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CVRA guideline regarding aspirin

A message from Jo Scott-Jones, medical director.

The new CVRA guideline regarding aspirin is causing confusion on a number of levels. Some GPs are interpreting the role of aspirin in the new guidance as meaning 'no more aspirin for anyone', which is incorrect for primary prevention and especially so for secondary prevention. The 2018 guideline states the following.

  • In patients under 70 years with a five-year CVD risk of 15 per cent or greater, the benefits of aspirin may outweigh the bleeding risk and should be considered. Potential benefit (reduction in non-fatal MI and possible small net years gained) and bleeding risk must be carefully assessed and discussed during shared decision-making.
  • In patients aged over 70 years with a five-year CVD risk of 15 per cent or more, the balance of benefits and harms cannot be determined with aspirin and use is not recommended for primary CVD prevention.
  • In patients with a five-year CVD risk of less than 15 per cent, aspirin for primary prevention of CVD alone is not recommended.

Aspirin is recommended for primary prevention for people under 70 with a 15 per cent risk or greater, but subject to shared decision making. This risk/benefit tool is the best we currently have to inform this. In secondary prevention, aspirin it is still recommended whatever age people are. It confers ongoing benefit of an absolute risk reduction of 36 (+/-5) events per 1000 patients over 2 years, balanced with a 1.6-2 x increase in relative risk of a GI bleed - higher doses higher risk, this translates to 0.8- 7.2 cases of GI bleeds per 1000 patients over 2 years

Patients of course have to decide the risk/benefit ratio for themselves. 

We are also working with BPAC on changes to the common form.

For more information visit the BPAC website or contact Jo Scott-Jones, medical director.

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