Summary
According to metaanalysis and the results of the two studies with the highest power, aspirin is effective in primary prevention of coronary heart disease. These beneficial effects, however, are at least partially out-weight by unwanted effects—such as intense gastrointestinal bleeding and hemorrhagic stroke. These side effects remain constant with increasing risk of coronary heart disease, whereas the protective effects increase. If an annual risk of coronary heart disease of ≤0.6% exists, aspirin is normally not indicated; for a risk of 0.7–1.4% the facts should be discussed with the patient. If a risk of ≥1.5% exists, aspirin should be given.
Problems of aspirin therapy—such as “aspirin paradox” and “aspirin resistance”—have been documented for secondary prevention; they might, however, have likewise clinical implications in primary prevention.
Zusammenfassung
In der Metaanalyse sowie nach den Ergebnissen der beiden Studien mit der höchsten Power zeigt Aspirin einen protektiven Effekt in der Primärprävention der koronaren Herzerkrankung. Dieser günstigen Wirkung stehen unerwünschte—wie stärkere gastrointestinale Blutungen oder hämorrhagische Schlaganfälle—entgegen. Diese bleiben jedoch mit steigendem koronarem Herzerkrankungsrisiko konstant, während die protektiven Effekte zunehmen. Bei einem jährlichen KHK-Risiko von 0,6% ist deshalb die Indikation für die Gabe von Aspirin in der Regel nicht gegeben; bei einem Risiko von 0,7–1,4% sollte die Problematik mit dem Patienten besprochen werden. Bei einem Risiko ≥1,5% sollte Aspirin gegeben werden. Probleme der Aspirintherapie wie das „Aspirinparadox“ und die „Aspirinresistenz“ wurden im Rahmen der Sekundärprävention aufgezeigt, sie dürften aber auch für die Primärprävention von Bedeutung sein.
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Kübler, W., Darius, H. Primäre Prävention der koronaren Herzkrankheit mit Aspirin. ZS Kardiologie 94 (Suppl 3), iii66–iii73 (2005). https://doi.org/10.1007/s00392-005-1309-8
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DOI: https://doi.org/10.1007/s00392-005-1309-8