WEDNESDAY, Oct. 29, 2003 (HealthDayNews) -- Many people who take aspirin for a heart condition appear to have an unexpectedly high risk of serious cardiac problems when they stop the medication, even on a doctor's order.
That's the conclusion of a new French study that was presented Oct. 29 at the American College of Chest Physicians' annual scientific meeting in Orlando, Fla.
The study included a review of 1,236 people hospitalized for heart attacks and other acute coronary events. Of that group, 500 of them had been taking aspirin for a heart condition on their doctor's orders. In that subgroup, 51, or slightly more than 10 percent, were hospitalized within a week after they stopped taking aspirin.
Twenty of those patients had stopped taking the aspirin without consulting their physicians. But the others were obeying doctors' orders to avoid potential bleeding problems during such medical procedures as dental work or minor surgery.
Dr. Emile Ferrari, a professor of cardiology at University Hospital Pasteur in Nice, detailed the study's findings.
"The main message for physicians is that stopping aspirin is not harmless," Ferrari says. "They must think carefully before doing it."
If the doctor who advises the patient to stop taking aspirin is not the one who recommended it, "doctors and patients should know that stopping aspirin should be discussed with the physician who prescribed it," Ferrari says.
The study's conclusions are "very new, very provocative and potentially very important, but they need to confirmed in a randomized clinical trial," says Dr. Richard S. Irwin. He is chief of pulmonary, allergy and critical care medicine at the University of Massachusetts Medical Center and president of the American College of Chest Physicians.
"But they are important enough to try to convince patients to stay on aspirin, especially for procedures where we know it is safe," Irwin says.
The standing recommendations of the American Heart Association and other cardiology organizations is that patients who are told to take aspirin regularly to reduce the risk of blood clots should not stop without consulting a physician.
"I would use this information to say that here is another important reason why you should not stop taking aspirin when you need it," Irwin says.
But the French finding is far from definitive, he says. A randomized, controlled trial is needed because "there are so many factors you can't control" in the kind of review of existing medical records done by the French researchers, Irwin says.
"I would take a large number of coronary patients, get informed consent and before performing a procedure randomly select patients to continue to take or not take aspirin," he says. "Then I would look for a difference in the two groups over the next weeks or months."
Several studies have been done on the safety of continued aspirin therapy during specific heart-related procedures, Irwin notes, so any randomized study would be done "only for operations in which we don't know whether there is excessive bleeding on aspirin."