Coronary artery diseaseCurrent Use of Aspirin and Antithrombotic Agents in the United States Among Outpatients With Atherothrombotic Disease (from the REduction of Atherothrombosis for Continued Health [REACH] Registry)
Section snippets
Methods
The REACH Registry is an international, prospective, longitudinal study of >68,000 patients across 6 continents recruited from December 2003 to June 2004.4, 5, 6 The present report was based on a database lock of July 2006. The methods have been described previously.6 In brief, the patients were eligible for enrollment if they were aged ≥45 years and had ≥1 of the following: (1) ≥3 atherothrombotic risk factors; (2) documented coronary artery disease (CAD); (3) documented cerebrovascular
Results
A total of 25,686 patients were registered in the REACH database from 1,599 practices in the US. At baseline, 15,360 (59.8%) had CAD, 5,478 (21.3%) had cerebrovascular disease, 2,382 (9.3%) had PAD, and 6,617 (25.8%) were asymptomatic with risk factors only. Of those with CAD, 11,677 had undergone previous angioplasty/stenting or coronary artery bypass surgery. Of those with cerebrovascular disease, 792 had previously undergone carotid angioplasty/stenting or carotid surgery. Of the patients
Discussion
In this large registry of >25,000 outpatients in the US with documented vascular disease or multiple risk factors, 70% of those enrolled were using aspirin. The most common dose of aspirin was 75 to 100 mg/day. This widespread use of low-dose aspirin was supported by the lack of additional clinical benefit1 and increased risk of major bleeding2 observed with higher doses. Among the aspirin nonusers, nearly 1/2 were taking other antithrombotic agents, although approximately 15% were not using
Acknowledgment
This report was written and edited by the authors, who take full responsibility for its content. The first draft was written by C. P. Cannon, MD. We wish to thank Susan Abulhawa, MS, and Melanie Leiby, PhD, for their editorial assistance with coordinating the revisions and creating the figures, and Danielle M. Brennan, MS, for her support with statistical analyses. The Cleveland Clinic Coordinating Center for Clinical Research verified all statistical analyses.
References (18)
- et al.
Analysis of risk of bleeding complications after different doses of aspirin in 192,036 patients enrolled in 31 randomized controlled trials
Am J Cardiol
(2005) - et al.
The REduction of Atherothrombosis for Continued Health (REACH) Registry: an international, prospective, observational investigation in subjects at risk for atherothrombotic events-study design
Am Heart J
(2006) - et al.
Increased major bleeding complications related to triple antithrombotic therapy usage in patients with atrial fibrillation undergoing percutaneous coronary artery stenting
Chest
(2008) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients
BMJ
(2002)- et al.
AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute
Circulation
(2006) - et al.
International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis
JAMA
(2006) - et al.
One-year cardiovascular event rates in outpatients with atherothrombosis
JAMA
(2007) - et al.
Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration
Ann Intern Med
(2007) - et al.
Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease
Circulation
(2006)
Cited by (56)
The Future of Aspirin Therapy in Cardiovascular Disease
2021, American Journal of CardiologyThe antithrombotic activity of the active fractions from the fruits of Celastrus orbiculatus Thunb through the anti-coagulation, anti-platelet activation and anti-fibrinolysis pathways
2019, Journal of EthnopharmacologyCitation Excerpt :Along history, the flavonoid-enriched traditional Chinese medicines, such as Abelmoschus manihot (Alwan and Alwan, 2011; Heit et al., 2000), Ginkgo biloba (Johansen, 2006), and Carthamus tinctorius (Mega and Simon, 2015) have been long used in clinical against thrombotic diseases with little side effects. The studies also proved the significant cardiovascular protective effects of flavonoids (Cannon et al., 2010). Traditional Chinese medicine Celastrus orbiculatus Thunb (C. orbiculatus) with peel and seeds is mainly composed of flavonoids, sesquiterpenes and tripenes (Guo et al., 2004; Jian-Juan et al., 2012).
Leeches attenuate blood hyperviscosity and related metabolic disorders in rats differently than aspirin
2019, Journal of EthnopharmacologyCitation Excerpt :Therefore, effective treatment for hyperviscosity could reduce the high risk to patients due to its increasing prevalence and etiologic role in the development of heart attack, stroke and cerebral infarction and so on. Anticoagulant therapy, such as aspirin, has shown to be effective in treating this condition (Rosenson, 2008; Cannon et al., 2010). On the other hand, traditional Chinese medicine (TCM) has been commonly used in the treatment of cardio- and cerebrovascular diseases and developed as a treatment tool due to its multitargeted effects (Layne and Ferro, 2016).
Coronary artery microvascular dysfunction: Role of sex and arterial load
2018, International Journal of CardiologyAntithrombotic components of Malus halliana Koehne flowers
2018, Food and Chemical ToxicologyCitation Excerpt :The formation of thrombosis is attributed to platelet aggregation and adhesion, endogenous and exogenous coagulation system, and the yield of fibrin [Liu et al., 2016]. Most of the existing antithrombotic drugs such as warfarin and aspirin have severe side effects [Baker and Johnson, 2016; Cannon et al., 2010]. With the increased occurrence of cardiovascular and cerebrovascular diseases, it is of particular significance and urgency to search for novel antithrombus agents with improved potency, safety profile and chemical stability.
Perioperative Aspirin in Cardiac and Noncardiac Surgery
2017, Journal of Cardiothoracic and Vascular Anesthesia
The REduction of Atherothrombosis for Continued Health (REACH) Registry, statistical support, and editorial assistance were supported by the Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership, New York, New York. The REACH Registry has been endorsed by the World Heart Federation, Geneva, Switzerland.