Objective: The American Diabetes Association (ADA) and the American Heart Association (AHA) recommend aspirin use for primary and secondary prevention of cardiovascular disease in patients with diabetes. There are, however, some doubts regarding the prescription of aspirin therapy to prevent cardiovascular events in diabetic patients, aspects of its safety, and contraindications of the drug administration. This study was conducted in order to evaluate the amount of prescribed aspirin for diabetic patients who received the treatment at Songklanagarind Hospital.
Material and Method: A cross-sectional study was conducted to review the medical records of diabetic patients who received the treatment at outpatient departments from 1st-31st December 2013.
Results: A total of 1,342 diabetic patients are included in this study: 80.3% from the primary prevention group and 19.7% from the secondary prevention group. Mean age was 64.3 years old. Of the patients, 44.7% were male. The study revealed that prescribed aspirin accounted for one-third of total prescriptions (31.7%). The primary prevention group was 19.0% (95% confidence interval (CI)=12.0-21.3) and the secondary prevention group was 83.7% (95% CI=78.6-87.9). The departments that frequently prescribed aspirin for the primary prevention group was endocrinology (21.2%) and for the secondary prevention group it was the Primary Care Unit (87.5%). Aspirin side effects were gastrointestinal 1.0% and tinnitus 0.1%. Aspirin contraindications were active peptic ulcer (0.1%), history of gastrointestinal bleeding (0.4%), bleeding disorders (0.2%), history of recent intracranial bleeding (0.2%) and severe liver disease (0.9%). There was a positive correlation between age, hemoglobin A1c (HbA1c) and the dose of prescribed aspirin (p-value<0.001, 0.003 respectively). These patients were more likely to have the dose of aspirin increased as age and HbA1c increased.
Conclusion: Despite aspirin being a safe, inexpensive and readily available therapy that is effective in preventing cardiovascular disease in diabetic patients and likely to provide benefits rather than side effects and contraindications. The author found significant underuse of aspirin therapy, especially in the primary prevention of cardiovascular disease in diabetic patients.