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USE IN CARDIOVASCULAR DISEASE

In nearly 200 clinical trials studying more than 135,000 patients, aspirin use prevented 36-38 vascular events per 1000 for each of the following conditions:

• myocardial infarction (MI)
• Ischemic (not hemorrhagic) stroke
• angina
• coronary artery bypass graft surgery
• angioplasty
• transient ischemic attacks

Consequently, most providers recommend 75-325 mg of aspirin daily for those with these conditions.

PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE

Several large trials, mainly with men, conclude that aspirin prevents a first heart attack in people who have no signs or symptoms of cardiovascular disease (primary prevention), though such trials were inconclusive concerning stroke and cardiovascular death. In one trial involving women, aspirin reduced the risk of a first stroke and also decreased the risk of a first heart attack among those age 65 and over. In patients with low risk for cardiovascular events, the benefit of primary prevention should be weighed against the risk of gastrointestinal side effects and bleeding.

The United States Preventive Services Task Force and the American Heart Association recommend aspirin 75-325 mg daily for apparently healthy men and women in whom the 10-year risk of having a coronary event of is least 6 to 10 percent (using Framingham risk tables). Most patients experiencing a possible MI or unstable angina should take 325 mg of aspirin immediately and 81-325 mg daily thereafter.

ASPIRIN USE IN THERASIM CLINICAL CASE SIMULATIONS

During the past 12 months, aspirin-related clinician performance was recorded during nearly 5,000 sessions involving 17 separate TheraSim clinical case simulations in which clinical evidence, guidelines and faculty review agree that the clinician should order aspirin. These cases were spread out among 12 different internet-based CME acute coronary syndromes, dyslipidemia, type 2 diabetes, rheumatoid arthritis, asthma and HIV medicine programs.

The TheraSim Health Metrics Dashboard recorded correct aspirin ordering behavior in 50% of the sessions, though clinician success related to the aspirin competency varied from 16% to 93% for individual cases. At present, those using the TheraSim Clinical Simulator have a direct link to dyslipidemia, diabetes, cardiovascular disease and other aspirin-related guidelines and monographs. In addition, poor choices made during the simulation elicit educational alerts and warnings. Finally, editorial comments, literature citations and a summary of performance metrics are offered at the end of the user’s session, allowing the user to improve clinical behavior through case simulation.

Appropriate management decisions regarding aspirin are but one of a multitude of diagnostic and therapeutic competencies available on current TheraSim clinical case simulations. We appreciate your feedback about this article and welcome suggestions for future topics.