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Role of aspirin debated

SHARJAH - Al Zahra Hospital in its monthly lecture held at Radisson Sas Hotel on Monday discussed "The role of new anti-platelet agents in management of acute coronary syndrome." The speaker was Dr Nadir Ali, Director of Cardiac Catheterisation Laboratory Veterans Affairs Hospital, Houston, Texas, and Prof. of Medicine, Baylor College of Medicine, Houston, Texas.

"This new group of medicines has revolutionised treatment of heart attacks and has helped save lives and also makes balloon angioplasty procedures safe," Dr Ali told Khaleej Times. In his presentation, Dr Ali talked about the utility and potency of aspirin in non-Q-wave MI&Untable Angin.

He also discussed in detail the concept of aspirin resistance and questioned its existence.

He said that there was absolute benefit of aspirin in primary prevention of vascular disorders for which aspirin is effective with a minimum dose. Dr Ali also presented the studies of Robert G. Hart, MD and Michael J.G. Harrison on the optimal dose of aspirin to prevent stroke. According to the study, "the best existing clinical evidence supports the concept that 75 mg/d aspirin is effective for stroke prevention and that higher doses may offer no additional protection."

However, he added that there are some loose ends. In the double-blind Dutch TIA Trial, epistaxis and minor non-gastrointestinal bleeding occurred twice as often in patients given 283 mg/d versus 30 mg/d aspirin.

Dr Ali also outlined the aspirin resistance syndrome which describes a number of different phenomena including failure to protect individuals from thrombotic complications - (stroke, MI or CV death), failure to cause a prolongation of the bleeding time; or inhibit platelet aggregations (in PRP), failure to produce (or a failure to) an anticipated effect on one or more invitro tests of platelet function. He presented the case of aspirin resistance and the actual findings.

He said that the apparent discrepancy between the theoretical predictions originating from studies of aspirin resistance and the actual findings of approximately 50 randomised clinical trials of aspirin prophylaxis in high-risk patients can be reconciled by acknowledging the limitations of platelet function studies.

The meeting was chaired by Prof. Dr Abhay K. Pande, Consultant Interventional Cardiologist at the Al Zahra Hospital. He showed coronary angiograms showing the balloon angioplasty done using these new agents.

He said that most modern treatment is available at the doorstep for the patients in the UAE for half the cost of overseas treatment. The presentation was sponsored by GlaxoSmithKline.