REPLY
Aspirin after Myocardial Infarction in the Elderly
Harlan M. Krumholz, MD
1 December 1996 | Volume 125 Issue 11 | Page 938
IN RESPONSE:
Dr. Ring raises an interesting question, but our database is not currently configured to determine how many patients in the group not prescribed aspirin were taking NSAIDs. However, although NSAIDs may have antiplatelet activity, their value in reducing mortality after acute myocardial infarction is less well established than that of aspirin [1]. Because administration of aspirin in medium-sized dosages (75 to 325 mg/d) results in a substantial reduction in risk for subsequent adverse cardiac events, it is appropriate to consider aspirin the standard of care. Moreover, current guidelines from the American Heart Association on secondary prevention for patients with coronary artery disease recommend the daily use of aspirin for patients with coronary artery disease [2]. For these reasons, we believe that it is reasonable to focus on the use of aspirin in this group. Studies should be done to test the therapeutic efficacy of NSAIDs after acute myocardial infarction before such therapy is accepted as an adequate substitute for aspirin.
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Author and Article Information
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Yale School of Medicine, New Haven, CT 06520-8017.
1. Collaborative overview of randomised trials of antiplatelet therapy. I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. Antiplatelet Trialists' Collaboration. BMJ. 1994; 308:81-106.
2. Smith S, Blair S, Criqui M, Fletcher G, Fuster V, Gersh B, et al. Preventing heart attack and death in patients with coronary disease. Circulation. 1995; 92:2-4.
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