Example Of Aspirin 81 MG –low Dose (I) Literature Review
For Men under the Age of 60 (P) Does the Daily Use of
Compared to Not Using Aspirin(C)
Reduce the Risk of Stroke (O) – PICO Assessment
The following literature review provides information on research about male patients 60 years of age and younger and the efficacy of use of 81 Mg of aspirin as a primary or secondary supplement as a blood thinner in reducing the risk of stroke according to the PICO Assessment instrument. Research of the use of the aspirin treatment compared to patients at risk of stroke not using it according to the following literature review determined its efficacy was aligned to variables according to individual patient demographics. These included whether the patient had high blood pressure or not, whether the patient was diabetic or not, and other considerations aligned to whether the patient tolerated ingestion of acetylsalicylic acid. The variables underscore the individual patient medical profile and the use of aspirin for reducing the risk of stroke.
Keywords: Stroke, Aspirin regimen, Younger men and stroke, cardio vascular disease, high blood pressure and aspirin
For Men under the Age of 60 (P) Does the Daily Use of
Compared to Not Using Aspirin(C)
Reduce the Risk of Stroke (O) – PICO Assessment
In a clinical practice setting review of the literature determining the reduction of the risk of stroke among men 60 years and younger using aspirin dose of 81 Mg compared to not using the aspirin proves the situation depends on varieties of variable according to the PICO question elements. The PICO elements are P -Problem/Patient/Population, I- Intervention/Indicator, C- Comparison, and O – Outcome. The plan includes objectives, outcomes, interventions, and evaluation.
As a clinical intervention design the literature on the efficacy of the 81 Mg low dose use of aspirin in men below age of 60 in reducing risk of stroke versus those who do not use it looks at the variables applicable to each individual patient. However, in the Becker, Burns, Gore, Lambrew et al (2000) study findings of their clinical application to patients with a history of acute myocardial infarction as applied in “gradual but steady increases” proved encouraging in specific sets of patients among younger males only (p. 207).
Frilling, Scheile, Gitt et al (2004) completed their meta-analysis of existing literature at the registry for patients listed under the Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) (AMI in Germany) concluding 10 percent of the patients sustaining an AMI did not receive the aspirin treatment and the majority discharged from the hospital remained high risk.
Related to aspirin therapy as a secondary prevention in patients with risk of stroke because of coronary disease looks at the findings of Gaspoz, Coxson, Goldman et al. (2002) about the cost effectiveness using aspirin as long as the patient is not able to use aspirin. This characteristic remains the most prevalent barrier to the use of aspirin for at risk of stroke patients.
Further to the literature of studies of the effect of low-dose aspirin to men under 60 years of age in treating risk of stroke MacMahon, Neat, Tzourio et al (2001) looked at stroke risk among patients with high blood pressure and not suffering from hypertension. Because there remains doubt of the efficacy as well as safety about use of blood pressure medicine in treating many such patients at risk of stroke.
Combinations of anti-platelet drug regimen with low-dose aspirin as a secondary part of the treatment looked at the effectiveness of the perindopril combination in lowering the risk among patients with hypertension and those not. The findings show strong implications of use of this treatment for stroke and transient ischemic attack histories without concern of their blood pressure status according to MacMahon, Neat, Tzourio et al (2001).
In another study, Serebrauny, Bahr, and O’Connor et al (1998) determined applied aspirin therapy long-term use mildly succeeded reducing patients’ baseline platelets but at the same time, the degree of the inhibition related to the platelet activity was not a safeguard against cardio related risks including stroke. This as well as the McMahon et al (2001) research outcomes provides another example of the types of variables when considering the use of low-dose aspirin treating high risk stroke patients.
Results of the study literature published on the research by Rodgers, MacMahon, and Collins et al (2000) found their meta-analysis of the existing literature of stroke prevention using low-dose aspirin treatment determined the efficacy of this therapy in reducing the risk of such a cardiovascular event by a minimum of one third. The implication of the findings prove highly encouraging for the use of such a combination of anticoagulants in treating high risk prevention of strokes.
Further to this literature review findings by Kim, Choi, and Kim et al (2015) looked at the use of low-dose aspirin in preventing ischemic stroke in diabetes patients. Their evaluation of the use of low-dose aspirin found among the data they evaluated in the Korean Health Insurance Review as well as the Assessment Service data over a four year period 2005 January through December 2009 with a population as young as 44 years of diabetic patients performing a retrospective cohort study focused on the index period between January 1, 2006 through December 31, 2007.
The process matched the low-dose aspirin regimen with the non-aspirin use applying a propensity score. With the Cox proportional hazard model they determined from the comparison of the risk of diabetic hospitalization showed for users and non-users showing the risk of hospitalization for ischemic stroke increased over the non-aspirin user diabetic. The implications take into account age was not a factor in the higher incident with the aspirin user and should be a consideration by health providers for use of low-aspirin treatment for ischemic stroke associated with diabetic patients (Kim et al, 2015).
Verdino (2015) in his study, reports the United States medical professionals treat atrial fibrillation as the most common type of arrhythmia with stroke representing the most harmful outcomes of atrial fibrillation. At the same time, the fact remains there exists varieties of reason anticoagulant therapy for risk of stroke is not a part of particular patient’s treatment. Among the reasons are the doctor’s overestimation of bleeding risk or an underestimation of the risk of stroke for the patient as well as patient reluctance taking a blood thinner of any kind related to the issues of interactions with both other medications and certain types of food.
Accordingly, defining better patient risks as well as benefits connect with risk score assessments and chronic anticoagulant use. Finally, the research outcomes reported by Yousef, Diener, Hans-Christoph et al (2008), of their use of aspirin as a secondary blood thinner test proved administered soon after an ischemic stroke with continuation for 2.5 years compared to placebo test groups as well as a non-aspirin group showed no significant difference in the occurrence of the unwanted rate of stroke.
The assessment of the literature review age of patient (P) low-dosage (I), aspirin (C), and risk of stroke (O) reveals important characteristics connected to low-dose aspirin use as a primary and secondary treatment plan for men younger than 60 years of age shows varied limitations that prove the need for an initial and reliable cardiovascular risk assessment by a qualified medical professional.
Intentionally the above literature review incorporated different types of research focus for the use of aspirin therapy in treating high risk stroke patients to provide a pragmatic base for creating a clinical working plan that considers demographics of patients with high risk for stroke using the PICO application for assessment. Even under the monitoring by scientific cardiovascular research experts the research outcomes revealed and concluded that it is not atypical for doctors’ evaluation of patient stroke risk results with inappropriate prescription application of aspirin as a stroke preventative for varieties of reasons not always apparent
Clearly, the use of a single formula determining the risk of using low-dose aspirin or relying on the use of low dose aspirin as either a primary or secondary supplement to another blood thinner medication does guarantee the protection of the client against stroke. As a nursing professional it is fundamental to adequate training knowing that a prerequisite for creating a treatment plan for at risk of stroke men age 60 and younger first requires several different clinical assessments.
Among one of the simplest is checking for coronary calcium as it remains strongly supported by experts as a reliable predictor of stroke risk aside from the fact of the original event of a stroke in a patient. The result of the computed tomography (CT) scan identifies higher levels of coronary calcium or calcium score as predicators of future stroke risk due to high levels of plague in the patient arteries (Given, Cilliler, & Koker et al, 2011).
Without such a risk assessment putting a patient on lifelong low-risk aspirin therapy is a ludicrous for high risk stroke patients of men 60 and younger. Benefits of the low-dose aspirin regimen for high risk stroke patients the secondary prevention looks at the benefits of an aspirin regimen some patients have bleeding risks aligned to stomach and colonic ulcers such as ulceric colitis that blood thinners like aspirin may exacerbate the condition.. Men 60 and younger with a history of a cardio event of a stroke nonetheless, may view the known benefits of aspirin for secondary prevention therefore, outweigh the bleeding risk.
In a clinical setting the objective for creating a preventative health regimen and treatment for men under the age of 60 (P) looks as the risks and benefits of whether the daily use of aspirin 81 Mg –low dose (I) compared to not using aspirin(C) reduces the risk of stroke (O). The objectives include working with the patient as a collaborative process creating the most pragmatically based medical application of a clinical plan safeguarding the client risk of stroke.
Primary to the intervention process is completing an assessment of the patient’s family and personal health history. This intends identifying the causal factors related to inherited health issues including high blood pressure that exacerbate the risk of heart disease and stroke. The fundamental process includes all applicable lab tests for blood work to eliminate any unknowns such as diabetes or to check the current blood levels if the client reports having diabetes.
Creating a clinical working relationship with the client encourages candid discussion about lifestyle practices including diet, exercise, whether client smokes tobacco, sleeping patterns, stressors affecting the client’s emotional state, as well as any other medical characteristics the client provides in the initial meeting with the patient.
Setting up the necessary tests, and having the patient follow through provides the basis for the next step in assessing the information and devising a clinically based treatment that includes consideration of the applicability of using low-dose aspirin as either a primary or secondary blood thinner medication option. The intervention process monitors the goal of lowering the risk of the patient for stroke.
With the culmination of all lab work and related tests determining the status of the patient as a candidate for inclusion of a low-dose aspirin therapy aligned to identifying his risk of stroke, the client then agrees to any diet changes, exercise, and other identified factors that contribute as intervention to stroke risk on a three month trial basis. Upon the end of the first month intervention plan, the client returns for the blood work and applicable tests for monitoring blood thinner reaction affecting blood pressure (if applicable), blood sugar (if applicable), any weight gain or loss, sleep patterns, stressors, and other related characteristics of the individual patient.
The one month evaluation of the lab work and related monitoring tests aligned to the individual medical framework of the patient characteristics for high risk of a stroke then discusses the outcomes with the patient comparing to the patient feedback on their reaction to the agreed plan if dietary changes occurred, reaction to the aspirin, and any other pertinent results the patient reports. At this time, any necessary identification of differentiating the intervention plan are discussed and changes in any aspect of the plan takes place with the client returning in for a 3 month testing and evaluation.
The focus of the outcomes of the testing with each scheduled monitoring of the patient through bloodwork and applicable other tests remains connected to lowering the patient risk of stroke. The monitoring process and the ongoing collaboration discussing all aspects of the variables affecting the health of the client and the risk of stroke connected to the intervention agreed by the patient.
As outlined in the introduction the above academic exercise conducted a literature review focusing on research applicable for a clinical practice setting determining the reduction of the risk of stroke among men 60 years and younger using aspirin dose of 81 Mg compared to not using the aspirin proving how the situation depends on varieties of variable according to the PICO question elements. From the outcomes of the literature review a discussion culminating in the overall findings determined there is no one size fits all for the use of aspirin as a primary or secondary blood thinner regimen for patients with the risk of stroke because each patient is different with different medical demographics that include family and personal history of cardio vascular health issues including stroke or risk of stroke as well as high blood pressure, or diabetes as inclusionary factors affecting the decision for using low-dose aspirin as an intervention clinical application. The plan section of the above discussed these factors as fundamental to the objective of the plan lowering the risk of stroke occurring in male patient 60 years and younger.
The intervention discussed the variables of individual patients and promoted the necessary blood work, heart calcium index test as well as the individual patient family health history, diet, exercise, life stressors and other aspects affecting the likelihood of having a stroke. The outcomes referred to an initial one month retesting and assessment of the initiated intervention schedule that hypothetically included using low-dose aspirin as part of the medical regimen with a follow up 3 month assessment after the same tests.
Becker, R. C., Burns, M., Gore, J. M., Lambrew, C., & al, e. (2000). Early and pre-discharge aspirin administration among patients with acute myocardial infarction: Current clinical practice and trends in the United States. Journal of Thrombosis and Thrombolysis, 9(3), 207-15.
Frilling, B., Schiele, R., Gitt, A. K., Zahn, R., Schneider, S., Glunz, H., Senges, J. (2004). Too little aspirin for secondary prevention after acute myocardial infarction in patients at high risk for cardiovascular events: Results from the MITRA study. The American Heart Journal, 148(2), 306-11
Given, H., Cilliler, A.E., Koker, C., Sarikaya, S.A., & Comoglu, S. S. (2011). Association of serum calcium levels with clinical severity of acute ischemic stroke. Acta Neurol Belg. 111(1), 48-9.
MacMahon, S., Neal, B., Tzourio, C., Rodgers, A., & al, e. (2001). Randomised trial of a perindopril-based blood-pressure-lowering regimen among 6105 individuals with previous stroke or transient ischaemic attack. The Lancet, 358(9287), 1033-41
Rodgers, A., MacMahon, S., Collins, R., & Prentice, C. (2000). Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary embolism prevention (PEP) trial. The Lancet, 355(9212), 1295-302.
Kim, Y.J., Choi, N.K., Kim, M.S., Lee, J., & et al. (2015). Evaluation of low-dose aspirin for primary prevention of ischemic stroke among patients with diabetes: a retrospective cohort study. Diabetology & Metabolic Syndrome. 7(8), 1-8.
Serebruany, V. L., Bahr, R. D., O'Connor, C.,M., Lowry, D. R., & Gurbel, P. A. (1998). Antecedent aspirin therapy inhibits baseline platelet activity in patients presenting with acute myocardial infarction. Cardiology, 90(1), 37-42.
Verdino, R J. (2015). Untreated atrial fibrillation in the United States of America: Understanding the barriers and treatment options. Journal of Saudi Heart Association. 27(1), 44-49. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4278438/
Yusuf, S., Phil, D., Hans-Christoph, H., Sacco, R. L. Cotton, D., Ôunpuu, S., Lawton, W. A, & Yoon, B.W. (2008). Telmisartan to prevent recurrent stroke and cardiovascular events. The New England Journal of Medicine, 359(12), 1225-37.
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