Taking an aspirin each day does more HARM than good for healthy middle-aged adults because it raises their risk of major internal bleeding

• Aspirin, a blood thinner, is regularly given to healthy people in middle age
• But a study says the harms of major internal bleeding outweigh the benefits
• King's College London scientists reviewed 13 trials of 160,000 participants 

By BEN SPENCER MEDICAL CORRESPONDENT FOR THE DAILY MAIL

PUBLISHED: 16:00 GMT, 22 January 2019 | UPDATED: 19:34 GMT, 22 January 2019

Aspirin, which is a blood thinner, is regularly given to healthy people in middle age, to lower the risk of heart problems

Healthy people who take a daily aspirin to prevent heart attacks in later life may be doing more harm than good, research suggests.

Aspirin - which is a blood thinner - has for decades been given to people diagnosed with heart disease to stop heart attacks and strokes.

But many healthy people in middle age also take the pills as an 'insurance policy' against heart problems.

A major new study, which includes data from more than 160,000 people, concludes the risk of major internal bleeding significantly outweighs the benefit of aspirin among those with no history of heart disease.

The review, led by experts at King's College London, reinforces growing evidence that aspirin should no longer be used for 'primary prevention' - the term for treatment of patients who have no symptoms of heart problems.

The researchers found among healthy people, use of aspirin saw risk of heart attack or a stroke drop 11 per cent.

But the risk of bleeding went up 43 per cent.

This means that 265 people would have to take aspirin for five years to prevent a single heart attack or stroke – but one in 210 would have a major bleed.

Study leader Dr Sean Zheng, academic clinical fellow in cardiology at King's College London, said: 'This study demonstrates that there is insufficient evidence to recommend routine aspirin use in the prevention of heart attacks, strokes and cardiovascular deaths in people without cardiovascular disease.' 

CAN TAKING ASPIRIN SLASH YOUR RISK OF CANCER? 

Taking just a quarter of an aspirin tablet a day could slash the risk of bowel cancer by a fifth, a major study concluded in March 2016.

Harvard scientists found middle-aged people who regularly took the painkillers were less likely to be diagnosed with cancer of any kind.

They found the cheap pills, which cost less than 2p per tablet, are particularly effective at warding off cancers of the digestive system.

The most dramatic impact was seen for bowel cancer, with people who took aspirin every day for six years seeing their risk drop by 19 per cent.

The experts, who tracked 136,000 people for 32 years, predicted that regular aspirin use in the US could prevent 30,000 tumours a year.

The team found the picture was more complicated for patients diabetes, who are at higher risk of heart disease and who are often prescribed aspirin.

Among these patients the risk of a heart attack or stroke also dropped 11 per cent - and the risk of bleeding went up 30 per cent.

Dr Zheng said: 'There has been more uncertainty surrounding what should be done in patients who are at higher risk of cardiovascular disease and in patients with diabetes.

'This study shows that while cardiovascular events may be reduced in these patients, these benefits are matched by an increased risk of major bleeding events.

'Aspirin use requires discussion between the patient and their physician, with the knowledge that any small potential cardiovascular benefits are weighed up against the real risk of severe bleeding.'

In the past low-dose aspirin, which is very cheap, was frequently prescribed for even healthy people in middle age to reduce heart disease.

Guidelines issued by several professional health bodies between 2005 and 2008 solidified this position, recommending routine use of aspirin for people aged 50 and older with type 2 diabetes or high blood pressure.

A decade ago a series of major studies started to reveal the risk of major bleeding, and guidelines were changed to remove the formal recommendation, but many doctors still prescribe the drugs.

Experts are also concerned many the 'worried well' who take the tablets without being aware of side-effects that can include internal bleeding.

Professor Jeremy Pearson associate medical director at the British Heart Foundation said: 'Current guidelines do not recommend aspirin for people who don't already have heart and circulatory diseases.

'This is because, while aspirin reduces these people's risk of heart attacks and strokes, any benefit is outweighed by an increased risk of bleeding.

'If you have a heart attack, your doctor will usually prescribe a daily aspirin to try and prevent a second attack. In this case, the reduced risk of a second life-threatening heart attack substantially outweighs the risk of side effects, such as bleeding.

'The risk of bleeding from aspirin is likely to differ between groups of people. Further research may well uncover subsets of people where benefits do outweigh risks, paving the way for personalised treatments.'

Professor Jane Armitage of the University of Oxford, said: 'The conclusion [in this paper] reinforces the message from those trials that, for healthy people, the small benefits of aspirin in preventing strokes and heart attacks are counter balanced by increases in the risk of serious bleeding.'

https://www.dailymail.co.uk/health/article-6619267/Daily-aspirin-does-harm-good-worried-well.html

Daily low dose aspirin to prevent blood clots 'may be lethal for some over-75s'

Taking a daily low dose aspirin to prevent blood clots can be disabling or even lethal for people aged 75 and over with a history of heart attacks or strokes, scientists have warned.

By PA  13 Jun 2017, 23:32

Updated: 13 Jun 2017, 23:45

The risk of internal bleeding caused by swallowing the blood-thinning pills is far higher in this group of patients than was previously thought, new research shows.

Compared with younger patients, older aspirin users were 10 times more likely to experience disabling or fatal gastro-intestinal bleeding.

The proportion of study participants suffering bleeds requiring hospital admission rose from 1.5% per year for those under 65 to 3.5% for those aged 75 to 84, the research showed.

For very elderly patients over 85, the annual bleed rate reached 5%.

The researchers, whose findings appear in The Lancet medical journal, urged doctors to prescribe elderly patients taking daily aspirin after a stroke or heart attack proton-pump inhibitor drugs to reduce the risk of bleeding.

Professor Peter Rothwell, from Oxford University, said: "We have known for some time that aspirin increases the risk of bleeding for elderly patients. But our new study gives us a much clearer understanding of the size of the increased risk and of the severity and consequences of bleeds.

"Our findings raise questions about the balance of risk and benefit of long-term daily aspirin use in people aged 75 or over if a proton-pump inhibitor is not co-prescribed."

Proton-pump inhibitors (PPIs) are commonly used to treat heart burn by reducing levels of stomach acid.

The Oxford Vascular Study recruited 3,166 patients who had previously had a stroke or heart attack and were being prescribed blood-thinning drugs that prevent platelets - blood clotting cells - clumping together. Most were treated with aspirin.

Half the patients were aged 75 or over at the start of the study, which followed the progress of participants over 10 years. During this time, a total of 314 patients were admitted to hospital for internal bleeding.

Older patients who suffered bleeds fared worse than younger patients. The proportion of survivors experiencing a new or worse disability rose from 3% for those under 75 to a quarter for those who were older.

For patients aged 75 or older, a major gastro-intestinal bleed as a result of taking aspirin was "at least as likely" to be disabling or fatal as a recurrent stroke, said the researchers.

Proton-pump inhibitors could reduce bleeding by 70% to 90% in patients receiving long-term anti-platelet treatment, they added.

Prof Rothwell said: "While there is some evidence that long-term PPI use might have some small risks, this study shows that the risk of bleeding without them at older ages is high, and the consequences significant.

"In other words, these new data should provide reassurance that the benefits of PPI use at older ages will outweigh the risks."

The research was not able to show that the observed increase in risk was entirely due to aspirin, the scientists pointed out. But previous trials had shown that at least half the bleeds occurring while taking aspirin are caused by the drug.

The vast majority of patients taking part in the study were taking low dose (75mg) aspirin, said the researchers. Only a few were being treated with a different anti-platelet drug, clopidogrel. It was not known if the findings applied to other blood-thinning drugs.

In a linked comment published in The Lancet, German expert Professor Hans-Christoph Diener, from the University of Duisburg-Essen, wrote: "The first consequence of (this) study is that the benefit-risk association in long-term anti-platelet therapy should be evaluated every three to five years in patients older than 75 years.

"The second consequence of (the) study is its support for the need to use PPIs in patients on anti-platelet therapy aged 75 years or older or in patients with a history of gastro-intestinal bleeds."

Dr Tim Chico, consultant cardiologist at the University of Sheffield, said: "Prescription of any drug is a balance between the benefits of the medication against its risks, and aspirin is no different.

"Certainly, people should not stop their aspirin if it has been prescribed by a doctor after a stroke or heart attack, since stopping it can cause another heart attack or stroke.

"However, I would strongly recommend that people who are considering taking aspirin to prevent potential future problems such as cancer or heart attack (ie not for secondary prevention) should discuss this with their doctor."

Professor Sir Nilesh Samani, medical director at the British Heart Foundation, which co-funded the research, said: "For some patients aspirin is an important part of our armoury to prevent heart attacks and strokes. But we have known for a long time that it is associated with an increased risk of bleeding, particularly from the stomach, and this can sometimes be very serious.

"This research is an important step forward as it shows that the risk of bleeding is substantially higher in people over 75 years and that older people who require aspirin may particularly benefit from also being routinely given heartburn drugs which protect the stomach."

http://www.aol.co.uk/living/2017/06/13/daily-low-dose-aspirin-to-prevent-blood-clots-may-be-lethal-for/

Do pharmacists know enough about supplements and traditional medicines?

In the traditional sense of the words, a pharmacy is a place where medicinal drugs are sold and pharmacists are the healthcare professionals who dispense those drugs.

September 11, 2016 Health, Wellness

By TAN SHIOW CHIN

While pharmacies in hospitals and clinics usually adhere strictly to this traditional definition, most retail or standalone pharmacies tend to sell far more products than just prescription and over-the-counter medicines.

According to a study conducted by Taylor’s University School of Pharmacy associate dean (learning and quality) Penny Wong Pei Nee, nearly three out of five Malaysian pharmacies (59%) stock a large variety of complementary medicines (CMs).

Only 1% say they don’t stock any CMs at all, while the remaining 40% report that they offer a limited variety of such products.

Wong showing the Meditag hologram decoder that helps to differentiate between real and fake holograms on medicines and supplements. Photo: The Star/Rohaizat Darus

This finding is probably due to the fact that over 90% of the pharmacists participating in the study agreed or strongly agreed that such products are an important part of a retail pharmacy’s finances.

They also agreed or strongly agreed that:

• Customers now expect more information about CM products from their pharmacist compared to five years ago;

• Pharmacists have a professional responsibility to counsel customers about CM products; and

• Pharmacists should play a greater role in providing customers with safety and drug interaction information about CM products.

Over 80% also thought that pharmacists should play a greater role in recommending CM products to their customers.

Complementary medicine in this study was defined as “herbal medicines, vitamin and mineral supplements, and other nutritional supplements” that “can be bought in a supermarket, pharmacy, health-food store, on the internet, from a mail-order company or from a T&CM (traditional and complementary medicine) practitioner”.

Local usage of CM

Says Wong: “The use of complementary medicines in Malaysia generally has three purposes for consumers.

“The first one is general health maintenance, like multivitamins; (the second is) treatment and prevention of minor ailments, such as when someone has a cold or flu and are recommended echinacea or vitamin C just to boost up the immune system; and for specific serious and chronic diseases, (for example) saw palmetto, black cohosh and things like that.”

She adds that while there are no specific statistics for CM, the Health Ministry’s Health Expenditure Report 1997-2013 published last year, estimated the sales of traditional and complementary medicines to be about RM1.7 billion in 2013.

“And this is only 7% less than pharmaceutical products,” she says.

According to Wong, CM products are regulated by the ministry’s Pharmaceutical Services Division and need to be registered with the Drug Control Authority.

“A registered product would be given a hologram, and also, a registration number.

“So, all CM products will have a registration number starting with MAL, and ending with the letter T or N – T represents traditional and N represents supplements (nutritional),” she says.

She adds that most pharmacies should have the Meditag hologram decoder issued by the ministry, which can help differentiate between a genuine hologram and a fake one on all registered CM and pharmaceutical products.

image: http://www1.star2.com/wp-content/uploads/2016/09/sfitx_anr_1109_top5CM.PDF.jpg

Knowledge on CM

Sponsored by the Blackmores Institute, the study called Survey of Integration and Usage of Complementary Medicines in Pharmacy was conducted between last April and December, and involved 453 community pharmacists from around the country.

Around 47% of them were from large-chain pharmacies (i.e. consisting of more than 10 outlets, like Guardian, Watsons and Caring), 41% from pharmacy chains with less than 10 outlets, and the remainder were from independent pharmacies.

More than half of them (54%) received their bachelor’s degree locally, while the rest graduated from a mix of both Asian and Western countries, especially the United Kingdom (26%) and Australia (12%).

Wong notes that the respondents mostly agreed that pharmacists need to provide integrative care, i.e. the combination of allopathic and complementary medicines.

Around 93% of them agreed or partly agreed that their personal practice of pharmacy centred around integrative care.

The factors that prevented the remaining 7% from practising integrative care included lack of sufficient knowledge, lack of information sources, limited opportunity or insufficient time to talk to customers, the ineffectiveness of the product, and because the promotion of CM products is the responsibility of other colleagues.

Three-quarters of the pharmacists learnt about CM products on their own, 60% through seminars from the product manufacturer, 37% each through seminars from a professional association and lectures during their undergraduate course, and 7% through formal studies like certificate or postgraduate courses.

Six percent said they had no training whatsoever about CM products.

image: http://www1.star2.com/wp-content/uploads/2016/09/sfitx_anr_1109_drugcminteraction.PDF.jpg

The study also found that the top three information sources about CM products used by pharmacists were the manufacturer or brand owner’s own material or training (59%), the World Wide Web (49%), and professional seminars, conferences or lectures (43%).

The top three factors that pharmacists consider when assessing information about CM products are: whether it has a scientific basis (68%), whether it contains both traditional and scientific information (49%), and whether it has been endorsed by a professional or educational organisation (46%).

The information they provide to customers is usually sourced from books or leaflets (65%); their own knowledge (63%); textbooks, journals and the Web (59%); manufacturers or brands (50%); and feedback from other customers (42%).

Explains Wong: “So, to ensure safe use of complementary medicines or conventional medicines, when customers present with a prescription, a brief medical history should be taken by the community pharmacist to see what medications they are taking so that safe drugs can be recommended.”

The study found that nearly three-quarters of pharmacists (74%) always or often ask their customers if they take CM when they present their drug prescriptions.

Fourteen of the pharmacies also currently employ a T&CM practitioner, while a similar number said they would consider employing one.

A T&CM practitioner in this study is defined as one who is registered with the Health Ministry. However, Wong cautions that registration for such local practitioners is currently voluntary, although compulsory for foreign practitioners.

While 17% of the respondents said they would definitely not employ a T&CM practitioner, the top three factors considered most important in employing such a practitioner for those considering doing so were tertiary qualifications (65%), increasing product sales (49%) and being a member of a professional association (43%).

Advice for patients

Wong says that the most important factors for those thinking of taking a CM product are ensuring that it is a registered product and knowing how to use it.

“It is a collaborative effort between pharmacist and patient.

“We know that the pharmacist has their professional role (in educating and providing information), but sometimes, customers need to know what kind of questions they need to ask,” she says.

Some of these questions should include the optimum dose of the product (in order to achieve the optimum effect), whether it is genuine or not, and whether it will interact with whatever medications they are currently taking.

Wong says that customers should also go back to their pharmacist and report if they have any adverse effects from the CM product they consume.

http://www.star2.com/health/wellness/2016/09/11/do-pharmacists-know-enough-about-supplements-and-traditional-medicines/

Grapefruit not only food that can affect medication

Michelle Healy, USA TODAY4:26 p.m. EST January 22, 2013

Healthwise

From grapefruit to calcium to licorice, some foods and their nutrients can interfere with the way your medicines work.

(Photo: Scott Olson, Getty Images)

STORY HIGHLIGHTS

• Food and beverages can delay, decrease or enhance absorption of medication
• Dietary supplements, including vitamins and herbs, can also interact with medications
• Ask your physician and pharmacist what you should avoid when given a new prescription

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From milk and cookies to chocolate and peanut butter, some foods make a tasty combination. But attention to medical labels, and not your taste buds, is needed when combining certain foods with medications.

Milk and other calcium products, for example, can block the absorption of certain antibiotics. And eating large quantities of chocolate while taking some antidepressants can cause a sharp rise in blood pressure. Even some licorice can reduce the effects of certain blood pressure drugs and diuretics.

A recently published review in the Canadian Medical Association Journal that found an increasing number of prescription drugs could have potentially dangerous interactions with grapefruit and grapefruit juice highlights the importance of consumers being aware of possible food and drug interactions.

It's been known for some time that grapefruit juice can "both increase or decrease the absorption of a small number of drugs," says Hartmut Derendorf, chairman of pharmaceutics at the University of Florida College of Pharmacy. Derendorf was not involved in the Canadian review.

"If the drug is metabolized in the gut wall to a large extent and this metabolism is blocked, then the concentrations in the blood will go up. An example is the lipid-lowering drug simvastatin (Zocor)," says Derendorf. "For other drugs such as the antihistamine fexofenadine (Allegra), grapefruit juice blocks the uptake into the bloodstream and the concentrations in blood will go down."

In all such cases there are alternative medications available that will not interact with grapefruit and the other citrus fruits that contain furanocoumarins, the culprit behind the "grapefruit juice effect," Derendorf says. These include Seville oranges (often used in marmalade), limes and tangelos, a cross between tangerines and grapefruit. Sweet oranges, such as navel and Valencia, do not contain furanocoumarins.

There's more attention than ever before being paid to reducing interactions between food and drugs, Derendorf says, and researchers are focused on finding safe alternatives, removing the chemical compounds that cause interactions, and in some cases, changing the genetic makeup of foods so that they do not interfere with medications.

In December, a team at the University of Florida's Citrus Research and Education Center published a paper about ongoing efforts to create a grapefruit hybrid with significantly reduced interaction risk.

Concerns about the interactions between foods and drugs are not limited to prescription medications. Dietary supplements (which also include vitamins, minerals and herbs) can likewise interfere with how some medications work.

"Often, people think that herbal supplements are benign and don't have interactions, and that's absolutely false," says Christine Gerbstadt, a registered dietitian and spokesperson for the Academy of Nutrition and Dietetics. "Most supplements have the exact same chemicals and ingredients as pharmaceutical drugs but simply in a naturally occurring form or lower dose," she says.

Drugs, of course, can have negative interactions with other drugs, and the same can be true of supplements. Calcium supplements, for example, may decrease the absorption of dietary iron, which is why people at high risk for iron deficiency are encouraged to take calcium supplements at bedtime, instead of with meals.

When being prescribed any medication it's important to inform your physician of all medications you're currently taking — prescription, over-the-counter and dietary supplements — to read the patient information material that comes with the medication and to ask about potential interactions, Gerbstadt says.

"Your pharmacist and registered dietitian can also provide a wealth of information," she says. "No one person can know it all, but huge databases are available to help professionals get access to this information."

A sampling of the potential interactions between foods and medications, including some supplements, according to the Food and Drug Administration:

-- Grapefruit juice: Some statin drugs to lower cholesterol, such as simvastatin (Zocor), atorvastatin (Lipitor), and pravastatin (Pravachol); some blood pressure-lowering drugs, such as Nifediac and Afeditab ; some organ transplant rejection drugs, such as Sandimmune and Neoral (both cyclosporine); some anti-anxiety drugs, such as BuSpar (buspirone); some anti-arrhythmia drugs, such as Cordarone and Nexterone (both amiodarone); some antihistamines, such as Allegra (fexofenadine); the anti-malaria drugs Quinerva or Quinite (quinine); and Halcion (triazolam), a medication used to treat insomnia.

-- Licorice: The sweetening compound glycyrrhizin in black licorice may reduce the effects of some blood pressure drugs or urine-producing drugs including Hydrodiuril (hydrochlorothiazide) and Aldactone (spironolactone). It may increase the toxicity risks from Lanoxin (digoxin), used to treat congestive heart failure and abnormal heart rhythms.

-- Chocolate: Antidepressant Monoamine Oxidase (MAO) inhibitors (such as phenelzine (Nardil, Nardelzine) and tranylcypromine (Parnate) are just one category of drugs that shouldn't be consumed with excessive amounts of chocolate and other caffeinated foods. Caffeine can also interact with stimulant drugs such as Ritalin (methylphenidate), increasing their effect, or by decreasing the effect of sedative-hypnotics such as Ambien (zolpidem). Using bronchodilators with caffeinated foods and drinks can increase the chance of side effects, such as excitability, nervousness, and rapid heart beat.

-- Potassium-rich foods (such as bananas, oranges, and green leafy vegetables): Can add to high potassium levels in the body caused by ACE (Angiotensin Converting Enzyme) inhibitors including captopril (Capoten) and enalapril (Vasotec) prescribed to lower blood pressure or treat heart failure. Too much potassium can cause an irregular heartbeat and heart palpitations.

-- St. John's Wort (Hypericum perforatum): Can reduce concentrations of medications in the blood, including digoxin (Lanoxin), used to treat congestive heart failure and abnormal heart rhythms; the cholesterol-lowering drug lovastatin (Mevacor and Altocor), and the erectile dysfunction drug sildenafil (Viagra).

-- Vitamin E: Taken with a blood-thinning medication such as warfarin (Coumadin) can increase anti-clotting activity and may cause an increased risk of bleeding.

-- Ginseng: May increase the risk of bleeding when taken with anticoagulants (blood thinners such as warfarin and heparin). Can also increase the bleeding effects of aspirin and non-steroidal anti-inflammatory drugs such as ibuprofen, naproxen, and ketoprofen. Combined with MAO inhibitors such as Nardil or Parnate may cause headache, trouble sleeping, nervousness and hyperactivity.

-- Ginkgo biloba: High doses can decrease the effectiveness of anticonvulsant therapy in patients taking seizure-control medicines Tegretol, Equetro or Carbatrol (carbamazepine), and Depakote (valproic acid).

For more information:

-- Download Avoid Food-Drug Interactions, an online guide by the U.S. Food and Drug Administration and the National Consumers League

-- Download What You Should Know About Your Medications, an online guide by the University of Florida, Institute of Food and Agricultural Sciences

-- View the list of medications that might interact with grapefruit cited in the Canadian Medical Association Journal article

http://www.usatoday.com/story/news/nation/2013/01/20/food-drug-interactions/1827229/

Other articles of interest:

http://healthticket.blogspot.my/2012/10/grapefruit-interferes-with-medication.html

http://healthticket.blogspot.my/2012/11/grapefruit-with-some-prescription-drugs.html

http://healthticket.blogspot.my/2014/08/grapefruit-not-only-food-that-can.html

Aspirin can't help a million heart patients

Healthwise

Previous NHS advice is reversed as people with a common heart condition are told not to take aspirin to guard against stroke

By Laura Donnelly, Health Editor

10:00PM BST 17 Jun 2014

254 Comments

More than than a million people with a common heart condition have been told not to take aspirin to guard against stroke, in a reversal of previous NHS advice.

New medical recommendations warn that the pills are ineffective in reducing the danger for those suffering heart rhythm disorders and that the risk of side-effects outweighs their benefits.

Up to 7,000 strokes and 2,000 premature deaths a year could be prevented if patients were put on new drugs instead, experts said.

Until now, adults suffering from atrial fibrillation have been advised to take a daily dose of aspirin – a blood thinning drug – as the heart condition often causes clots, leading to a risk of stroke that is five times higher than in other people.

But revised guidance from the National Institute of Health and Care (Nice) says a new generation of drugs is far better than aspirin at reducing the danger for such patients and is less likely to cause side effects including internal bleeding.

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Patients are advised to seek advice from their GP before stopping their current medication, but the guidance recommends that anticoagulant drugs which prevent clots forming should be prescribed instead.

Several of the medications have only recently been recommended for NHS use, and medical advisers said thousands of lives could be saved if patients were switched to them. The advice recommends so-called “novel oral anticoagulants” including dabigatran etexilate and rivaroxaban as the best medication for those suffering from atrial fibrillation.

The condition becomes more common in later life, with one in 10 pensioners diagnosed with the disorder. It occurs when electrical impulses in the heart become jumbled, so that blood is pumped less effectively, increasing the chance of clots, which can cause strokes.

However, experts said aspirin remained the best drug for thousands of other patients, such as 1.5 million heart attack survivors, who are usually prescribed it alongside other medications, and for heart disease sufferers assessed with a high risk of stroke.

Prof Mark Baker, Nice’s director of clinical practice, called for significant changes in prescribing to save thousands of lives.

He said: “We know that around 7,000 strokes and 2,000 premature deaths could be avoided every year through effective detection and protection with anticoagulant drugs that prevent blood clots forming. Unfortunately only half of those who should be getting these drugs are.

“This needs to change if we are to reduce the numbers of people with AF who die needlessly or suffer life-changing disability as a result of avoidable strokes.”

Dr Campbell Cowan, chairman of Nice’s guideline development group, said: “Aspirin has been a bit of a smokescreen to anticoagulation. We now know it is not safer and it’s questionable whether it has any effect at all.” Nice said atrial fibrillation led to an estimated 12,500 strokes each year.

“Any stroke occurring in a patient with atrial fibrillation is a tragedy because it was preventable,” Dr Cowan said.

He said that patients with the heart problem should not take themselves off aspirin, but should make an appointment with their GP to find out which treatment is best for them.

The Nice guidelines, updated for the first time since 2006, suggest some patients with atrial fibrillation could still be given Warfarin, an earlier anti-coagulant. However, it suggests many patients will benefit from the new drugs, which need less monitoring and many of which have been introduced in this country since 2012.

Amy Thompson, senior cardiac nurse at the British Heart Foundation, said: “The new Nice guidelines reflect the growing body of evidence that warfarin and the newer anticoagulants are much more effective at preventing stroke than aspirin.

“But this does not mean aspirin is not an effective means of preventing heart attacks and strokes in other circumstances.”

The charity stressed that the advice from Nice relates specifically to the impact of aspirin on patients with atrial fibrillation, who have a high risk of clots within the heart, where anticoagulant drugs have been found to be more effective. Aspirin is still effective in reducing the risk of strokes from other causes, they stressed.

The drug is recommended by GPs for heart disease sufferers at high risk of stroke. However it is not usually advised for those assessed as low risk, because it can cause ulcers and bleeding.

The causes of atrial fibrillation are not fully understood.

The condition affects more men than women, becoming more common with age, and in those with other heart conditions such as high blood pressure or clogged arteries.

Most sufferers will have some symptoms ranging from palpitations to dizziness but as many as a third have no obvious signs of the condition, research for the new guidelines showed.

http://www.telegraph.co.uk/health/healthnews/10907673/Aspirin-cant-help-1-million-heart-patients.html

Healthwise

9 Symptoms You Should Never Ignore (2)

3. Unexplained Weight Loss

The big worries: Losing more than 5 percent of your body weight — without trying — over a period of six months could mean cancer: Weight loss is a symptom in up to 36 percent of cancers in older people. "If you or a family member is suddenly losing weight after trying 400 times before, you have to ask, 'Why is this time the charm?' " says Lichtenfeld.

What else it might be: Endocrine disorders are a common cause of unintentional weight loss. Of those with an endocrine disorder (especially hyperthyroidism, an overactive thyroid), up to 11 percent experience weight loss. The condition also triggers restlessness, sweating, increased appetite and difficulty concentrating.

If your weight loss is accompanied by extreme thirst or hunger, fatigue and frequent urination, it could be a sign of diabetes.

Gastrointestinal conditions like inflammatory bowel disease and celiac disease cause weight loss as well — in addition to symptoms such as diarrhea and abdominal pain.

Depression and other psychiatric conditions could be to blame, too. "Decreased appetite and weight loss are very common symptoms of depression," says Susan G. Kornstein, M.D., professor of psychiatry and obstetrics/gynecology at Virginia Commonwealth University. "But patients with unexplained weight loss should undergo a workup to rule out general medical causes."

Related

• Will you be ready to handle a medical emergency?
• Is it just a bad headache — or something worse?
• Manage your medical info with AARP Health Record.

4. Unusual Bleeding

The big worries: Ulcers and colon cancer can cause rectal bleeding or black or tarry stools, says Andres Pardo-Agila, M.D., a family medicine physician at the University of Texas Health Science Center at Houston. If you haven't had a colonoscopy recently, talk to your physician. Vaginal bleeding can be linked to gynecologic cancers. Bloody vomit can result from stomach or esophageal cancer, and people with lung cancer can cough up blood. "Whenever you see blood where it shouldn't be, see a doctor," says Lichtenfeld.

What else it might be: Blood in the stool may be due to hemorrhoids, while blood in the urine may be the result of a bladder or kidney infection. Vaginal bleeding long after menopause may be due to the growth of benign polyps or fibroids. Vomiting blood can result from a tear in the blood vessels or an ulcer in the stomach or esophagus. And coughing up blood can happen with noncancerous conditions, like bronchitis, pneumonia or tuberculosis. "There are many common reasons for seeing blood where you don't expect it, but it still has to be checked out and treated," Lichtenfeld advises.

5. High or Persistent Fever

The big worries: Fever is your body's way of fighting infection. But "fever of 103 degrees and higher warrants a trip to the doctor — period," says David Bronson, M.D., president of the American College of Physicians. It may indicate a urinary tract infection, pneumonia, endocarditis (inflammation of the lining of the heart chambers and valves) or meningitis, which may require antibiotics to clear up. A persistent low-grade fever — for several weeks — with no obvious cause is characteristic of some infections, including a sinus infection, and some cancers, like lymphoma and leukemia. "Cancer is on the list of things we think about, but it is usually not the first thing," says Ronan Factora, M.D., a geriatrician at the Cleveland Clinic in Ohio.

What else it might be: Fever can be triggered by a virus, which, depending on your health and other symptoms, may require hospitalization.

http://www.aarp.org/health/conditions-treatments/info-12-2012/symptoms-you-should-never-ignore.2.html