Dr Rao Kondapally, NIHR Clinical Lecturer in Cardiology, St George’s University of London, UK

Dr Rao Kondapally, NIHR Clinical Lecturer in Cardiology, St George’s University of London, UK, describes the latest controversial findings on aspirin, including benefits in healthy patients and the possible anti-cancer effects of this drug.

Although aspirin is well-established as an anticoagulant drug, recent research has re-evaluated the risks and net benefit of aspirin in patients, and has also uncovered potential anti-cancer effects. ”When things have been around for a very long time, they either go into oblivion or people take it for granted for what it’s known to do rather than what it’s capable of doing,” says Dr Kondapally.

Most of the current risks surrounding aspirin are focusing primarily on whether it is of net benefit in people who are otherwise healthy, and the second side of the story is whether aspirin is useful for any cancer outcomes. A lot of research has gone into this in recent times,” he adds.

A recent meta-analysis conducted by Dr Kondapally and colleagues found that there was indeed a net benefit associated with giving aspirin for the primary prevention of cardiovascular events, however one needs to be aware of the risk of bleeding when prescribing aspirin.

This is because the benefit of aspirin [in the meta-analysis] was with regard to preventing non-fatal CV events,” he says. “It could not prevent fatal CV events. Additionally, it was associated with a significant excess harm of bleeding episodes, a lot of which were major bleeding episodes that you tend to see in the GI tract, or fatal bleeding events.

In a sense the benefit was proportionally offest by the risk of bleeding, and that is something we need to be aware of when we prescribe aspirin to otherwise healthy people and medicalise them.”

In terms of cancer prevention, Dr Kondapally and colleagues did not find any clear evidence that aspirin prevented cancer deaths in otherwise healthy patients. “Having said that, one must acknowledge the fact that these were trials that were not focused primarily on looking at cancer outcomes. Therefore a lot more needs to be done to clarify the situation,” he adds.