Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, September 18, 2019

Some people without CVD may benefit from aspirin regimen

So ask your doctor about that benefit-harm analysis

Some people without CVD may benefit from aspirin regimen


If one CVD event was considered to be equivalent to one major bleed, 2.5% of women and 12.1% of men without CVD were likely to have a 5-year net benefit from an aspirin regimen, researchers reported in the Annals of Internal Medicine.
If one CVD event was considered to be equivalent to two major bleeds, the percentage of people without CVD with a net benefit from a 5-year aspirin regimen rose to 21.4% of women and 40.7% of men.

Those who would benefit from aspirin “could be identified by using a personalized benefit-harm analysis, and sharing the findings of such an analysis with patients might support more informed decision-making,” Vanessa Selak, MBChB, PhD, senior lecturer in epidemiology, biostatistics and public health at the University of Auckland, New Zealand, and colleagues wrote.
Selak and colleagues analyzed 245,028 people (44% women) who were part of the PREDICT electronic decision-support program used in certain primary care practices in New Zealand. All participants were aged 30 to 79 years, did not have CVD at baseline and received a CVD risk assessment between 2012 and 2016.
Personalized predictions
The researchers calculated the proportional effect of aspirin on CVD and bleeding risk using data from a meta-analysis of 13 randomized controlled trials of aspirin for primary prevention. From there, the researchers developed a personalized prediction model, calculating the net effect by subtracting the predicted reduction in CVD events from the predicted increase in major bleeds during 5-year aspirin use.
The model assumed one CVD event was equivalent to one major bleed, but a sensitivity analysis was conducted assuming one CVD event was equivalent to two major bleeds.
Participants were stratified by those who had net benefit (net effect score of less than –1), equipoise (net effect score of –1 to 1) or net harm (net effect score of 2 or more). In some analyses, patients were further stratified into substantial net benefit (net effect score of –5 or less) or substantial net harm (net effect score of 5 or greater).
Aspirin and the heart 
If one CVD event was considered to be equivalent to one major bleed, 2.5% of women and 12.1% of men without CVD were likely to have a 5-year net benefit from an aspirin regimen.
Source: Adobe Stock
Compared with those who had net harm from aspirin use, those who had net benefit were older had greater baseline risk for CVD and bleeding, had higher systolic BP and had a higher ratio of total cholesterol to HDL, Selak and colleagues wrote.
The net benefit group compared with the net harm group also were more likely to be current smokers, to have diabetes and to be taking BP or lipid-lowering medication, according to the researchers.
In contrast, they wrote, the net harm group was more likely than the net benefit group to have a history of cancer, major bleeding, peptic ulcer disease or alcohol-related conditions and to be taking drugs for peptic ulcer disease or other drugs known to increase bleeding risk.
“For some persons without CVD, aspirin is likely to result in net benefit,” Selak and colleagues wrote.
Balancing risks, benefits
In a related editorial, John B. Kostis, MD, director of the Cardiovascular Institute of New Jersey, associate dean for cardiovascular research, John G. Detwiler Professor of Cardiology and professor of medicine and pharmacology at Rutgers Robert Wood Johnson Medical Center, wrote: “Establishing firm, evidence-based recommendations for aspirin use in primary prevention is difficult. It seems reasonable to recommend aspirin for the primary prevention of CVD in select patients, including those who are at high risk for CVD, provided that the bleeding risk is low, as evidenced by a history of bleeding and comorbid conditions.” – by Erik Swain

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