#128 Aspirin Overhyped and Overused

The Curbsiders Internal Medicine Podcast

Aspirin’ to figure out if ASA can help prevent a heart attack? Interpreting all the new trials doesn’t have to cause chest pain! Join Dr. Ambarish Pandey from UT Southwestern as he helps The Curbsiders ASCEND the mountains of the latest studies to ARRIVE at some well-informed conclusions on the role of aspirin in primary prevention for cardiac events. The team also discusses secondary prevention, aspirin and dual (or triple) antiplatelet therapy, and whether it’s okay to stop giving aspirin to older adults without known CAD (Spoiler alert: it’s okay). ACP members can visit https://acponline.org/curbsiders to claim free CME-MOC credit for this episode and show notes (goes live 0900 EST).

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Credits

Written and produced by: Justin Berk MD, Matthew Watto MD

CME questions by: Justin Berk MD

Hosts: Matthew Watto MD, Paul Williams MD, Stuart Brigham MD

Edited by: Matthew Watto MD and Chris Chiu MD

Guest: Dr. Ambarish Pandey MD

Time Stamps

• 00:00 Disclaimer, intro and guest bio
• 04:15 Guest one liner, book recommendation, career and research advice
• 11:07 Case of aspirin for primary prevention, aspirin’s public persona, and nocebo effects of statins
• 21:40 ARRIVE and ASCEND trials
• 28:14 Aspree trial
• 32:38 Coronary artery calcium; aspirin use for secondary prevention
• 37:42 Dual antiplatelet therapy and the DAPT score
• 41:25 Should we continue aspirin when a patient also needs a DOAC?
• 46:14 Should we continue DAPT in a patient who needs a DOAC (or warfarin)?
• 49:40 Deprescribing aspirin for primary prevention in older adults?
• 50:51 Closing remarks
• 52:33 Outro