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February 2005, Volume 35 Number 2 , p 20 - 20





  • Focus on risky patients

  • Is your patient sticking to the plan?

  • How to intervene


    MANY PATIENTS with cardiovascular disease are prescribed aspirin therapy for its antiplatelet effects—usually 75 to 325 mg daily unless contraindicated. Inexpensive and readily available, aspirin is a very effective antiplatelet medication; research has shown that it can reduce the risk of recurrent heart attack or stroke by up to 25%. But not all patients receive the intended benefits.

    When you care for a patient on aspirin therapy, assess him carefully to determine if it's working for him. If you suspect that he has resistance to the drug, he may require a change in his treatment plan.

    Focus on risky patients

    A patient who has a thrombotic event despite aspirin therapy is considered to have clinical aspirin resistance. Learning which factors put a patient at risk for aspirin resistance may help you intervene before he suffers an adverse event. Risk factors documented by research include:

    * certain medications , especially nonsteroidal anti-inflammatory drugs (NSAIDs), which can interfere with the cardioprotective effects of aspirin. Regular use of NSAIDs competitively blocks aspirin's antiplatelet actions. Closely evaluate patients with chronic pain, who may be taking an NSAID.

    * cigarette smoking , which enhances platelet function and stimulates platelet aggregation, interfering with aspirin therapy. Encourage your patients who smoke to quit.

    * certain surgical procedures , including coronary artery bypass graft (CABG) surgery performed with cardiopulmonary bypass and ventricular assist device (VAD) implantation. Aspirin resistance is most significant for these patients within the first 5 days post-CABG and the first 6 weeks post-VAD implantation. The reasons these surgeries contribute to aspirin resistance may ...

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