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Senior Citizen Health & Medicine
Failure to Give Aspirin to Cancer Patients with
Heart Attacks is Deadly Error
Nine out of ten who did not get aspirin died says
study
 January 19, 2007 – The medical decision to not give
aspirin to cancer patients who have heart attacks – based on the premise
it could cause lethal bleeding – is a deadly mistake. Researchers at The
University of Texas M. D. Anderson Cancer Center say the
notion of lethal bleeding from aspirin is now proven wrong and that without aspirin, the majority of
these patients will die.
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Researchers say that their study, to be published
in the February 1, 2007 issue of the journal Cancer and now available
online, turns common medical assumptions upside down and will likely
change medical practice for cancer patients.
Because aspirin can thin blood and cancer patients
experience low platelet counts and abnormal clotting, physicians view
aspirin as a relative contraindication. Given that blood platelets are
responsible for the clotting process, physicians do not eagerly
prescribe aspirin as a standard treatment.
In this study, however, the investigators found
that 9 of 10 cancer patients with thrombocytopenia (low platelet count)
who were experiencing a heart attack and who did not receive aspirin
died, whereas only one patient died in a group of 17 similar cancer
patients who received aspirin. They also found aspirin helps cancer
patients with normal platelet count survive heart attacks, just as it
does for people without cancer.
"The notion that heart attacks in patients with low
platelets should be treated with clot-dissolving aspirin defies logic,
that is unless you suspect that the cancer is interfering with platelet
function," says the study's senior investigator and author, Jean-Bernard
Durand, M.D., assistant professor in the Department of Cardiology at M.
D. Anderson Cancer Center.
"We believe tumors may be releasing chemicals that
allow the cancer to form new blood supplies which makes blood more
susceptible to forming clots." Durand, a heart failure specialist, says.
"There appears to be a platelet paradox suggesting that cancer may
affect the mechanism of the way that blood clots, and from this
analysis, we have found that the single most important predictor of
survival in these patients is whether or not they received aspirin."
Durand says more research is needed to better understand this
contraindication.
According to the World Health Organization there
are approximately 10 million cancer patients worldwide, of which 1.5
million may develop blood clots during their cancer treatment and, as
such, are at a much higher risk of dying from heart disease if not
treated properly. "Now that we have this study, it would be a travesty
if you survive treatment for cancer only to die of a heart attack soon
thereafter," Durand says.
According to Durand, no guidelines currently exist
for treatment of heart attacks in patients with cancer. He says that
physicians are especially perplexed about what to do for cancer patients
with thrombosis (blood clots), a condition that affects about 15 percent
of all cancer patients and can be due to the use of chemotherapy or the
presence of cancer.
Durand came to M. D. Anderson in 2000 to start the
Cardiomyopathy Services, which is believed to be the only program in the
world specifically designed to look at cardiovascular complications
caused by chemotherapy treatment. He is also the co-founder of CONQUER
(Cardiology Oncology International Quest to Educate and Research Heart
Failure in Cancer), a newly created organization with goals of
increasing the success of chemotherapy by reducing cardiovascular
disease as a barrier and long term risk.
He and anesthesiologist Mona Sarkiss, M.D., Ph.D.,
made the observation that patients with thrombocytopenia who suffered a
heart attack and were being treated in the intensive care unit at M. D.
Anderson tended to die more often when they were not given aspirin.
However, they noted that some of the patients given aspirin and/or
beta-blockers had "great" clinical outcomes. "Because no practice
guidelines exist, physicians were treating their patients with great
variability and the disparity was obvious," Durand says.
Sarkiss, who is the study's lead author, Durand,
and a team of researchers which included investigators from Baylor
College of Medicine and Duke University Medical Center, conducted a
retrospective analysis of cancer patients treated for heart attacks at
M. D. Anderson Cancer Center in 2001. These 70 patients were divided
into two groups based on their platelet counts, and data was collected
on the use of aspirin, bleeding complications, and survival.
They found that heart attack patients with low
platelets who did not receive aspirin had a seven-day survival rate of 6
percent, compared with 90 percent survival in those who received
aspirin. Dr. Durand notes that there were no severe bleeding
complications in patients who used aspirin. Conversely, patients with
low platelet counts who formed a blood clot and were not exposed to
aspirin died.
The beneficial effect of aspirin also was seen in
patients with normal platelet counts. Seven-day survival was 88 percent
in aspirin-treated patients as compared to 45 percent in patients who
did not receive aspirin, the researchers found.
Durand observed that these deaths rates are
abnormally high. "In the non-cancer patient with acute coronary syndrome
anywhere in the United States, an expected seven-day mortality is less
than 1 percent," he says.
There were parallel findings for those patients in
either group who were treated with beta-blockers, which block the
heart's use of adrenalin. The protective effect was not as strong as
seen with aspirin, but was still life saving.
In those patients with a normal platelet count, 91
percent survived seven days when treated with beta-blockers, whereas 36
percent survived if they were not treated with the agent. In the
thrombocytopenic group, 73 percent survived seven days when treated with
beta-blockers, whereas only 13 percent survived if they were not
treated.
Editor's Notes:
Investigators working with Durand and Sarkiss
were: Andrew Shaw, M.D., from Duke; Nasser Lakkis, M.D. from Baylor; and
S. Wamique Yusuf, M.D., Carla Warneke, M.D., Gregory Botz, M.D., Cheryl
Hirsch-Ginsburg, M.D., J. Chris Champion, M.D., Joseph Swafford, M.D.,
and Daniel Lenihan, M.D., from M. D. Anderson.
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