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Aspirin About-Face

47 点作者 ahilsa超过 3 年前

12 条评论

rdmirza超过 3 年前
This piece entirely misses the point of the recommendation.<p>The new recommendation is that aspirin should not be used to prevent heart attack in those without a history of heart disease (ie avoid routine aspirin for &quot;primary prevention&quot;). Aspirin for primary prevention has always been a grey area. The reversal came after a large trial in the New England Journal of Medicine looking at this. The trial showed the decrease in cardiovascular events was balanced by a similar increase of bleeds. So it&#x27;s still grey because some people would prefer to bleed because blood is easily replaceable, your heart is not.<p>What remains clear is that people who have had heart attacks, strokes, or peripheral arterial disease should in most cases continue their anti-platelet agent.
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giantg2超过 3 年前
I would love to see this analysis for statins.<p>On a slightly related note, it seems many people don&#x27;t know (aren&#x27;t being told) the risks associated with not taking a drug and taking it. It seems like is just &quot;the FDA ruled the benefits out weight the risks&quot; and that gets applied to everyone. Just like <i>generally</i> safe is often misinterpreted as <i>completely</i> safe.
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breput超过 3 年前
&quot;That means if 1,000 elderly women take aspirin daily for a decade, 11 of them will avoid a heart attack; meanwhile, twice that many will suffer a major gastrointestinal bleeding event that would not have occurred if they hadn’t been taking aspirin.&quot;<p>&quot;The U.S. task force wants to strongly discourage anyone 60 and older from starting a low-dose aspirin regimen, citing concerns about the age-related heightened risk for life-threatening bleeding.&quot;<p>I understand that the bleeding is a serious concern, but does that have an immediate, potentially fatal or life changing impact - or does it happen with enough warning that you could stop taking aspirin and&#x2F;or get medical assistance?<p>If so, then I think most people would feel that is worth the risk to take aspirin even though it has a more numerically higher likelihood of a bad outcome.
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canada_dry超过 3 年前
<a href="https:&#x2F;&#x2F;web.archive.org&#x2F;web&#x2F;20211019181426&#x2F;https:&#x2F;&#x2F;davidepstein.bulletin.com&#x2F;563262208234593&#x2F;" rel="nofollow">https:&#x2F;&#x2F;web.archive.org&#x2F;web&#x2F;20211019181426&#x2F;https:&#x2F;&#x2F;davidepst...</a>
Lacaranian超过 3 年前
As others here have hinted at, while NNT and NNH are both extremely useful concepts, they (deliberately) leave the consideration of whether a treatment&#x27;s level of effectiveness, or the magnitude of a harmful side effect, subjective. When, after all, should a negative side effect be counted as &quot;harm&quot;? This is especially true for NNH; there are usually far more possible (helpful or harmful) side effects than the one intended remedy for the ailment, for a given drug.<p>As an example, in one study, for elderly patients the NNT of a number of (admittedly different) sedative hypnotics was 13, while the NNH was 6 [1]. From that alone, you&#x27;d probably rightfully avoid using them! But for certain populations who have chronic insomnia, the benefits may still outweigh the risks.<p>Of course, there are ways to (less subjectively albeit still subjectively) quantify harm, and these get used to keep &quot;harm&quot; comparable to &quot;treatment&quot;. But it can definitely be more of an art than an exact science.<p>[1] <a href="https:&#x2F;&#x2F;www.ncbi.nlm.nih.gov&#x2F;books&#x2F;NBK71441&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.ncbi.nlm.nih.gov&#x2F;books&#x2F;NBK71441&#x2F;</a>
karmakaze超过 3 年前
&gt; relative risk reduction [...] “is just another way of lying.”<p>&gt; You read that a new drug reduces your chance of dying from Ryantastic syndrome by 40 percent. Here’s what that means in practice: if 10 in 100,000 people normally die from Ryantastic syndrome, and everyone takes the new drug, only 6 in 100,000 people will die from Ryantastic syndrome. Now let’s think about it from an NNT perspective.<p>&gt; For 100,000 patients who took the new drug, four deaths by Ryantastic syndrome were avoided, or one per 25,000 patients who took the drug. So the NNT is 25,000; that is, 25,000 patients must take the drug in order for one death-by-Ryantastic to be avoided. Ideally, you also want to know the NNH, or “number needed to harm.”<p>&gt; Let’s say that 1 in 1,000 patients who take the new drug suffer a particular grievous side effect. In that case, the NNH is 1,000, while the NNT is 25,000. Suddenly, the decision seems a lot more complicated than if you’re just told the drug will lower your chance of dying from Ryantastic syndrome by 40 percent.
smileysteve超过 3 年前
This is surprising for 2 reasons<p>1) that there was this significant bleeding from baby aspirin<p>2) that a miracle drug from 300bc is being found to have downsides.<p>I&#x27;m still an aspirin proponent for treating sunburns and minor ailments. And salycilic acid for my face routine.<p>Fish oil&#x27;s recent science on hormone regulation and inflammation reduction should make it a first stop.<p>Then there is AKG.
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woodpanel超过 3 年前
Is this an American thing? I&#x27;ve never heard of people (without any preconditions, or feaver, pain or illness) taking Aspirin on daily basis. But apparently 30 million US citizens do. How did that happen? (Was this only caused by the pre-reversal recommendation?)
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zwieback超过 3 年前
It would be interesting to learn whether some other forms of treatment or drugs have appeared in the years people have been taking daily aspirin. The article makes it sound like &quot;whoops we&#x27;ve been wrong all these years, sorry for all the bleeding&quot; but in reality the risk balance constantly shifts so what made sense for great-grandma may not make sense for grandma.
pomian超过 3 年前
Brilliant short article about decision making in general, and in medical uses as an example. The aspirin example is great for everyone to read, because it is so ubiquitous.
gHosts超过 3 年前
Anybody got the NNT vs NNH for the Pfizer covid vaccine?
matchbok超过 3 年前
Please no FB content here.
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