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Posts Tagged ‘aspirin’

 

An Aspirin a Day Keeps Breast Cancer Away?

Wednesday, November 5th, 2014

By Lauren Haines, Pharm.D. student

According to the American Cancer Society, one in eight U.S. women will develop breast cancer in their lifetime.1 Breast cancer involves cancer cells forming a tumor in the breast tissue. Risk factors include: women ages 65 and older, inherited genetic mutations, two or more close relatives diagnosed at an early age, postmenopausal obesity, use of combined estrogen and progestin menopausal hormones, cigarette smoking, alcohol consumption, and women who breastfed for a long time. Currently, breast cancer is treated with surgery, radiation therapy, systemic therapy, chemotherapy, hormone therapy, and targeted therapy. Treatment with surgery is the most common and involves removing cancer from the breast to determine the disease severity. However, other methods may also be used to kill the cancer cells such as chemotherapy and radiation. These methods have many side effects that women must choose to endure to treat their cancer, including increased risk of uterine cancer, pain, hair loss, nausea, vomiting, fatigue, increased risk of infections, and depression.1

A new method researchers are evaluating to help prevent death from breast cancer is the use of aspirin. In a recent article by Michelle Holmes and colleagues, researchers evaluated the relationship between aspirin use and breast cancer survival. Researchers identified women newly diagnosed with breast cancer and then assigned them one of three groups, which were either to not receive any daily dose (75mg to 160mg depending on where it was bought) of aspirin, receive less than one daily dose of aspirin, or receive one or more daily doses of aspirin. Patients were followed throughout the study, for up to five and a half years, to determine if they died from breast cancer. When the women taking at least one daily dose of aspirin were compared to those not taking any aspirin in the last six months of the study, there was about a 4% decreased risk of death from breast cancer in the women taking the aspirin. However, the women taking less than a daily dose compared to those not taking any aspirin had about a 3% increased risk of death from breast cancer. The limitations of this study included that aspirin could be bought over-the-counter, so anybody could buy it without pharmacy record; low dosages were only available through prescriptions; and researchers lacked additional clinical data on breast cancer characteristics and treatment.2

Although using aspirin is still being researched to determine its effect on breast cancer patients, it may be a good option for women aside from standard treatment options. Current methods involve aggressive strategies to destroy breast cancer and prevent future cases, which must be authorized by a doctor or surgeon.  Aspirin is available over-the-counter, which would provide easy access for patients who can’t receive other types of treatment. However, aspirin does have side effects of its own that patients should be aware of, including: nausea, vomiting, stomach pain, and heart burn. Aspirin can also cause decreased blood clotting, which may cause increased bleeding. Also, aspirin shouldn’t be used during pregnancy, and it has many drug interactions with blood pressure, water, and blood thinner medications.3

Although the previous article doesn’t provide clear evidence that aspirin decreases death from breast cancer, other articles support its conclusions. In another article, researchers tested the effect of aspirin used with tamoxifen, a prescription drug used to treat breast cancer, to determine if the combination of the medications helped with the treatment. Researchers found that aspirin helped balance blood protein levels when used with tamoxifen, which improved treatment. However, research showed an increased risk of bruising and upset stomach with aspirin and tamoxifen therapy.4 Other research evaluated the use of aspirin while also using beta-blockers and ACE inhibitors, common drugs used to promote breast cancer patient survival.5 Results showed the use of aspirin with these drugs helped promote the survival process versus the use of the drugs without aspirin by increasing survival rate by more than 50%.5 Evidence also showed the use of aspirin greatly reduced the risk of developing breast cancer in women.6 However, the use of ibuprofen (Advil) and acetaminophen (Tylenol) didn’t reduce breast cancer risk like aspirin did. Ibuprofen had a slight reduction in breast cancer risk, but acetaminophen had no relationship with it. Aspirin especially showed a reduction in postmenopausal women.6 Research on the frequency of aspirin use and potential breast cancer diagnosis concluded that women using aspirin more than six times a week had a 23% decreased risk of developing breast cancer and was not associated with altering hormones.7

Thus, aspirin may be an appropriate choice for women with a high risk of developing breast cancer and women who have been diagnosed with it previously. Aspirin doesn’t require a prescription, so patients can easily buy it usually at a lower cost than many prescription medications. However, patients should consult their primary care physicians before taking aspirin to ensure they are not taking other medications that would interact with it, and that aspirin has potential to help them. Patients should also receive additional advice from loved ones to ensure they support their decision to use aspirin.  With both a decreased risk in developing breast cancer and an increased promotion of breast cancer survival, aspirin may be a good option for women.

Would you recommend aspirin to a friend diagnosed with breast cancer or who may have a risk of developing breast cancer?

 

References

 

  1. American Cancer Society- Breast Cancer. http://www.cancer.org/breastcancer/index. Updated 2014. Accessed October 3, 2014.
  1. Holmes MD, Olsson H, Pawitan Y, et al. Aspirin intake and breast cancer survival – a nation-wide study using prospectively recorded data in sweden. BMC Cancer. 2014;14(1):1150-1165.
  1. Aspirin. Aspirin: MedlinePlus Drug Information Web site. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682878.html#side-effects. Updated 2014. Accessed October 3, 2014.
  1. Holmes CE, Jasielec J, Levis JE, Skelly J, Muss HB. Initiation of aspirin therapy modulates angiogenic protein levels in women with breast cancer receiving tamoxifen therapy. CTS: Clinical & Translational Science. 2013;6(5):386-390.
  1. Holmes MD, Hankinson SE, Feskanich D, Chen WY. Beta blockers and angiotensin-converting enzyme inhibitors’ purported benefit on breast cancer survival may be explained by aspirin use. Breast Cancer Res Treat. 2013;139(2):507-513.
  1. Chung CT. Association of frequency and duration of aspirin use and hormone receptor status with breast cancer risk. Women’s Oncology Review. 2004;4(4):279-281.
  1. Bardia A, Olson JE, Vachon CM, et al. Effect of aspirin and other NSAIDs on postmenopausal breast cancer incidence by hormone receptor status: Results from a prospective cohort study. Breast Cancer Res Treat. 2011;126(1):149-155.

Can Aspirin Eventually Replace Warfarin?

Friday, October 31st, 2014

by Kristin Lessig, PharmD Candidate

For patients that have experienced serious trauma, surgical procedures, long periods of bed rest, or have taken certain oral forms of birth control, there is an increased risk for a condition known as deep vein thrombosis (DVT).  Deep vein thrombosis (DVT) is a blood clot that most commonly forms within the deep veins of the legs. This clot can become dislodged from the vein and eventually make its way into the lung where it can become stuck in a pulmonary artery and result in serious complications. 1

One of the primary treatments for DVT is to prescribe a medication that acts as a blood thinner so that the blood cannot form clots that block the blood vessels. These types of medications are known as anticoagulants, with one of the most commonly used anticoagulants being a medication known as warfarin. This medication works by blocking the mechanism that initiates blood clotting. 1 However, warfarin tends to interact with many different medications, and warfarin also tends to make the blood so thin that it is difficult to stop any internal or external bleeding. 1, 2

U.S. News recently published a report discussing the possibility of using over-the-counter aspirin to help treat DVT.3 The news report stated that many patients who take warfarin generally take the medication long enough for the blood clot to be destroyed and then as a preventative measure to keep another clot from forming. 3 Most patients only take warfarin for approximately 6 months because while taking warfarin, it is necessary to have frequent doctor appointments and blood tests to determine if a change in dose is needed. Since many patients do not wish to continue taking warfarin for extended periods of time, physicians need to utilize some other form of treatment that will bring about better results and be easier for the patient to follow.

Recent studies have revealed that aspirin may actually be an efficient treatment for DVT since aspirin also works to thin the blood like warfarin does. Aspirin acts as a blood thinner by blocking the production of certain enzymes that cause blood platelets to clot together. 4 Prospective studies and randomized control trials have been performed in order to determine if aspirin was able to prevent the formation of another blood clot in patients who had previously suffered from DVT. In addition, these studies observed the effects of 100mg aspirin versus a placebo on myocardial infarction (heart attack), stroke, major bleeding, and cardiovascular death. 3, 5 As a result of these studies, it was shown that aspirin was more effective than the placebo at decreasing the risk of DVT by approximately 42%. 4,5 It is very important to realize, however, that these studies showed a serious limitation because they did not show the effects of treatment of DVT with aspirin alone. Instead, the studies focused on the effects of aspirin on DVT after the patient had already taken a much stronger anticoagulant medication. Therefore, it is necessary for a patient who has been diagnosed with DVT to seek a doctor’s approval before beginning self-treatment with aspirin. While these studies have shown that aspirin is capable of blood-thinning properties and can significantly decrease the risk of DVT recurrence, aspirin is not as strong as warfarin or other anticoagulant medications. 5

Based on the evidence from the studies, it is easy to see that a new and potentially more patient-friendly treatment for DVT is evolving. Using over-the-counter aspirin as a blood-thinner to prevent another blood clot from forming is potentially a safer option since the patient won’t experience as many drug interactions as they would if they were on warfarin. Also, taking aspirin instead of warfarin can be easier and more cost effective for the patient. The patient would not have to go to the physician as often for testing and dose changes, therefore giving the patient a more consistent treatment as well as cutting down on medical costs. If an individual has previously suffered from a DVT, I would highly recommend meeting with the physician to discuss the option of possibly using aspirin as a precaution against a second DVT.

Do you think it is wise for people to self-treat a fairly serious condition with over-the-counter aspirin instead of seeing their physician frequently?

 

References:

  1. Obalum DC, Giwa SO, Adekoya-Cole T, Ogo CN, Enweluzo GO. Deep vein thrombosis: Risk factors and prevention in surgical patients. West Afr J Med. 2009; 28(2):77-82.
  1. Aspirin’s role in preventing recurring deep vein blood clots. Mayo Clin Health Lett. 2013; 31(5):4-4.
  1. Reinberg, S. Study: Aspirin Might Work Instead of Warfarin for Deep Vein Clots. U.S. News Website. http://health.usnews.com/health-news/articles/2014/08/26/study-aspirin-might-work-instead-of-warfarin-for-deep-vein-clots. Published August 26, 2014. Accessed October 4, 2014.
  1. Cossetto DJ, Goudar A, Parkinson K. Safety of peri-operative low-dose aspirin as a part of multimodal venous thromboembolic prophylaxis for total knee and hip arthroplasty. J Orthop Surg (Hong Kong). 2012; 20(3):341-343.
  1. Simes J, Becattini C, Agnelli G, et al. Aspirin for the prevention of recurrent venous thromboembolism: The INSPIRE collaboration. Circulation. 2014; 130(13):1062-1071.

 

Is Aspirin a Viable Option for the Prevention of Dementia?

Saturday, December 7th, 2013

by Nick Daniels, PharmD student

Dementia is one of the most prevalent health issues facing the elderly today. The disease state is characterized as a decline in memory or thinking skills severe enough to reduce a person’s ability to perform everyday activities.1 It is heavily correlated with Alzheimer’s in that 60 to 80% of those affected by the disease also suffer from dementia.1 One study estimates that 13.9%, which accounts for roughly 3.4 million people, of the population in the United States who are 71 years of age or older are affected by the disease with numbers increasing steadily as they progressed in age, with it ultimately effecting over 37% of the population older than 90.2 The severity of the symptoms associated with dementia, and its prevalence among the elderly, makes it a critical problem for which a preventative solution must be found.

The article, “Aspirin may Prevent Dementia and Cancers, World’s Largest Study Shows” published by ABC News discusses how researchers working in Australia are trying to do just that. The study, involving the participation of over 15,000 healthy Americans and Australians aged over 70, is using aspirin as a preventative agent to stop the development of the disease state through a suppression of stroke incidence.3 Researchers involved with the ASPREE study are using the aspirin in this case in an effort to keep constant the flow of blood to all areas in the brain in hopes of preventing tissue necrosis, microinfarcts, caused by ischaemic stroke.3 Tissue necrosis in the brain would result in reduced ability to think thereby causing advancement in dementia.3 Researchers began this double blind clinical trial in January of 2010 and they are expecting a reliable primary outcome measure by August of 2016.4 This sample is expected to be the most large scale available in regards to measuring aspirin preventative outcomes for dementia.5

While the aforementioned study into this area seems promising given the proven cardiovascular benefits of moderate aspirin usage and the study’s statistical power provided by its large sample size, I would advise caution to patients looking to dive headfirst into this type of preventative plan thinking it will be the guaranteed answer to solving the problem of dementia. To this point there is just not enough of a sample base to prove that the benefits of aspirin usage for the prevention of stroke outweigh the negatives, such as stomach bleeding and increased risk of massive stroke due to advanced movement of blood through the brain, associated with the medication.6 Hopefully the study currently being conducted can bring to light the answers to some of these questions. To this point, being so early on in the study, only the initial speculation by the researchers is available.

Without further evidence that validates the effectiveness of aspirin use in the prevention of dementia I cannot recommend its use for this indication. A previous study done by the NHMRC Psychiatric Epidemiology Research Centre in Australia tracking aspirin’s potential in use for preventing dementia actually found no difference between control and study groups.In cross-sectional data obtained in the study, those who had been taking NSAIDs or aspirin performed no better on the cognitive tests after account had been taken of other confounding variables.7

There are a few reasons behind the questionable results of some of these studies. The most important is they fail to acknowledge that stroke related dementia is only a portion of the larger problem of dementia as a whole.1 As was mentioned previously, up to 80% of all cases of dementia can be related to the development of Alzheimer’s which is different than the microinfarct dementia addressed by these studies.1 Many articles, like the one published by ABC, have the potential to heavily exaggerate the applicability of research being done. This could serve to mislead the public into adopting preventative strategies that could be ineffective, and at worst detrimental to their health. Also, the sample size in the NHMRC study is much smaller which could affect its validity in comparison to the larger study currently being conducted. Results from the larger study should give a more accurate representation of the medication’s effectiveness. I feel the ASPREE study also limits itself through a constrained diversity of ages. It would be more advantageous to begin the study using individuals who were much younger than 70 in order to reasonably ensure that patients had not already experienced some of the symptoms of dementia onset.

As health care professionals it is important to spread awareness in regards to dementia and the potential benefits, or shortcomings, of various preventative measures. Do you believe the limited base of evidence available for aspirin usage in the prevention of dementia is enough to warrant its use for this indication? What future do you believe the medication has in the prevention, or treatment, of neurodegenerative diseases?

References

[1] What is Dementia? Available at: http://www.alz.org/what-is-dementia.asp. Published June 28, 2013. Accessed December 2, 2013

[2] Plassman BL, Langa KM, Fisher GG, et al. Prevalence of dementia in the United States: the aging, demographics, and memory study. Neuroepidemiology. 2007;29(1-2):125-32

[3] Ogilvie, Felicity. Aspirin may Prevent Dementia and Cancers, World’s Largest Study Shows. ABC News. http://mobile.abc.net/news/2013-11-28/aspirin-may-prevent-dementia-cancers-world-largest-study-shows/5122836. Published November 28, 2013. Accessed December 3, 2013.

[4] Nelson M, http://clinicaltrials.gov/show/NCT01038583. Accessed December 6, 2013.

[5] ASPREE Study. Available at: http://www.aspree.org/AUS/aspree-content/aspree-study-details/about-aspree.aspx. Accessed December 6, 2013.

[6] Paikin JS, Eikelboom JW. Cardiology patient page: Aspirin. Circulation. 2012;125(10):e439-42.

[7] Henderson AS, Jorm AF, Christensen H, Jacomb PA, Korten AE. Aspirin, anti-inflammatory drugs and risk of dementia. Int J Geriatr Psychiatry. 1997;12(9):926-30.

Another possible health benefit to taking Aspirin?

Wednesday, November 20th, 2013

By Brittany Santee, PharmD Student, Cedarville University

Aspirin is one of the most used drug worldwide, and this usage has been going on for centuries. It is most known for treating pain, inflammation, and cardiovascular disease.1 Aspirin has been used by many because of it’s ability to reduce the chance of having a heart attack due to it’s anti-platelet activity.2 The American College of Chest Physicians recommends people who reach 50 years old or older who do not have cardiovascular disease should take a daily low dose aspirin.3 But this might not be the only way aspirin can save lives.

Recently Yahoo News posted an article about a study done in Sweden published by the British Journal of Cancer.4 The study looked at how low dose aspirin use affects cancer characteristics. Colorectal, lung, prostate, and breast cancer patients were studied and their cancer progression was recorded as well as if they regularly used aspirin. The patients’ tumor size and progression were then compaired based on regular aspirin use.5

There are some considerations to take when thinking about taking aspirin daily. First, it interacts with the absorption of many vitamins and food substances. Alcohol should not be taken with this medication. If any kind of heart medication is taken, a primary care physician should be consulted because many of these interact with aspirin both in how it is absorbed and how it works. Aspirin may cause stomach ulcers or stomach pain in 6 to 31% of patients.6

So now the question is whether the study done shows enough evidence to start taking a daily dose of aspirin. Looking at the data for metastasis in the lung cancer, it would take treating around 14 people with low dose aspirin to have no distant metastasis (M0) instead of presenting with cancer that has spread to other areas of the body(metastasis-M1). Overall there was around a 20-30% reduction in the odds of metastasis among aspirin users across lung cancer.  The data from the colorectal cancer is very similar.5 The evidence is less clear with hormone based cancers such as prostate and breast cancer, in these patients the study actually shows that tumor progression and tumor size were greater in the patients who were on a low dose of aspirin.  This finding was not statistically significant and compounded by low sample size in the aspirin users group.5 Overall the evidence presented is not something to panic about, further studies are needed to determine if low dose aspirin effects tumor progression and metastasis.

Studies have consistently found aspirin to be beneficial in many different health conditions, but the problem with aspirin is that there are can be serious side effects if it is not used carefully under medical supervision. This limits the studies done because aspirin can’t be given to certain groups in the population. In general the scientific community is aware of the wide range of health benefits that come from regularly taking aspirin. Because the lack of evidence from this study, I would not recommend taking a daily dose of aspirin to lower the risk of tumor progression.

 

References

 

1. Fuster V, Sweeny J. Aspirin: A Historical and Contemorary Therapeutic Overview. 2011. 123(7): 768-778. Avaliable from: http://circ.ahajournals.org/content/123/7/768.full.pdf+html. Accessed October 27, 2013.

2. Centre for Reviews and D. Collaborative meta‐analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients (Structured abstract). Bmj [serial online]. 2002;324:71-86. Available from: Database of Abstracts of Reviews of Effects, Ipswich, MA. Accessed November 18, 2013.

3. Guyatt GH, Akl EA, Crowther M, et al, “Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines,” Chest, 2012, 141(2 Suppl):7-47.

4. Aspirin tied to smaller lung and colon cancer tumours. Yahoo News[serial online]. August 21, 2013:Available from: http://news.yahoo.com/aspirin-tied-smaller-lung-colon-cancer-tumors-130628628.html. Accessed October 27, 2013.

5. Jonsson F, Yin L, Lundholm C, Czene K, Pawitan Y, Smedby K. Low-dose aspirin use and cancer characteristics: A population-based cohort study. British Journal Of Cancer [serial online]. October 1, 2013;109(7):1921-1925. Available from: Scopus®, Ipswich, MA. Accessed October 27, 2013.

6. Lexi-Comp, Inc. (Lexi-DrugsTM). Lexi-Comp, Inc.; November 1, 2013.

7. Berardi RR, Kroon LA, McDermott JH et al. Handbook of nonprescription drugs, an interactive approach to self-care. APhA Publications; 2006.