Case Report
Aspirin for prophylaxis of venous thromboembolism
Chloe Ting,1 Leonardo P. de Carvalho,1, 2 Mark Y. Chan1, 2
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Abstract
Objectives:Cessation of vitamin K antagonists (VKA) after a primary incidence of spontaneous venous thromboembolism (VTE) has been associated with recurrent events in about one-fifth of patients. Although long-term continuation of VKA prophylaxis has been suggested as a means to prevent recurrent VTE, concerns remain over issues of high bleeding risk, patient non-compliance as well as dosage irregularities. Antiplatelet therapy has been proposed as a safer, cheaper and more convenient alternative for long-term prophylaxis after initial treatment with VKA following VTE. Here we compare two major randomized trials that were conducted back-to-back – the WARFASA trial and the ASPIRE trial – to determine the role of aspirin as a long-term treatment option to reduce the incidence of recurrent VTE. Despite the encouraging results of these trials, suggesting that aspirin may have a beneficial effect on secondary prevention of VTE, it must be emphasized that both trials only started aspirin after 6-18 months of treatment with VKA, which remain a cornerstone of management for a first unprovoked VTE.
Correspondence to Mark Y. Chan, Associate Professor
Yong Loo-Lin School of Medicine, National University of Singapore
1E, Kent Ridge Road, NUHS Tower Block, Level 9, Cardiac Department, Singapore 119228
Tel: +65 67725596 Fax: +65 68722998
Email: mark_chan@nuhs.edu.sg
Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
Supplementary Material
Nil
Â
References
1.Kearon C. Long-Term Management of Patients After Venous Thromboembolism. 2004; 110 (9 suppl 1): I-10-I-18. Available from: https://​circ.​ahajournals.​org/​content/​110/​9_​suppl_​1/​I-10.​full [Accessed 3 Apr 2014].
2. Jaff, Michael R, M Sean Mcmurtry, Stephen L Archer, Mary Cushman, Neil Goldenberg, Samuel Z Goldhaber, J Stephen Jenkins, Jeffrey A Kline, Andrew D Michaels, Patricia Thistlethwaite and Others. “Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension A Scientific Statement From the American Heart Association.” Circulation, 123. 16 (2011): 1788–1830. Print.
3. Quintero-Gonz\’Alez, JA. “[Fifty years of clinical use of warfarin].” Investigacion clinica, 51. 2 (2010): 269–287. Print.
4. S, Ercock P, Counsell C, Tseng M, Cecconi E. Oral antiplatelet therapy for acute ischaemic stroke. status and date: New search for studies and content updated (no change to conclusions), published in. 2014; (3).
5. S-Orensen H, Mellemkj-Aer L, Blot W, Nielsen G, Steffensen F, Mclaughlin J, Olsen J. Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin. The American journal of gastroenterology. 2000; 95 (9): 2218–2224. CrossRef
6. Becattini C, Agnelli G, Schenone A, Eichinger S, Bucherini E, Silingardi M, Bianchi M, Moia M, Ageno W, V, Elli M, Others. Aspirin for preventing the recurrence of venous thromboembolism. New England Journal of Medicine. 2012; 366 (21): 1959–1967.
7. Becattini C, Agnelli G, Pr, Oni P, Silingardi M, Salvi R, Taliani M, Poggio R, Imberti D, Ageno W, Pogliani E, Others. A prospective study on cardiovascular events after acute pulmonary embolism. European heart journal. 2005; 26 (1): 77–83.
8. Brighton T, Eikelboom J, Mann K, Mister R, Gallus A, Ockelford P, Gibbs H, Hague W, Xavier D, Diaz R, Others. Low-dose aspirin for preventing recurrent venous thromboembolism. New England Journal of Medicine. 2012; 367 (21): 1979–1987. PubMed  CrossRef
9. Brighton T, Eikelboom J, Mann K, Mister R, Gallus A, Ockelford P, Gibbs H, Hague W, Xavier D, Diaz R, Others. Low-dose aspirin for preventing recurrent venous thromboembolism. New England Journal of Medicine. 2012; 367 (21): 1979–1987. PubMed CrossRef
10. Jaff, Michael R, M Sean Mcmurtry, Stephen L Archer, Mary Cushman, Neil Goldenberg, Samuel Z Goldhaber, J Stephen Jenkins, Jeffrey A Kline, Andrew D Michaels, Patricia Thistlethwaite and Others. “Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension A Scientific Statement From the American Heart Association.” Circulation, 123. 16 (2011): 1788–1830. Print.
11. Sardar P, Chatterjee S, Mukherjee D. Efficacy and safety of new oral anticoagulants for extended treatment of venous thromboembolism: systematic review and meta-analyses of randomized controlled trials. Drugs. 2013; 73 (11): 1171–1182. PubMed CrossRef
About this Article
Title
Aspirin for prophylaxis of venous thromboembolism
Open Access
Available under Open Access
Journal
>>Â 22:1
Online Date
21 November 2019
DOI
10.7603/s40602-014-0009-x
Online ISSN
2315-4551
Publisher
ASEAN Federation of Cardiology
Additional Links
>> About The AHJ
Topics
Cardiology
Keywords
Aspirin
Antiplatelet Therapy
High Bleeding Risk
Aspire Study
Aspire Trial
Author Affiliations
1. Yong Loo-Lin School of Medicine, National University of Singapore, Singapore, Singapore
2. National University Heart Centre, Singapore, Singapore
Correspondence to:
Mark Y. Chan,mark_chan@nuhs.edu.sg
Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
Supplementary Material
Nil
Â
References
1.Kearon C. Long-Term Management of Patients After Venous Thromboembolism. 2004; 110 (9 suppl 1): I-10-I-18. Available from: https://​circ.​ahajournals.​org/​content/​110/​9_​suppl_​1/​I-10.​full [Accessed 3 Apr 2014].
2. Jaff, Michael R, M Sean Mcmurtry, Stephen L Archer, Mary Cushman, Neil Goldenberg, Samuel Z Goldhaber, J Stephen Jenkins, Jeffrey A Kline, Andrew D Michaels, Patricia Thistlethwaite and Others. “Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension A Scientific Statement From the American Heart Association.” Circulation, 123. 16 (2011): 1788–1830. Print.
3. Quintero-Gonz\’Alez, JA. “[Fifty years of clinical use of warfarin].” Investigacion clinica, 51. 2 (2010): 269–287. Print.
4. S, Ercock P, Counsell C, Tseng M, Cecconi E. Oral antiplatelet therapy for acute ischaemic stroke. status and date: New search for studies and content updated (no change to conclusions), published in. 2014; (3).
5. S-Orensen H, Mellemkj-Aer L, Blot W, Nielsen G, Steffensen F, Mclaughlin J, Olsen J. Risk of upper gastrointestinal bleeding associated with use of low-dose aspirin. The American journal of gastroenterology. 2000; 95 (9): 2218–2224. CrossRef
6. Becattini C, Agnelli G, Schenone A, Eichinger S, Bucherini E, Silingardi M, Bianchi M, Moia M, Ageno W, V, Elli M, Others. Aspirin for preventing the recurrence of venous thromboembolism. New England Journal of Medicine. 2012; 366 (21): 1959–1967.
7. Becattini C, Agnelli G, Pr, Oni P, Silingardi M, Salvi R, Taliani M, Poggio R, Imberti D, Ageno W, Pogliani E, Others. A prospective study on cardiovascular events after acute pulmonary embolism. European heart journal. 2005; 26 (1): 77–83.
8. Brighton T, Eikelboom J, Mann K, Mister R, Gallus A, Ockelford P, Gibbs H, Hague W, Xavier D, Diaz R, Others. Low-dose aspirin for preventing recurrent venous thromboembolism. New England Journal of Medicine. 2012; 367 (21): 1979–1987. PubMed  CrossRef
9. Brighton T, Eikelboom J, Mann K, Mister R, Gallus A, Ockelford P, Gibbs H, Hague W, Xavier D, Diaz R, Others. Low-dose aspirin for preventing recurrent venous thromboembolism. New England Journal of Medicine. 2012; 367 (21): 1979–1987. PubMed CrossRef
10. Jaff, Michael R, M Sean Mcmurtry, Stephen L Archer, Mary Cushman, Neil Goldenberg, Samuel Z Goldhaber, J Stephen Jenkins, Jeffrey A Kline, Andrew D Michaels, Patricia Thistlethwaite and Others. “Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension A Scientific Statement From the American Heart Association.” Circulation, 123. 16 (2011): 1788–1830. Print.
11. Sardar P, Chatterjee S, Mukherjee D. Efficacy and safety of new oral anticoagulants for extended treatment of venous thromboembolism: systematic review and meta-analyses of randomized controlled trials. Drugs. 2013; 73 (11): 1171–1182. PubMed CrossRef
About this Article
TitleJournal >>Â 22:1
Online Date
DOI
Publisher
Topics
Keywords
Author Affiliations
Correspondence to: