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Warning on high aspirin doses in CVD

GPs should avoid high doses of aspirin in the prevention of cardiovascular disease, a new systematic review suggests.

Current NICE guidance recommends doses of up to 150mg/day in some cases but the review says long-term aspirin should be given in doses of 81mg/day or less. The US review found higher doses offered no better protection against cardiovascular disease but were associated with increased risk of gastrointestinal bleeding. The study, published in JAMA last week, found in clinical trials involving 10,000 patients prescribed aspirin at dosages from 30 to 1300mg/day no significant benefit of higher dosages was demonstrated in any trial.Lead author Dr Charles Campbell, a cardiologist at the Gill Heart Institute, University of Kentucky, said: 'An association between increases in aspirin dose and risk of adverse events has been confirmed in multiple studies, whereas no such dose relationship has been identified for efficacy. Every effort should be made to minimise the long-term dosage.'Recommended doses of aspirin vary across NICE guidelines; from 75mg/day in type 2 diabetes guidance to 75-150mg/day in myocardial infarction.However, Dr Stewart Findlay, a GP in Bishop Auckland, County Durham, and treasurer of the Primary Care Cardiovascular Society, said it would be 'unusual' for UK GPs to prescribe doses higher than 75mg/day.

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