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GPs 'should review low-dose aspirin' in patients with type 2 diabetes

GPs have been advised to review any prescriptions of low-dose aspirin in patients with type 2 diabetes, after a large study found its use for primary prevention of vascular disease in such patients was associated with an increased risk of ischaemic stroke.

The Korean study, published in the journal Diabetology and Metabolic Syndrome, found patients with type 2 diabetes who took low-dose aspirin were 70% more likely to be admitted to hospital with ischaemic stroke than those who did not take aspirin.

Current NICE guidelines on type 2 diabetes still recommend low-dose aspirin for primary prevention in patients over 50, although evidence has failed to demonstrate its benefits outweigh harms, and the advice is likely to be dropped when the guidelines are updated, due later this summer.

Dr Colin Kenny, a GPSI in diabetes based in County Down, Northern Ireland, said the study ‘further questioned aspirin’s safety’ in this setting.

Dr Kenny wrote on the Primary Care Diabetes Society website: ‘These results suggest that low-dose aspirin use for the primary prevention of ischaemic stroke should be reconsidered in people with diabetes.’

Diabetol Metab Syndr 2015; 7: 8

Readers' comments (11)

  • Hilarious - a patient came in just on Tuesday with the latest paper cutting showing aspirin was halving the rate of breast cancer recurrence. She asked what I thought and I said that next week there would be a story saying aspirin was dangerous and should be avoided! I was clearly too conservative in my estimate!!

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  • Now I wonder if this is a case of causation or correlation and is there another co-morbidity involved in this that may explain why aspirin is prescribed in the first place, so ischaemic stroke may replace corking it or a another hospital visit for cancer or a coronary.

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  • Being alive is just too dangerous these days.

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  • All very Orwellian. Encourage GPs to make an intervention, then declare that intervention to be dangerous so that we have to spend hours reversing it. We'd have nothing to do otherwise. Next up: hypertension in the elderly is best left well alone, insulin is hazardous for people with type 2 diabetes, bisphosphonates increase the risk of hip fracture, and quinolones are an effective treatment for the common cold.

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  • Well Dr Gold, I would probably agree already with hypertension, insulin and biphosphonates but have not seen the evidence on quinolones yet! I agree that stranger things have happened!!

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  • Samuel Lewis

    This study was retrospective, and matched controls were selected using a 'prosperity'score. It is therefore subject to bias. E.g. those prospectively put on aspirin may have been most likely to have a stroke, which the propensity score did not cover.

    That said, we have known for years that aspirin preventsIpreventsIschaemic strokes in high cvd risk patients. PAPAD trial showed that diabetics were an inexplicable exception - the prospective blinded RCT showing no significant benefit nor harm.

    So what do you do with your cancer-prone diabetic who has had a heart attack ?

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  • Samuel Lewis

    Propensity , not prosperity!
    Damn that predictive text !!!

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  • Samuel Lewis "your cancer-prone diabetic who has had a heart attack" is not needing primary prevention, they are now needing secondary prevention and that (for now) still involves aspirin

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  • Samuel Lewis

    dear David Ruben,

    you obviously feel the h/o heart attack dominates, and are entitled to your view on aspirin. But it is not RCT-based.

    My point was that PAPAD showed aspirin was inexplicably unhelpful in Diabetics, yet we know from other RCTs that it is helpful after heart attacks, and in high-risk primary prevention. We do not know from the trial evidence which path to take in multimorbidity situations.. so you can happily toss a coin.

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  • Samuel Lewis

    see http://www.bmj.com/content/324/7329/71?ijkey=65501c9e1d6cdbaf4b236af7bf08fe0858325c32&keytype2=tf_ipsecsha

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