ACC 2013: Most U.S. physicians prescribe high-dose aspirin for acute heart attack patients

March 10, 2013 – Nearly 80 percent of hospitals studied had cardiac patients on high-dose aspirin.

Physicians in the United States are more likely to prescribe high-dose aspirin to acute heart attack patients, according to the results of a new study presented Sunday morning at a late-breaking clinical trial session at the 2013 Scientific Sessions of the American College of Cardiology in San Francisco.

The DCRI’s Ying Xian, PhD; Tracy Wang, MD, MHS; Eric Peterson, MD, MPH; and researchers from other institutions conducted the study, which was based on data from the TRANSLATE-ACS (Treatment with ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome) study.

TRANSLATE-ACS was designed to evaluate the long-term outcomes of acute coronary syndrome patients treated with percutaneous coronary intervention (PCI). More specifically, the TRANSLATE-ACS researchers are interested in learning how physicians choose between approved medications; what factors influence patients’ adherence to prescribed medication regimens; and the actual effectiveness, safety, and health care costs of antiplatelet therapy.

Aspirin has a long history as an antiplatelet treatment for cardiac patients. Despite this, the optimal dose of aspirin has never been definitively established. For this study, the researchers compared the difference in outcomes between acute heart attack patients given high-dose aspirin versus low-dose aspirin. They examined patient data from 8,760 patients who experienced an acute heart attack and underwent PCI at 221 U.S. hospitals between 2010 and 2012.

The researchers found that nearly 80 percent of hospitals had at least half of their patients on higher-dose aspirin. Overall, two-thirds of the patients received high-dose aspirin, and these patients were more likely to be older, have suffered a previous heart attack or stroke, or have diabetes. Low-dose aspirin patients were also more likely to receive bare-metal stents and second-generation adenosine diphosphate receptor inhibitors such as prasugrel or ticagrelor.

The researchers also found no significant difference in the rates of major adverse cardiac events between the low-dose and high-dose aspirin groups. High-dose aspirin patients were at a slightly increased risk of bleeding, though this result only narrowly missed the threshold of statistical significance.

“It really doesn’t seem as though high-dose aspirin confers any benefit to the patient in this observational study,” Wang said. “However, it may be associated with more bleeding, so physicians should consider this when prescribing aspirin to their patients.”