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Diabetes mellitus
Aspirin in diabetes
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Why?
- Patients with diabetes are at increased risk of premature coronary artery
disease, peripheral vascular disease and stroke
Target
- Unless there is a contra-indication, to offer aspirin to all patients with
diabetes if they have coronary peripheral or cerebrovascular disease or if
their 10 year risk of a coronary event is > 25 %
Benefits
- Aspirin reduces the risk of coronary events and thrombotic stroke by about
25 % and saves lives in patients ai incresed risk of heart disease (10 year
risk >25 %)
Risks
- In patients in whom the risk of a coronary event is low (< 5 %
per 10 years) aspirin does more harm than good. The risks of major upper GI
bleeding are trebled with aspirin (1 per 500 patient years, and of these 10
% are fatal), are dose related and are probably not influenced by enteric
coated preparations. hi patients taking aspirin the risk of heamorrhagic
stroke and hospitalisation for acute renal failure may be increased.
Cautions and contra-indications
- In patients with hypertension avoid starting aspirin until blood pressure
<160/90.
- Aspirin is contra-indicated in genuine aspirin allergy (consider
clopidogrel), active peptic ulceration or gastro-intestinal bleeding,
warfarin therapy and in clinically active liver disease.
Suggested action
- Calculate the risk of a coronary event using Joint Societies Tables. If 10
year risk is > 25% then discuss benefits, risks and personal preferences
with the patient. Check for contra-indications. a Consider the value of
upper GI investigation in patients with unexplained upper GI symptoms.
- If patient wishes to take aspirin warn him/her to call for medical advice
and stop therapy in the event of abdominal pain, vomiting, nausea or
bleeding.
Suggested preparation and dose
- Aspirin 75 mg od for patients with no symptoms or history of peptic ulcer
disease
- Aspirin EC 75 mg od for patients with minor symptoms or history of
previous peptic ulcer disease
- Aspirin EC 75 mg od and H2 blocker + Helicobacter eradication for patients
at very high risk of coronary event (eg immediately post MI) and with upper
GI symptoms or history of peptic ulcer disease
Source: Northumbria NHS Health Care Trust diabetes protocol