unmet need for achieving better anticoagulation in these patients. Although...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: James A. Reiffel Tags: CME multimedia activities Source Type: research

A ‘Posterior Circulation Stroke’ that Benefits from Vitamins
A 75-year-old woman was admitted for somnolence and confusion. She had been treated for hypertension and hyperlipidemia. One year before, she had been hospitalized for a mild right ataxic hemiparesis attributed to a lacunar stroke and received aspirin 100 mg/day. For the past 6 months, she regularly complained about gastric discomfort and bloating, which was attributed to the aspirin intake. As a consequence of her gastric problems and her decreasing appetite, her food intake was very limited. During a call, 24 hours before admission, she complained about nausea and vomiting for the past 2 days; she felt dizzy and staggere...
Source: The American Journal of Medicine - December 13, 2013 Category: Journals (General) Authors: Theodoros Karapanayiotides, Athanasia Anastasiou, Nikolaos Barmpas, Nikolaos Grigoriadis, Dimitrios Karacostas Tags: Clinical communications to the editor Source Type: research

NSAID Use and Association with Cardiovascular Outcomes in Outpatients with Stable Atherothrombotic Disease
Abstract: Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin have been linked to heart failure, salt retention, adverse ventricular remodeling, and thrombosis. We therefore sought to assess their impact on cardiovascular events in outpatients with stable atherothrombotic disease.Methods: We analyzed 44,095 patients in the REduction of Atherothrombosis for Continued Health (REACH) registry with information on NSAID use and 4-year follow-up. Cox proportional hazard models, including NSAID use as a time-dependent covariate, were constructed and adjusted for key baseline characteristics. End points of...
Source: The American Journal of Medicine - November 25, 2013 Category: Journals (General) Authors: Payal Kohli, Ph. Gabriel Steg, Christopher P. Cannon, Sidney C. Smith, Kim A. Eagle, E. Magnus Ohman, Mark J. Alberts, Elaine Hoffman, Jianping Guo, Tabassome Simon, Emmanuel Sorbets, Shinya Goto, Deepak L. Bhatt, REACH Registry Investigators Tags: Clinical research studies Source Type: research

Aspirin in the Treatment and Prevention of Cardiovascular Disease: Past and Current Perspectives and Future Directions
Abstract: In secondary prevention among a wide range of patients who have survived a prior occlusive vascular event, as well as during acute myocardial infarction and acute occlusive stroke, aspirin produces statistically significant and clinically important reductions in the risk of subsequent myocardial infarction, stroke, and vascular death. In primary prevention, aspirin reduces risk of a first myocardial infarction, but the data on stroke and vascular deaths remain inconclusive. In addition, the average absolute risk of subjects randomized in the primary prevention trials was so low that it is not possible to get rel...
Source: The American Journal of Medicine - March 15, 2013 Category: Journals (General) Authors: Charles H. Hennekens, James E. Dalen Tags: Reviews Source Type: research