Re: aspirin toxcic?

[Guest guest]

"to prevent stroke and systemic embolism, and to patients with a history of stroke or transient ischaemic attack to prevent further ischaemic events."

I've found that if I am having a terrible time with myoclonic attacks that aspirin helps alot. I have noticed though that everyt

There is now strong evidence in this issue of the BMJ from yet anothersystematic review of randomised trialsthat this may not necessarily be so (p 1183).9 These authors tested therisk of gastrointestinal haemorrhage fromlong term (average duration 28 months) treatment with subanalgesic dosesof aspirin used for preventingischaemic events. There were two main results. Firstly, gastrointestinalhaemorrhage occurred on average in2.5% of patients exposed to aspirin compared with 1.4% who were not;this difference was statisticallysignificant. Secondly, there was no evidence of dose responsiveness overa wide range of doses (50 to 1500mg/day). How do these numbers compare with others, and what are theimplications?A previous systematic review reported a considerably lower incidence ofgastrointestinal bleeds withnon-steroidal anti-inflammatory drugs including aspirin, and there wasevidence of dose-responsiveness forbleeds that were related to aspirin.8 The difference between the twometa-analyses is probably due to differentdefinitions of adverse events. For instance, in the physician's healthstudy,1 a large randomised trial included inboth meta-analyses, 8 9 of 11 037 patients given aspirin 325 mg everyother day for 60 months, as many as 3.6%had symptoms of haematemesis or melaena. This was the level of harm thatDerry and Loke were extractingfor the purpose of their systematic review.9 Using this definitionthroughout, the number needed to harm forhaemorrhage with aspirin compared with placebo was about 100, and therewas a lack of dose responsiveness.9However, in the same randomised trial 10 times fewer patients takingaspirin (0.34%) had a potentially fatalhaemorrhage compared with those taking a placebo.1 Using this moreserious level of harm, there was evidenceof dose responsiveness8: the incidence of serious bleeds (andperforations) was 0.3% with 325 mg aspirin everyother day for 60 months,1 0.6% with 1 g/day for 36 months,10 and 0.9%with 2.5-5.2 g/day for two months.11An earlier meta-analysis has also shown a consistent tendency (althoughnot statistically significant) for asmaller risk of gastrointestinal bleeds with smaller doses of aspirin(<300 mg/day).12The results of these meta-analyses are not contradictory butcomplementary. 8 9 12 Indeed, the most importantmessage in Derry and Loke's paper is that there is no gain without pain.And as with many systematic reviews,their's leaves more questions open than it answers. Thus, the researchagenda is set: Who should be given whatdose of aspirin, and for how long? In patients with a history of strokeor transient ischaemic attack, the minimaleffective dose of aspirin to prevent further vascular accidents remainsunknown.13 Nor do we know how longpatients have to take aspirin. In the prevention of recurrent strokeaspirin seems to be of benefit independent ofthe patient's age.5 However, in elderly patients with atrialfibrillation the benefit of prophylactic aspirin to preventstrokes is unproved.4 Also the risk of both gastrointestinalcomplications and perhaps congestive heart failurewith non-steroidal anti-inflammatory drugs may increase with increasingage. 14 15Finally, there is a methodological message. Derry and Loke analysed datafrom almost 66 000 patientschronically exposed to a wide range of different doses of aspirin. It isunlikely that the same body of data wouldever be tested in a single randomised controlled trial. Innovativemodels are needed to estimate rare events withconfidence, and systematic reviews currently provide the best solution.In the light of Derry and Loke'sanalyses, it may be more appropriate for some people to eat an applerather than an aspirin a day.6 R Tramèr, staff anaesthetist.Division of Anaesthesiology, Geneva University Hospitals, CH-1211 Geneva14, Switzerland (martin.tramer@...) 1. Steering Committee of the Physician's Health Study Research Group.Final report on the aspirin component of the ongoing physicians' health study. N Engl J Med1989; 321: 129-135[Medline]. 2. The RISC Group. Risk of myocardial infarction and death duringtreatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease.Lancet 1991; 336: 827-830. 3. ISIS-2 (Second International Study of Infarct Survival)Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; 336: 349-360. 4. Preliminary report of the stoke prevention in atrial fibrillationstudy. N Engl J Med 1990; 322: 863-868[Medline]. 5. Chen ZM, Sandercock P, Pan HC, Counsell C, R, Liu LS, et al.Indications for early aspirin use in acute ischemic stroke. A combined analysis of 40,000 randomizedpatients from the Chinese Acute Stroke Trial and the International Stroke Trial. Stroke 2000; 31:1240-1249[Abstract/Full Text]. 6. Dalen JE. An apple a day or an aspirin a day? Arch Int Med 1991;151: 1066-1068[Medline]. 7. Henry D, Lim LLY, Rodriquez LAG, Gutthann SP, Carson JL, M,et al. Variability in risk of gastrointestinal complications with individual non-steroidalanti-inflammatory drugs: results of a collaborative meta-analysis. BMJ 1996; 312: 1563-1566[Medline]. 8. Tramèr MR, RA, Reynolds DJ, McQuay HJ. Quantitative estimationof rare adverse events which follow a biological progression: a new model applied to chronicNSAID use. Pain 2000; 85: 169-182[Medline]. 9. Derry S, Loke YK. Risk of gastrointestinal haemorrhage withlong-term use of aspirin: meta-analysis. BMJ 2000; 321: 1183-1187[Abstract/Full Text]. 10. Kurata JH, Abbey DE. The effect of chronic aspirin use on duodenaland gastric ulcer hospitalizations. J Clin Gastroenterol 1990; 12: 260-266[Medline]. 11. Roth S, Agrawal N, Mahowald M, Montoya H, Robbins D, S, etal. Misoprostol heals gastroduodenal injury in patients with rheumatoid arthritisreceiving aspirin. Arch Intern Med 1989; 149: 775-779[Medline]. 12. Roderick PJ, Wilkes HC, Meade TW. The gastrointestinal toxicity ofaspirin: an overview of randomised controlled trials. Br J Clin Pharmaco 1993; 35: 219-226[Medline]. 13. ES, Lanes SF, Wentworth III CE, Satterfield MH, Abebe BL,Dicker LW. A Metaregression analysis of the dose-response effect of aspirin on stroke. Arch IntMed 1999; 159: 1248-1253[Medline]. 14. Hawkey CJ. Non-steroidal anti-inflammatory drugs and peptic ulcers.Facts and figures multiply, but do they add up? BMJ 1990; 300: 278-284[Medline]. 15. Page J, Henry D. Consumption of NSAIDs and the development ofcongestive heart failure in elderly patients. Arch Int Med 2000; 160: 777-784[Medline].SheenaLive Life to the YoungestThe Being Sick CommunityVisual problems with colors?Click the link below and select the modify link to your right. Then select the **Send Plain Text Email** option. This will stop you receiving emails with colored or enlarged fonts. Members Lounge:-Photo Album, memorial page, members profiles, birthdays, locations, medical resources, counselling via email, and a whole bunch of free things.http://www.elderwyn.com/members Message Archives and Digest Attachment Pictures:-messages/Chat:- Scheduled Daily Chats at # on IRC DALnet.chat.htmlSharing our resources:-Add a website URL you have found useful. 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[Guest guest]

Hate it when my email sends itself lol..

Was going to say that I had noticed that when I've been admitted to hospital on the forms it always asks if you have taken aspirin.

Is anyone here on aspirin constantly?

Love Aisha

[Guest guest]

At 02:01 PM 11/19/2000 +1100, you wrote:

>Hate it when my email sends itself lol..

>

>Was going to say that I had noticed that when I've been admitted to

>hospital on the forms it always asks if you have taken aspirin.

>

>Is anyone here on aspirin constantly?

>Love Aisha

Aisha,

I take two 81mg (baby aspirin) per day (as recommended by my GP and

Cardiologist), and take aspirin for kidney stone pain (two 325mg tablets at

a time, every four hours or until it gets really bad and I need something

stronger), and for headaches.

Owner of Kidney Stones E-Mail List:

A support group for people with kidney stones.

http://www.smartgroups.com/groups/kidneystones

or mailto:kidneystones-subscribe@...

E-Mail: mailto:tabco@...

Web Page: http://www.bee.net/tabco/

Net Pager: http://wwp.mirabilis.com/3106983

ICQ # 3106983

[Guest guest]

Aisha Hi there

I take one low dose adult asprin everyday. For the rest of me life, says the

Dr.

Nothing new here, just the usual frustrations. Trying to get some issuses

worked out with the warden. Don;t know how it's going to go. Physically I'm

doing much better The Imuran really seems to be working. I have more

interest in things around me. I am doing sometings that I couldn't do

before. I'm walking around the house more. I get u p every hour or two and

walk. Still having trouble with the vision but working on it.

I'm going for the changes too. Hope that you are doing as well as you want

to. I love you so much and want the best for you.

Great Big Hugs

Grandma Hen Carolyn

[Guest guest]

Hi Aisha,

I'm new to the list but I wanted to put my hand up to taking aspirin daily. It was recommended to me to take a quarter of an aspirin a day when I was diagnosed with Diabetes. Diabetes and heart problems tend to go together so the aspirin is a sort of preventative measure.

Looking forward to getting to know everyone!

anneI believe that friends are quiet angels who lift us to our feet when our wings have trouble remembering how to fly.

Is anyone here on aspirin constantly?

Love Aisha

[Guest guest]

Carolyn

Not to be nosey, but what are you taking Imuran for?

[Guest guest]

anne,

Welcome to the group, you do have your hands full by the sounds of it. You

will find a lot of support and information here. Feel free to put your 2

cents in anytime.

Welcome

[Guest guest]

Hello

I have Myasthenia Gravis, High blood pressure, Lung disease, heart disease,

diabetes, divirticulities. I am taking the Imuran to replace prednisone as

soon as I can be weaned off it for tthe myasthenia gravis. We have been

trying differrent combinations of meds. for over a year . We're hoping for

success this time.

Hugs

Carolyn