Coronary artery disease
Current Use of Aspirin and Antithrombotic Agents in the United States Among Outpatients With Atherothrombotic Disease (from the REduction of Atherothrombosis for Continued Health [REACH] Registry)

https://doi.org/10.1016/j.amjcard.2009.10.014Get rights and content

Despite its proven efficacy, low cost, and wide availability, aspirin remains underused. We examined current aspirin use and determined factors that influence its use among outpatients in the United States (US). The REduction of Atherothrombosis for Continued Health (REACH) Registry is an international, prospective, longitudinal study of >68,000 outpatients with established atherothrombosis or ≥3 atherothrombotic risk factors. The rates of aspirin use were compared in various patient subgroups. Multivariate logistic regression models were constructed to determine the factors influencing the baseline use of aspirin and other antithrombotic agents in the US population. Approximately 70% of 25,686 US outpatients were treated with aspirin, with greater use in the Midwest and among men, whites, and those aged <65 years. Among aspirin users, 18% took other antiplatelet agents and 6% took oral anticoagulants. Low-dose aspirin (≤100 mg/day) was used in approximately 2/3 of aspirin users. Of patients not taking aspirin, 1/2 were receiving oral anticoagulants or other antiplatelet agents. However, 15% of patients used no antithrombotic agent at all. Female gender, current smoking, or having diabetes mellitus were predictors of a lack of antithrombotic use; white race, atrial fibrillation or vascular disease, the use of other risk-reducing medications, or treatment by a cardiologist were associated with a greater likelihood of receiving antithrombotic therapy. In conclusion, approximately 1/4 of US patients with vascular disease are not treated with aspirin for secondary prevention, and 15% are not treated with any antithrombotic agent.

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Methods

The REACH Registry is an international, prospective, longitudinal study of >68,000 patients across 6 continents recruited from December 2003 to June 2004.4, 5, 6 The present report was based on a database lock of July 2006. The methods have been described previously.6 In brief, the patients were eligible for enrollment if they were aged ≥45 years and had ≥1 of the following: (1) ≥3 atherothrombotic risk factors; (2) documented coronary artery disease (CAD); (3) documented cerebrovascular

Results

A total of 25,686 patients were registered in the REACH database from 1,599 practices in the US. At baseline, 15,360 (59.8%) had CAD, 5,478 (21.3%) had cerebrovascular disease, 2,382 (9.3%) had PAD, and 6,617 (25.8%) were asymptomatic with risk factors only. Of those with CAD, 11,677 had undergone previous angioplasty/stenting or coronary artery bypass surgery. Of those with cerebrovascular disease, 792 had previously undergone carotid angioplasty/stenting or carotid surgery. Of the patients

Discussion

In this large registry of >25,000 outpatients in the US with documented vascular disease or multiple risk factors, 70% of those enrolled were using aspirin. The most common dose of aspirin was 75 to 100 mg/day. This widespread use of low-dose aspirin was supported by the lack of additional clinical benefit1 and increased risk of major bleeding2 observed with higher doses. Among the aspirin nonusers, nearly 1/2 were taking other antithrombotic agents, although approximately 15% were not using

Acknowledgment

This report was written and edited by the authors, who take full responsibility for its content. The first draft was written by C. P. Cannon, MD. We wish to thank Susan Abulhawa, MS, and Melanie Leiby, PhD, for their editorial assistance with coordinating the revisions and creating the figures, and Danielle M. Brennan, MS, for her support with statistical analyses. The Cleveland Clinic Coordinating Center for Clinical Research verified all statistical analyses.

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The REduction of Atherothrombosis for Continued Health (REACH) Registry, statistical support, and editorial assistance were supported by the Bristol-Myers Squibb/Sanofi Pharmaceutical Partnership, New York, New York. The REACH Registry has been endorsed by the World Heart Federation, Geneva, Switzerland.

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