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Panel Discussion on Medical Uses of Aspirin at Sargodha and Faisalabad

Experts highlight safety and efficacy of Low
Dose Aspirin Therapy in reducing morbidity
and mortality in various medical disorders

 
       
   

From our correspondent

SARGODHA & FAISALABAD: Pakistan Aspirin Foundation in its Continuing Medical Education programme organized Panel Discussions on Medial Uses of Aspirin at Sargodha on April 20th and at Faisalabad on April 21st 2016.  The meeting at Sargodha was chaired by Prof. Siddique the senior most physician in the city while the meeting at Faisalabad was presided over by Prof. Abdul Hafeez Chaudhry a well-known cardiac physician. The panel of Experts at Faisalabad meeting included Prof. Naeem Aslam, Prof. of Cardiology at Punjab Medical College, In charge of Coronary Care Unit at Allied Hospital Faisalabad and Dr. Javed Iqbal Consultant Cardiologist and in charge of Cardiac Center at DHQ Hospital Faisalabad.

Prof. Abdul Hafeez Chaudhry moderated the Panel Discussion on Medical Uses of Aspirin organized
by Pakistan Aspirin Foundation at Faisalabad on April 21st 2016. Group photograph taken on the 
occasion shows Prof. Abdul Hafeez Chaudhry along with other members of the Experts panel 
Prof. Naeem Aslam and Dr. Javed Iqbal and Mr. Shaukat Ali Jawaid and some of the participants.

Copies of the Consensus Report on Guidelines on Medical Uses of Aspirin prepared by a panel of experts headed byProf.Abdul Samad an eminent cardiologist of Pakistan in collaboration with Prof. Ejaz Ahmad Vohra and Prof. M.Akbar Chaudhry besides a Booklet in Urdu authored by late Dr. Maqbool Jafary and Mr. Shaukat Ali Jawaid Chief Editor of Pakistan Journal of Medical Sciences and Pulse International were distributed among the participants before the discussion. In his introductory remarks at both the places Mr. Shaukat Ali Jawaid General Secretary of the Pakistan Aspirin Foundation gave the background of the consensus document which gives comprehensive details about the established indications with doses in various medical disorders. It also gives details about the absolute as well as relative contra indications for the use of Aspirin therapy.

The literature on Aspirin till 2014,he  said,  was reviewed in detail before finalizing this document and each and every recommendation has been properly referenced. He also highlighted the salient features from the latest US Preventive Services Task Force on the use of Aspirin in Primary Prevention of Cardiovascular Diseases and Colorectal Cancer published on April 13th 2016. It also recommends use of Aspirin for primary prevention in patients over the age of fifty years with one or two risk factors while its efficacy in colorectal Cancer is only after it is used for a period of ten years. Since life expectancy in Pakistan is about ten years less as compared to the developed world, Pakistan Aspirin Foundation has recommended the use of Aspirin for primary prevention in patients above forty years of age. Those with one or two risk factors, must get aspirin while for others one has to calculate the risk score which can be done using the information provided in these Guidelines, he added.

Participating in the discussion at Sargodha, Dr. Jamil said that we use Low Dose Aspirin therapy in angina, after acute myocardial infarction and in all Acute Coronary Syndromes regularly.  It is a lifesaving drug for patients with heart diseases while it also has a preventive role in stroke. Our patients cannot afford expensive medications and there are compliance issues as well. Aspirin is economically priced antiplatelet agent which is also easily available everywhere. It has come as a revolution for the poor. It is also known as Poor Manís Streptokinase or Poor Manís statin. For the poor countries it is not less than a blessing, he remarked.

Participating in the Panel Discussion on Medical Uses of Aspirin organized by Pakistan Aspirin Foundation at Sargodha on April 20th from (L t R) are Prof. M. Siddique, 
Dr. Jamil, Dr. Humaira and Dr. Nusrat.

Stroke he pointed out was a big burden and the patient often remain wheel chair bound for ten to fifteen years. Its regular use prevents stroke.  The dosage recommended for cardiovascular diseases was  75-100mg daily while for stroke the maintenance dosage is 150mg. For acute myocardial infarction one has to use the full tablet of 325mg and soluble aspirin is preferred. However, for long term use, enteric coated aspirin tablets are safe and should be preferred.

Dr Fida remarked that Aspirin has a very wide range of uses in a number of medical disorders starting from ACS, Acute MI, prevention of secondary AMI, Stroke, after angioplasty and stenting, for prevention of deep vein thrombosis and pulmonary embolism, hypertension and diabetes mellitus. However, he cautioned that one has to be careful of gastropathy. Low Dose Aspirin therapy can be used for primary prevention in patients with one or two risk factors or those who are in high-risk and family history of heart disease. One also has to be careful in cardiomyopathy and inpatients with diabetes who also suffer from atrial fibrillation, it should not be used.

Dr. Humaira and Dr.Nusrat sharing their views pointed out that Aspirin has also come as a wonder drug for the obstetricians and gynecologists.  We use it with excellent results in intra uterine growth retardation, DVT, Pulmonary embolism, in those patients who have a history of pregnancy loss, recurrent abortions and miscarriages where it is used in combination with low molecular weight heparin, bad obstetric history and infertility. It is also useful to take care of intra uterine deaths, dysfunctional uterine bleeding where it is used along with Metformin. Aspirin also improves endometrial lining. It has a good role in IVF cases as well. It is effective in pregnancy induced hypertension as well.

Dr. Munawar Jamshed participating in the discussion said that its side effects are dose dependent.Dr. Iqbal pointed out that let us not forget the brain. Its efficacy in prevention of stroke are well established and it also prevents recurrent strokes and TIAs. He further stated that if used on alternate days, it does not work since the life of the platelets is about eight to ten days and every day about 10% new platelets are formed. He further stated that there is no increased antiplatelet activity with increases dose hence one has to use 75-100mg which has been recommended in various studies.

In response to a question Mr. Shaukat Ali Jawaid clarified that in various studies doses of 75mg, 81mg and 100mg has been used. It is because in United States low dose Aspirin is mostly marketed in 81mg, in Europe and other countries it is marketed as 75mg, hence these doses have been used in various studies conducted in United States and Europe. It was also stated that one should first get the blood pressure under control and only then the patients should be prescribed low dose aspirin therapy.  In addition since most of the cardiac events take place early in the morning, it is preferable to take Aspirin after dinner at bed time to take care of early morning peaks in blood pressure.

Dr. Mumtaz referred to Aspirin resistance.  At this it was pointed out that it  wasvery expensive to study resistance to aspirin but in fact these are the patients who can be termed as non-responders.  There are some patients who do not respond to any hypertensive medication or anti-depressant. Likewise there are some patients who may not respond to Aspirin therapy as well. Dr. Zafar from WAPDA Hospital said that one has to careful while using various NSAIDs as well.

A group photograph of some of the participants in the Panel Discussion on Medical Uses of Aspirin
held at Sargodha on April 20th along with Prof. Siddique who chaired the session.

Prof Siddique in his concluding remarks said that Aspirin has a wide range of indications which are now very well established. However, one has to be careful and weigh the benefit vs. harm. Higher dose of aspirin can lead to serious complications. Real problems comes with the patient comes for surgery. Now it is said that one does not need to stop aspirin therapy though previously it was recommended to stop it five to seven days before surgery. However, one has to take into account individual patient as all patients are not the same. Those who have a tendency of bleeding should not be given aspirin. In such patients one has to be very careful and do not use it unless it is indicated. There is still some controversy as regards its use in primary prevention of cardiovascular diseases but small dose is not harmful and is quite safe and effective. We can use it prophylactically. If used in combination with clopidogril, it increases the antiplatelet activity but one must be mindful of the fact that the combination of these two anti-platelets also increases the risk and side effects.

Meeting at Faisalabad

Prof. A. Hafeez Chaudhry moderated the session at Faisalabad where it was attended by cardiac physicians and a select group of family physicians besides a neurosurgeon.

Addressing the participants Prof. Naeem Aslam said that the use of low dose Aspirin therapy became very popular when ISIS study showed that when compared with Streptokinase, there was equal reduction in mortality after AMI. If Aspirin was combined with Streptokinase, the mortality reduction was also significantly increased. Now it is recommended that every patient with chest pain must have aspirin immediately whether they are at home, in office or in the hospital as it could prove lifesaving. Not to use Aspirin in such a situation is not advisable at all. In Acute Myocardial Infarction one has to use 325mg tablet of Aspirin and soluble aspirin should be preferred and if it is enteric coated, these tablets should be chewed immediately. In case of myocardial infarction one can use Aspirin, Clopidogril and Streptokinase together. However, one has to be careful about the chances of bleeding in patients with history of acute bleeding or chronic liver disease.

Responding to a question as to how long one should take Aspirin after AMI, Prof. HafeezChaudhry remarked that it has to be taken for life long. Low dose aspirin therapy should also be prescribed to all the patients after interventional procedures like angioplasty and stenting unless it is contra indicated.

Mr. Shaukat Ali Jawaid clarified that in the developed world, Aspirin is promoted direct to the patients and it is available as OTC product but keeping in view the low literacy rate in Pakistan and to ensure that it is not misused andto  promote its rational use, Pakistan Aspirin Foundation had decided from the very beginning that we will promote it through the healthcare professionals.

One of the participants pointed out that many patients come with high blood pressure and when they are asked if they were taking any drug, they say they are taking Aspirin. As such the patientsí needs to be educated that Aspirin was not a drug for control of high blood pressure. It should only be used after blood pressure has been controlled where it is effective in BP management and keeping it under control. While performing surgery one can continue with Aspirin therapy but clopidogril has to be stopped.

Dr. Javed Iqbal pointed out that one has to be extremely careful with high doses of Aspirin. We give a loading dose of 325mg of Aspirin with Heparin and 600mg of Clopidogril before PCI because after PCI patient might come with acute thrombosis.  PCI patients should take aspirin forat least one year. In case of Drug Eluting Stents, patients should take aspirin for at least one year as they are high risk cases including those who are suffering from diabetes. After stenting care, some patients may end up with coronary occlusion if anti- thrombotic therapy is stopped.


 

Mr. Shaukat Ali Jawaid Chief Editor Pulse International presenting 
his latest book ďPlight of a Medical Editor: an autobiographyĒ to 
Prof. Mohammad Siddique at Sargodha on April 20th after 
the panel discussion on Medical Uses of Aspirin.

When asked about the use of Proton Pump Inhibitors (PPIs) for H. Pylori eradication and in gastric ulcer cases, it was pointed out that one should use the PPIs at leastfor six to eight weeks. If GERD patients come, do not continua using PPIs for too long? Replying to another question about stroke patients,it was stated that if CT is available it is advisable to get the CT immediately to eliminate the chances of hemorrhagic stroke and to see that  there is no bleeding. Once it is ruled out, then use Aspirin. However, in case of an emergency and if CT facility is not available, one can take chance with one tablet of Aspirin. Let the patient stabilize and then manage it appropriately. However, it is always advisable to have CT in such patients during the first twenty four hours.

In the end Mr. Shaukat Ali Jawaid thanked Prof. Siddique and all the distinguished participants at the meeting in Sargodha. He also thanked Prof. Hafeez Chaudhry for presiding over the session at Faisalabad and Prof. Naeem Aslam and Dr. Javed Iqbal for their valuable contributions during the panel discussion. He further clarified that these are manmade Guidelines and we in Pakistan Aspirin Foundation have tried our best to come up with Evidence Based Guidelines but still it was up to the treating physicians to look at the patients and after careful history, physical examination, calculate the risk and then decide for prescribing low dose aspirin therapy. He also thanked Atco Laboratories in general and Mr. Kashif Riaz their Business Unit Head and his team in particular for making all the arrangements for these meetings and sponsoring all the CME activities of the Foundation. However, he make it clear that keeping up the professional ethics, Pakistan Aspirin Foundation from its platform does not  promote any company or patronize any particular brand name of Aspirin. It was up tothe healthcare professionals to use any aspirin preparation, he remarked.

 
   

 
       
   

 Regular use of Low Dose Aspirin Therapy
reduces morbidity and mortality in ACS

Aspirin should be prescribed to patients with

hypertension after their BP has been controlled

 
       
   

RAJANA: Pakistan Aspirin Foundation as a part of its Continuing Medical Education programme organized a panel discussion at Foundation Hospital Rajana to highlight the safety and efficacy of regular use of Low Dose Aspirin Therapy on April 20th 2016. The meeting was jointly chaired by Prof. Altaf Hussain Rathore and Dr. Zeeshan Medial Superintendent of the Hospital. It was attended by all the consultant staff and Medical Officers of the hospital while Dr. Salman Athar Consultant Cardiologist at DHQ Hospital Toba Tek Singh also specially came to attend this meeting which was sponsored by Atco Laboratories.

Copies of the Guidelines for Medical Uses of Aspirin prepared by the Experts Panel of Pakistan Aspirin Foundation headed by Prof. Abdus Samad an eminent cardiologist of Pakistan as well as an informative booklet in Urdu entitled ďAspirin- the lifesaving miracle drugĒ were distributed among the participants.  Earlier a similar meeting was organized at Gogra on April 19th which was attended by a select group of cardiac physicians and Family Physicians. In his introductory remarks at both the meetings Mr.Shaukat Ali Jawaid General Secretary of the Foundation traced the history of the formation of this multidisciplinary group and its achievements, accomplishments so far.


Prof. Altaf Hussain Rathore and Dr. Mian Zeeshan Omar chairing the 
panel discussion on Medical Uses of Aspirin organized by Pakistan 
Aspirin Foundation at Foundation Hospital Rajana on April 20,2016.

The main objective is to promote the use of Aspirin in its well established indications by creating, awareness among the healthcare professionals and the public. The established uses of Aspirin include Acute Myocardial Infarction, Acute Coronary Syndromes, Secondary prevention of AMI, Primary Prevention of CAD, Acute Ischemic Strokes, TIAs, Hypertension, Diabetes Mellitus, Acute Rheumatic Fever, prophylaxis against Deep Vein Thrombosis and Pulmonary Embolism. In addition it has many emerging uses like pregnancy induced hypertension, Phospholipids Antibody Syndrome, colorectal cancer etc.

During the discussions Dr. Mian Omar Zeeshan and Dr. Salman Athar shared their views on the use of low dose aspirin therapy in ACS and other cardiovascular diseases and termed it as a lifesaving drug which is extremely economically priced and affordable for everyone and which is also easily available. However, it was pointed out that sometimes patients with severe hypertension come and when they are asked which drug they are taking, they say Aspirin which needs to be discouraged. Patients need to be educated that Aspirin is not a drug for treatment of high blood pressure. However, it should be used once the blood pressure has been controlled. In the past it was said that one should stop Aspirin before surgery but now it is recommended that one does not need to stop it and surgery can be performed safely. It was emphasized that in case of Acute Myocardial Infarction one full tablet of Aspirin 325 should be used and soluble Aspirin should be preferred in such cases. It was also stated that there is no difference in the efficacy of various doses of Aspirin and one can take 75mg, 81mg and 100mg whichever is available for long term use for prevention of cardiovascular events. Maintenance dose for Stroke and other cerebrovascular disorders including diabetes mellitus was 150mg daily. Responding to a question it was stated that there are no studies to prove that if one takes Aspirin on alternate days or once a week full tablet of 325 mg Aspirin which proves effective. Hence one has to take low dose aspirin therapy daily and enteric coated tablets were quite safe in long term use.


Participants of the panel discussion on Medical Uses of 
Aspirin organized at Gojra on April 19th 2016.

The participants were also informed that though one can take aspirin after meal any time in the day but now it is preferred that one should take it after dinner at bed time because it takes care of the early morning spikes as most of the cardiovascular events occur early in the morning. Aspirin was also being used with good results in patients with bad obstetric history, recurrent miscarriages in combination with low molecular weight heparin and in cases of infertility.

Hypersensitivity to Aspirin, Hemorrhagic diathesis, documented acute gastric or duodenal ulcer and pregnancy after thirty six weeks of gestation are some of the absolute contra indications for the use of Aspirin. The relative contra indications include G6PD deficiency, breast feeding, chronic and recurrent peptic ulcer, and bronchial asthma, severs renal or hepatic damage. Bronchial asthma is one of the contra-indications due to Aspirin sensitivity.  Guidelines on Aspirin it was stated have reviewed the literature on Aspirin till 2014 before finalizing this document which gives comprehensive details about its use, dosage in various disorders and contra indications. Pakistan Aspirin Foundation keeping up professional ethics, Mr. Shaukat Ali Jawaid stated does not recommend any particular brand of Aspirin and it is up to the physicians to use any aspirin preparation. However, we are extremely grateful to Atco Laboratories which is helping Pakistan Aspirin Foundation by sponsoring its CME programmes. Recommendations of the US Preventive Services Task Force on Aspirin Use for the Primary Prevention of Cardiovascular Diseases and colorectal cancer released on April 13, 2016 were also shared with the participants.  They recommend use of low dose Aspirin Therapy for primary prevention in patients with no risk of bleeding and one or two risk factors after the age of fifty years.  Since our life expectancy is about ten years less as compared to the developed countries, Pakistan Aspirin Foundation recommends it after the age of forty years.

In the end Dr. Mian Zeeshan Omarand Prof. Altaf Hussain Rathore thanked Pakistan Aspirin Foundation and Atco Laboratories for organizing this academic activity at Foundation Hospital Rajana which the participants found quite informative and useful. The participants were encouraged to share their observations and in case they have any queries, send it to Pakistan Aspirin Foundation and an effort will be made to provide an answer in the shortest possible time. Mr. Kashif Riaz from Atco Laboratories thanked the management of Foundation Hospital and the participants for sparing some of their precious time to attend this meeting.

The meeting at Gojra was attended by cardiac physician Dr. Mian Atif Mahmood andDr. M. Sultan, noted Family Physicians Dr. M. Ishfaq Wahla, Dr. M. Akram, Dr.M. Ishfaq, Dr. Asif Mehmood, and Dr. M. Waseem ophthalmologist.

 
   

 
       
   

 Panel discussion on use of Aspirin at Gujranwala and Sialkot

Healthcare professionals reminded to promote
the use of Low Dose Aspirin therapy in 
its well established indications

Guidelines prepared by Pakistan Aspirin Foundation 

gives comprehensive details about indications, dosage, 

contra-indications as well as emerging uses of Aspirin

 
       
   

GUJRANWALA & SIALKOT: Pakistan Aspirin Foundation as a part of its Continuing Medical Education programme for healthcare professionals organized panel discussion on Medical Uses of Aspirin at Gujranwala and Sialkot on March 8thand 9th respectively. A select group of cardiologists, physicians, obstetricians &gynecologists and Surgeons besides leading Family Physicians were invited to have their feedback on these Guidelines which were distributed among the participants along with an informative booklet in Urdu on Aspirin- a lifesaving miracle drug authored by late Dr. Maqbool H. Jafary and Mr. Shaukat Ali Jawaid Chief Editor of Pulse International who is also Secretary of the Foundation.

It may be mentioned here that despite lot of studies and literature proving the safety and efficacy of low dose aspirin therapy in a wide range of medical disorders, cardiovascular diseases in particular, aspirin is still under used in Pakistan and the situation is not different in many other countries as well. That is why Pakistan Aspirin Foundation has started this campaign of creating awareness about the use of Low Dose Aspirin therapy among the healthcare professionals.


Pakistan Aspirin Foundation organized a panel discussion on Medical Uses of Aspirin in its 
well established indications at Gujranwala on March 8th2016. Picture taken on this occasion 
shows Dr. Ikram Warraich and Mr. Shaukat Ali Jawaid (in the center) speaking on this 
occasion along with the participants.

Some of the well-establishedindications for regular use of low dose aspirin therapy are as under:

  1. Acute Myocardial Infarction(AMI)
  2. Acute Coronary Syndrome
  3. Secondary prevention of AMI
  4. Primary prevention of CAD
  5. Acute Ischemic strokes
  6. Transient Ischemic Attacks(TIAs)
  7. Primary and Secondary prevention of strokes
  8. Hypertension
  9. Diabetes Mellitus
  10. Acute Rheumatic Fever
  11. Prophylaxis against DVT and Pulmonary Embolism

In addition to the above there are some emerging indications for the use of Aspirin therapy which includes colorectal cancer, pregnancy induced hypertension, Eclampsia, Phospholipid Antibody Syndrome, Dementia and Alzheimerís Disease etc.


 

At the Gujranwala meeting after brief introduction of the Pakistan Aspirin Foundation and the Guidelines by Mr. Shaukat Ali Jawaid, Dr. IkramWarraich moderated the session and asked for input from the participants who actively participated in the discussion and put forward their views. Dr. Ikram Warraich remarked that Aspirin is also called as poor manís Streptokinase and poor manís Statin as it reduces mortality after acute myocardial infarction by 23% if one soluble tablet of Aspirin is taken immediately while the streptokinase injection which costs about five thousand rupees achieves similar mortalityreduction. However, if both are combined the mortality reduction is further increased. He also pointed out that even in impending cases of myocardial infarction, Aspirin is highly effective and proves lifesaving. Hence in case of chest pain, cardiac or non-cardiac in nature, one tablet of Aspirin 325mg should be give immediately. In acute conditions soluble aspirin should be preferred while for longer use low dose Aspirin enteric coated tablets are preferred because of safety.


Dr. Zeeshan and Mr. Kashif Riaz speaking at the Panel Discussion on Medical Uses of Aspirin 
organized by Pakistan Aspirin Foundation at Sialkot on March 9th 2016. Prof. Eice Mohammad
Prof. of Medicine at Islam Medical College presided who is also seen in the picture along 
with Mr. Shaukat Ali Jawaid. On extreme right is a view of the participants.

During the discussion it was also highlighted that first the patients should be advised to change their life style and reduce the known risk factors before starting any therapeutic intervention. Elderly patients who are already taking too many medications should avoid the use of Aspirin or use it very carefully. Replying to a questions regarding the use of Aspirin in Gout and Hyperuricemia, it was pointed out that in order to provide protection against cardiovascular disease to these elderly patients who are also suffering from Gout, low dose aspirin therapy is quite safe and can be given. However, it was emphasized that for long term use, lose dose of 75mg, 81mg or 100mg was recommended but for stroke the recommended dosage of Aspirin was 150mg daily. One of the participants suggested that in case of chest pain radiating to left side, one should first take an ECG. However, it was pointed out that it is neither feasible nor practical and ECG facilities may not be available at that time. It was also highlighted that the toxicity score of NSAIDs which are being extensively used was much higher as compared to Aspirin.


 

An obstetrician and Gynaecologist remarked that Aspirin therapy is indicated in patients with bad obstetric history, frequent miscarriages, secondary infertility besides pregnancy induced hypertension and we use it regularly. The panel discussion at Sialkot was chaired by Prof. Eice Mohammad and it was also attended by  cardiologists, physicians, surgeons, nephrologists, postgraduate students and leading family physicians. Consultant cardiologist Dr. Zeeshanspeaking at the occasion said that without cardiology there is no Medicine and without Aspirin there is no Cardiology which highlights the importance of Aspirin in management of cardiovascular diseases. He reiterated its use in well-establishedindications like AMI, CAD, primary and secondary prevention of AMI, stroke, IHD, TIAs, Acute Coronary Syndrome after PCI, angioplasty and Stenting besides numerous emerging indications for the regular use of low dose aspirin therapy. 

All individuals after the age of forty years with more than two risk factors like hypertension, obesity, overweight, family history of heart disease etc., should be put on regular low dose aspirin therapy.  One of the participants remarked that most of the doctors have a sedentary life style, hence they should also take low dose aspirin regularly. Dr. Zeeshan further stated that one can also use combination therapy of Aspirin with clopidogril which further enhances its efficacy. If it cannot be taken orally, one can administer aspirin through rectal route in emergency in acute conditions.

 

Some of the participants at the Panel Discussion on Medical Uses of Aspirin organized 
by Pakistan Aspirin Foundation at Sialkot on March 9th 2016.

Dr. Khawar Qureshi participating in the discussion endorsed the use of low dose aspirin therapy in its well established indications which he said, have been discussed in detail. Aspirin is being used now for more than one hundred years and its safety and efficacy in a wide range of medical disorders has been well established. For the first time it was also used for the treatment of arthritis. Dr. Mrs. Khawar Qureshi consultant obstetrician and Gynaecologist referred to the use of Aspirin therapy in PIH, cases of secondary infertility, repeatedmiscarriages, Eclampsia where Aspirin was being used regularly. Dr. Khawar Qureshi was of the view that while using Aspirin therapy one should always calculate the risk benefit ratio which is quite easy to calculate and then prescribe aspirin therapy. Responding to a question Mr.Shaukat Ali Jawaid said that there was no difference in efficacy hence one can use either 75mg, 81mg or 100mg enteric coated Aspirin tablets for long term use.  He also informed that recent studies suggest that low dose Aspirin therapy should be taken at night which will take care of the early morning spike in blood pressure as most of the heart attacks occur early in the morning.

Prof. Eice Mohammad in his remarks thanked Pakistan Aspirin Foundation for promoting the medical uses of Aspirin. However, he cautioned that in case of combination of Aspirin and Clopidogril, the risk of bleeding also increases and one has to be careful in such conditions.


 

Earlier in his introductory remarks Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation pointed out that the Foundation has no company bias. We strictly uphold professional ethics and do not support or promote any company or brand name. It is up to the healthcare professionals to use any Aspirin they like. However, he thanked Atco Laboratorieswhich has been sponsoring these CME programmes for the last many years. We are extremely thankful to them for this generosity and extending us their valuable help and assistance in this noble cause. These Guidelines, he further stated, have been prepared by an Experts Panel of Pakistan Aspirin Foundation headed by Prof. Abdus Samad an eminent cardiologists of Pakistan. Other members of the group included Prof. Ejaz Ahmad Vohra another distinguished physician from Ziauddin Medical University, Prof. M. Akbar Chaudhry presently Principal of Azra Naheed Medical College and all of them have served as Presidents of Pakistan Aspirin Foundation.  We reviewed the literature on Aspirin until 2014 before finalizing these guidelines and it was shared with a large number of eminent cardiologists to have their input before its final publication. He also thanked the participants for joining in the panel discussion and specially thanked Prof. Eice Mohammad who was kind enough to have graced the occasion with his presence and share his views on use of low dose aspirin therapy. Both these meetings were sponsored by Atco Laboratories.


 
       
   

HCPs are keen to promote Low Dose Aspirin
Therapy in its well established indications

Experts in group discussion highlight the safety, efficacy of this
most cost effective antiplatelet therapy which reduces morbidity
and mortality in various diseases

 
       
   

MULTAN: Pakistan Aspirin Foundation organized Group Discussions on Medial Uses of Aspirin at Rahim Yar Khan on November 16th, at Bahawalpur on November 17th and at Multan on November 18th 2015. It was attended by a select group of cardiologists, physicians, surgeons, gynecologists, neuro physicians, General Practitioners besides plastic surgeons. These meetings were sponsored by M/s Atco Laboratories and it generated lot of useful discussion providing an opportunity to the participants to share their knowledge and experience with the use of Aspirin.

Pakistan Aspirin Foundation, it may be mentioned here, has been organizing seminars for the last many years all over the country to create awareness among the healthcare professionals as well as general public about the usefulness of this highly economically priced anti-platelet therapy which reduces morbidity and mortality in a number of diseases. It has also been called as Poor Manís Statin and Poor Manís Streptokinase and just one tablet of 325mg taken immediately after acute myocardial infarction could prove lifesaving. This was first established by Dr. Peter Elwood the eminent Scottish Physician who published his findings in Lancet in 1974 and since then there has been a large number of studies on Aspirin in various diseases. Apart from cardiovascular diseases and cerebrovascular diseases i.e. Acute Coronary Syndrome, Coronary Artery Diseases, TIAs and Stroke, there are a large number of emerging indications for Aspirin therapy which are being studied and reported in the medical literature.

The Experts Panel of Pakistan Aspirin Foundation headed by Prof.Abdus Samad an eminent cardiologist and former General Secretary of Pakistan Cardiac Society who retired as Prof. of Cardiology from NICVD a few years ago has revised and updated its Consensus Report on Medical Uses of Aspirin which was published in December 2014. The copies of these guidelines as well as another highly useful informative booklet in Urdu on Aspirin the lifesaving miracle drug, are being distributed among the healthcare professionals. These group discussions were organized in the light of these guidelines and the main objective was to hear from the participants about their practice of using Aspirin therapy. They were also provided copies of these Guidelines and the booklet on Aspirin.

The first group discussion was organized at Rahim Yar Khan. In his introductory remarks Mr.Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation gave background information of Pakistan Aspirin Foundation and then highlighted salient features of this Consensus Report. The well-established indications for Aspirin therapy are:

1. Acute Myocardial Infarction
2. Acute Coronary Syndrome
3. Secondary prevention of AMI
4. Primary prevention of CAD
5. Acute Ischemic Strokes
6. Transient Ischemic Attacks(TIAs)
7. Primary and secondary prevention of strokes
8. Hypertension
9. Diabetes Mellitus
10. Acute Rheumatic Fever
11. Prophylaxis against DVT and Pulmonary Embolism

Some of the emerging indications for Aspirin Therapy include Phospholipids Antibody Syndrome, Pregnancy Induced Hypertension, Colorectal Cancer and Insulin resistance etc. The guidelines also give details about the mechanism of action of Aspirin, its pharmacokinetics, dosage in various diseases, side effects and contra indications. All the information included in this document has been properly referenced. Enteric coated Aspirin therapy is preferred because of its safety and long term use.

Absolute Contra-indications

Aspirin should not be used if the patient has Hypersensitivity to Aspirin or other Salicylate, Hemorrhagic diathesis, documented acute gastric or duodenal ulcer and in pregnancy after 36 weeks of gestation. Relative contraindications include G6PD deficiency, breast feeding, chronic or recurrent peptic ulcer, bronchial asthma, severe renal or hepatic damage etc.

Sharing their experience participants at Rahim Yar Khan Meeting said that they use Aspirin therapy in ACS, AMI, TIAs, Stroke. However, there was some discussion on the use of Aspirin in primary prevention, some felt it should be used while others were of the view that still there was not enough evidence for its use. Consensus Report on Medical Uses of Aspirin therapy contains over half a dozen studies in primary prevention with different results. Mr.Shaukat Ali Jawaid pointed out that the results of a multicenter multicounty study of Aspirin in primary prevention (ARRIVE) will be available soon which will give us a clear message. However, physicians are using it in primary prevention as well. Aspirin is also used in combination with clopidogrel in certain conditions which enhances its usefulness and efficacy in further reducing the morbidity and mortality. Dr. Shaukat Ali Rao, Dr.Abdul Majid, Prof. Tariq Rehan, Dr. Akhtar Malik, Dr. Ghulam Fareed, Dr. Abid Shah, Dr. Haque Nawaz Rahi and many others shared their experience. Prof.Tariq Rehan said that they stop Aspirin a few days before elective surgery. There was discussion on various doses of Aspirin being used and mentioned in the literature at which it was stated that any dose above 50mg has adequate antiplatelet effect hence 75mg, 81mg or 100mg were all effective.

Dr. Shahadat Hussain moderated the discussion at Bahawalpur. Dr. Altaf highlighted its use in diabetes and hypertension besides antiphospholipid syndrome. Dr. Shahid said they use it in TIAs and stroke besides Deep Vein Thrombosis and pulmonary embolism. Dr. Asifa Shahid said that Aspirin was very beneficial in complicated pregnancy, in patients with poor fetal outcome, even it is advised to use it in pre conception period about three months prior to conception. It is suggested that the pregnant women should be prescribed calcium, aspirin and folic acid regularly. Aspirin can be discontinued three months after pregnancy. Dr.Fahad plastic surgeon said that they do stop aspirin during surgery but once wound healing starts; use of aspirin allows adequate blood supply. Dr.Waseem said they use Aspirin in Hypertension and DVT. However, it was emphasized that one must make sure to control blood pressure first and then start low dose aspirin therapy.

Prof. Munir Azhar Chaudhry in his detailed discourse said that Aspirin was safe and an effective antiplatelet therapy in thrombosis, antiphospholipid syndrome, auto immune disorders, scleroderma, cardiomyopathies as well apart from ACS and CAD. However, it is contraindicated in chronic liver failure and cardiac failure as there was an additional risk of bleeding. One of the general practitioners opined that after the age of forty years, regular use of low dose aspirin was desirable. As regards use of Aspirin in primary prevention it was generally felt that one should calculate the risk score and if it was more than 10%, only then Aspirin therapy should be used. Dr. Shahadat opined that since the platelets have a half-life of six days, one should always weigh the benefits and risks as regards side effects. If the benefits outweigh the risks, then aspirin therapy should be started. He suggested calculating the risk scores in men over forty five years and women over fifty five years before putting them on regular low dose aspirin therapy. Low dose aspirin has to be taken daily and not once, twice or three times a week. Others who actively participated in the discussion included Dr. Sarwar Khalid, Dr. Aftab Jameel, Dr. Akram Ahsan, Dr. Arif Ali Zaidi and Dr.Shaukat Ali. Prof.Haroon Khursheed Pasha, Principal of QAMC and Prof. Javed Iqbal Head of the Dept. of Surgery at QAMC also came to the meeting venue for a while and left soon after since they were having a meeting with the Audit team.

Winding up the discussion Prof. Usman Ghani emphasized that Aspirin remains the ideal anti platelet agent and the most cost effective antiplatelet in atherosclerosis, IHD, prevention of recurrence of acute myocardial infarction. Those patients who have many other risk factors like diabetes, smoking, obesity, strong history of sudden death, family history of CAD should benefit from the regular use of low dose aspirin therapy. However one should be careful in case of hemorrhages. Similarly those patients who have bleeding diathesis, active ulcer are seen with bleeding from the whole stomach and these hemorrhages could be catastrophic. Always control the blood pressure first and then start using low dose aspirin therapy. It can be safely used in pregnancy induced hypertension. Some patents may complain of bleeding from gums and have many other similar problems hence in such cases one should always avoid use of aspirin. However, those with sedentary life style, high LDL cholesterol can benefit from Aspirin. Stroke and strong family history of IHD are highly disabling diseases. Hence use of aspirin in these patents, if there are no contra indications, can reduce the morbidity and mortality.

Dr. Tariq Abbas from CPI Institute of Cardiology moderated the group discussion at Multan. The meeting was very well attended by cardiologists from institute of cardiology, cardiac surgeons, faculty members from Nishtar Medical College Multan, eminent Family Physicians besides gynecologists. Participating in the discussion cardiac surgeon Dr.Haider Zaman said that Aspirin is a wonder drug. We use it regularly in post CABG. It is also used after stenting and angioplasty. Another participant opined that we use it with other anti-coagulants in high risk cases for dilatation of the vessels. American Heart Association has also recommended the use of low dose aspirin therapy in may cardiac diseases including post CABG. It is also recommended for primary prevention. Others who actively participated in the deliberations included Prof. Ajmal Malik, Dr. Ali Bin Saeed, Dr. Abdul Sattar, Dr. Saeed Ahmed, Dr. Nisar and Dr. Sadaf.

The participants were of the view that in high risk cases with other co morbidities like hypertension, diabetes one can use aspirin therapy for primary prevention. Its efficacy in pregnancy induced hypertension was also highlighted. However, it was emphasized that every drug has certain side effects which must be kept in mind. The first and foremost duty of the healthcare professionals is education of patient, advising them to modify their life style, use healthy balanced diet and also do regular exercise. Promotion of health and healthy life style should be given due importance and preference. It was also pointed out that one can use low dose aspirin therapy in Gout because it will ensure protection from cardiac diseases in these elderly patients who are also suffering from many other co morbidities. It was further stated that low dose aspirin therapy should be taken at bed time as it will take care of early morning spike in blood pressure since most of the acute myocardial infarction occurs early in the morning. The dose recommended for patients with stroke was 150mg daily.

Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation addressing the participants of these group discussions at all the places emphasized that they were extremely grateful to Atco Laboratories for sponsoring their CME programmes for the last many years. However, keeping up the professional ethics, the Foundation does not have any company bias and does not patronize any particular brand of aspirin. It is up to the healthcare professionals to choose any aspirin preparation.

Mr. Akhtar Tahir Director Marketing from Atco Laboratories thanked the participants of these group discussions at Rahim Yar Khan, Bahawalpur and Multan for sparing their precious time to share their knowledge and experience. Atco Laboratories, he said was very conscious of quality control and to ensure production of high quality drugs, it has made huge investments in modernization and expansion of its drug manufacturing plant. Hence they can use with confidence drugs produced by Atco Laboratories at its state of the art most modern drug manufacturing facility as we follow current Good Manufacturing Practices to ensure availability of high quality cost effective medications. Earlier Mr. Kashif Riaz Business Unit Head in Atco Laboratories welcomed the participants of the meeting on behalf of Atco and Pakistan Aspirin Foundation.


 
       
   

 Seminar on Medical Uses of Aspirin during  PAFP Familycon 2015

CAD patients with absolute risk of more than
10% should be put on low dose Aspirin
therapy - Prof. Akbar Chaudhry

Regular use of LDA significantly reduces morbidity,
mortality and vascular events - Prof. Javed Akram

 
       
   

ISLAMABAD: The first scientific session during the Mid Year Familycon 2015 organized by Pakistan Academy of Family Physicians in collaboration with SZABMU PIMS as well as Pakistan Aspirin Foundation held here on July 26th was devoted to Medial Uses of Aspirin. Prof. Javed Akram Vice Chancellor of Shaheed Zulfikar Ali Bhutto Medical University who is also current President of Pakistan Aspirin Foundation was the first speaker. He made a presentation on mode of action of Aspirin. He discussed in detail platelet adhesions and activation, platelet aggregation leading to thrombosis which eventually leads to myocardial infarction. Anti Platelet Trialists Collaboration study, he said, has showed that regular use of low dose Aspirin results in 30% reduction in morbidity and mortality and it is also known as poor manís Statin. Aspirin works in primary as well as secondary prevention. It is quite effective in unstable angina and prevents vascular events. Low dose Aspirin therapy overweighs benefits as compared to harm. Those who wish to donate blood, if taking Aspirin should stop Aspirin therapy at least ten days before donating blood.


Dr. Aftab Iqbal President Pakistan Academy of Family Physicians
presenting a mementoe to Prof. Javed Akram VC SZABMU at
the Familycon 2015 Mid Year Conference held at Islamabad on
July 26th2015. Also seen in the picture are Prof. Maj. Gen.
M.Aslam VC UHS, Dr. Altaf Cheema and others.

Continuing Prof. Javed Akram said that Aspirin was a wonder drug which continues to surprise us every day with its new and emerging indications. It is very effective in antiphospholipid syndrome and quite useful in infertility. The reported resistance to Aspirin was just about 9%. Most often we use 75mg of Aspirin for long term use but in some cases like stroke, upto 150 Mg is used which is quite safe and effective. In severe cases it can be combined with clopidogrel. Aspirin is a gold standard antiplatelet agents and all other antiplatelet are judged while comparing with Aspirin. In acute MI, soluble Aspirin should be used for immediate effect which reduces mortality by 23%, he added.

Prof. Akbar Chaudhry an eminent physician, former President of Pakistan Aspirin Foundation who is currently Principal of Azra Naheed Medical College in his most comprehensive presentation on Medical Uses of Aspirin discussed in detail its well established indications. Speaking about the real threat to urban health, he pointed out that about 7.8 million deaths occur annually in developing countries due to coronary artery disease. Cardiovascular diseases also account for 29% of global deaths and 82% of CVD deaths are in poor and low income countries. Cardiovascular diseases are also more prevalent in India, China and it is reported that almost 25% of people above the age of forty years suffer from coronary artery disease.


Prof. M. Akbar Chaudhry and Dr. Shehryaar Bhatti speaking at the Familycon 2015
meeting by PAFP held at Islamabad on July 26, 2015.

In Pakistan, Prof. Akbar Chaudhry said, we develop cardiovascular diseases a bit early; hence we should lay more emphasis on prevention which is also cost effective rather than on treatment of these diseases. Some of the known risk factors for CAD which can be modified include hypertension which accounts for almost 18%, diabetes mellitus from which 6.9 million people are suffering in Pakistan, dyslipidaemias account for 27.54%, obesity which accounts for 46-68% and metabolic syndrome 34-49%. Smoking cessation, physical activity, diet therapy, weight control, blood pressure, lipids and diabetes control should be combined with regular use of low dose Aspirin Therapy. At present 37.6% Aspirin use is in cardiovascular diseases and its regular use reduces mortality by 25% in MI but if it is combined with clopidogrel, the mortality reduction can be up to 45%. If we treat one thousand patients with low dose Aspirin, we will prevent thirty Myocardial Infarction and angina. As regards its usage in primary prevention, it leads to one third reductions in Myocardial Infarction and one sixth reduction in vascular events. Following are the well established indications for use of aspirin therapy:

  1. Acute Myocardial Infarction

  2. Acute Coronary Syndrome

  3. Secondary prevention of AMI

  4. Primary prevention of CAD

  5. Acute Ischemic Strokes

  6. Transient Ischemic Attacks

  7. Primary and Secondary Prevention of Strokes

  8. Hypertension

  9. Diabetes Mellitus

  10. Acute Rheumatic fever

  11. Prophylaxis against DVT and Pulmonary Embolism

Continuing Prof. Akbar Chaudhry said that those CAD patients who have an absolute ten years risk of less than 6% should not be prescribed aspirin therapy but those whose risk is between 7-9%, it should be patientís choice and this should be discussed with the patient. However in those CAD patients whose absolute ten years risk is over 10%, they must be put on Low Dose Aspirin therapy. Use of enteric coated Aspirin in low dose is quite safe and effective in long term use. It will result in 46% reduction in unstable angina, 33% reduction in stable angina. Despite the fact that the safety and efficacy of Aspirin has been very well established in numerous studies, even then it is quite under used. Pakistan Aspirin Foundation, Prof. Akbar Chaudhry said conducted Aspirin Usage and Awareness Study some years ago which revealed that only 16% of patients got Aspirin at home when they suffered from chest pain, only 20% of these patients were prescribed Aspirin by Family Physicians within six hours of MI while Aspirin use in Emergency Room was 60% and 71% in the Ward. However, what was more surprising was the fact that only 50% of these acute coronary syndrome patients were prescribed low dose aspirin therapy on discharge. This prompted us to start these CME programmes to create awareness among public as well as healthcare professionals about the use of Aspirin. Now a latest study Climate Asia has showed that 31% of patients were taking Aspirin for primary prevention, 43% of patients were already on low dose Aspirin therapy, 92% of these ACS patients were prescribed Aspirin whereas 42% were using it along with Clopidogrel. Patients suffering from Type 2 Diabetes Mellitus should also be put on low dose aspirin therapy using 150mg daily.


Prof. M. Akbar Chaudhry, Dr. Aftab Iqbal Sheikh President PAFP,
Prof. Javed Akram VC SZABMU, Prof. Waris Qidwai performing
the cake cutting ceremony celebrating the 20 Years of launch
of Ascard after the seminar on Medical Uses of Aspirin
organized during the Mid Year Familycon 2015
held at Islamabad on July 27th 2015.

Speaking about the new and emerging indications for Aspirin therapy Prof. Akbar Chaudhry mentioned colorectal cancer, prostate cancer, pre eclampsia, DVT, pulmonary embolism, insulin resistance etc. In high risk cases it should be combined with Statins. Some of the contraindications for use of Aspirin therapy include allergy to Aspirin, active peptic ulcer disease and other blood disorders. It should also be used with caution in people over eighty years of age.

Earlier Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation gave a historical background of the formation of PAF, its activities and accomplishments so far. He mentioned the series of CME programmes which are being organized all over the country in collaboration with various professional specialty organizations and PMA in different cities which are all sponsored by Atco Laboratories. Publication of Book on Aspirin, publication of a booklet in Urdu besides revision and updating the Guidelines on Medial Uses of Aspirin. These revised guidelines were finalized by a panel of experts headed by Prof. Abdus Samad. Other members included Prof .Ejaz Ahmad Vohra, Prof. M. Akbar Chaudhry, Mr. Shaukat Ali Jawaid while a large number of eminent physicians have also contributed to this document. Lt.Gen. Mahmud Ahmad Akhtar former Surgeon Gen. of Pakistan Army has also made significant contribution to the development and finalization of these Guidelines which are now being distributed among the healthcare professionals. Pakistan Aspirin Foundation, Mr. Shaukat Ali Jawaid further stated has a very democratic set up, office bearers are elected every two years. Its website www.Pakaspirin.org.pk gives details of members, CME activities, achievements and accomplishments so far. It also has the latest revised Guidelines on Medical Uses of Aspirin. Its membership is open to Healthcare professionals and public and life membership is just Rs. 2,000/- (Rupees two thousand only). We are extremely grateful to Atco Laboratories for sponsoring our CME activities for the last many years but keeping up the professional ethics, we do not patronize any particular brand name of Aspirin and doctors are advised to use Aspirin in its well established indications and ensure its optimal usage which will go a long way in reducing morbidity and mortality in a wide range of diseases.

 
   
 
   

 
       
   

Prevention and Treatment of CAD, ACS
Family Physicians advised to promote the
 use of Low Dose Aspirin Therapy to
reduce morbidity and mortality

Aspirin remains the most economically
priced safe and effective antiplatelet agent

 
       
   

LAHORE: Pakistan Aspirin Foundation in collaboration with Pakistan Association of Family Physicians organized a special session on Aspirin during the recently concluded FAMILYCON 2014 at Lahore. This session was chaired by Prof. Bilal Zakariya Khan, Chief Executive of Punjab Institute of Cardiology. The speakers included Prof. Javed Akram President of Pakistan Aspirin Foundation and Vice Chancellor of Benazir Bhutto University (PIMS) Islamabad and Prof. Akbar Chaudhry Principal of Azra Naheed Medical College Lahore besides Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation.
Prof. Javed Akram in his presentation highlighted the mode of action of Aspirin and how it inhibits the aggregation of platelets. He also referred to various studies highlighting the safety and efficacy of Aspirin in CAD and various other medical disorders.
Prof. Akbar Chaudhry another eminent physician who is also former President of Pakistan Aspirin Foundation highlighted the use of Aspirin in its well established indications wherein it has proved that it significantly reduces morbidity and mortality. Even a single tablet of 325mg of Aspirin, taken immediately after myocardial infarction can be life saving and its regular use reduce the chances of re-infarction. Studies Prof. Akbar Chaudhry said have shown that the burden of cardiovascular diseases is going to increase further in the coming years and most of this burden will be in developing low resource countries. Since curative services are extremely expensive, prevention remains the only viable option for these countries.
He then referred to various studies which showed that regular use of Aspirin not only prevents heart attacks but is also quite useful in Acute Coronary Syndromes. Coronary Artery Disease has emerged as an epidemic in Pakistan. Modifiable risk factors include control of hypertension, diabetes mellitus, Dyslipidemia, obesity, metabolic syndrome and smoking and this should be supplemented with regular use of low dose Aspirin therapy. Talking about benefits of Aspirin, Prof. Akbar Chaudhry said that it reduces risk of first MI by 33%, risk of first stroke by 25%, risk of CVD death by 17%. In Secondary prevention with Aspirin the risk of serious vascular events are reduced by 46% in unstable angina, 33% in stable angina, 23% in peripheral arterial disease and 53% in patients undergoing angioplasty. Previously Aspirin Awareness and Usage study (AAUS) conducted by Pakistan Aspirin Foundation which enrolled over fifteen hundred patients in seventeen CCUs all over Pakistan showed that only 50% of ACS patients were prescribed Aspirin at the time of discharge, only 20.8% of patients were prescribed Aspirin by their family physicians and only 16% of patients took aspirin at home when they suffered from chest pain. Now as a result of CME activities by Pakistan Aspirin Foundation the use of Aspirin has increased but still the Family Physicians, he said, need to promote its use in its well established indications. It is an extremely safe and effective antiplatelet agent which is economically priced. It is useful in hypertension once the blood pressure has been controlled, is recommended in patients undergoing interventional procedures like angioplasty and stenting, after CABG, in Type-2 diabetics, pulmonary embolism, TIAs and Stroke while its new and emerging indications include colorectal cancer, gastric ulcer, dementia and renal diseases. In case of contra indication like peptic ulcer, asthma, or allergy to Aspirin, other antiplatelet agents should be used. The combination of Aspirin and Clopidogrel, he said is more effective in reducing morbidity and mortality in CAD. Various studies have also showed its efficacy in primary prevention of CAD, he added.
Mr. Shaukat Ali Jawaid Chief Editor Pulse International speaking on the occasion said that you go to any medical conference, use of Aspirin always figures in presentations and discussion. This is the most widely researched drug and every month thousands of papers are published on the safety and efficacy of Aspirin in various medical disorders. Eminent Scottish Physician Dr. Peter Elwood who first proved in 1974 that Aspirin reduces the chances of death in Acute Myocardial Infarction and also prevents secondary infarction always carries Aspirin tablets in his Jacket saying that he or any of his friend might use it any time. Mr.Shaukat Ali Jawaid urged the family physicians to educate the patients to take one tablet of Aspirin immediately when they feel chest pain. They should also keep Aspirin with them all the time in office, clinic and home. Most often heart attacks occur early in the morning when neither the doctor nor transport is available easily hence if the patients experiencing chest pain take one tablet of Aspirin immediately, it might save their lives. Regular use of Low Dose Aspirin 75-100mg is preferable at night. Enteric coated Aspirin is extremely safe and effective in long term use. However, in case of any contraindication, other antiplatelet agents can be used, he added.
Pakistan Aspirin Foundation, he pointed out has also published an informative booklet on Aspirin in Urdu which gives comprehensive details about indications as well contra indications for Aspirin therapy and its doses in various indications. These guidelines are available on its website www.pakaspirin.org.pk. He also advised the family physicians to adhere to ethical medical practice and improve the quality of general practice and make sure that their services are affordable for the common man. If they failed to do so, they will be indirectly promoting quackery which is already a great menace.
It was also announced that though Pakistan Aspirin Foundation is extremely grateful to M/s ATCO Laboratories for sponsoring its CME activities for the last many years but keeping up the professional ethics, we do not patronize and support any particular brand of Aspirin. It is up to the physicians to prescribe any Aspirin preparation.
Prof. Bilal Zakariya in his concluding remarks said that there have been some reports of Aspirin resistance. The doctors should prescribe Aspirin which is produced by quality conscious pharmaceutical companies so that there are no dissolution problems.

 
   
 
   

 
       
   

 
       
   

Healthcare professionals must balance risk
and benefits before prescribing any
medication- Prof. Khawaja Saadiq Hussain

Aspirin like any other drug has its own side effects, hence
must be used carefully in its well established indications

 
       
   

LAHORE: Healthcare professionals must balance the risk and benefits before prescribing any medication. Aspirin like any other drug has its own side effects hence members of the medical profession should be careful and use it judiciously in its well established indications. This was stated by Prof. Khawaja Saadiq Hussain an eminent physician former Principal of King Edward Medical College and former President of College of Physicians and Surgeons Pakistan. In his concluding remarks at the first scientific session of the 6th National Conference of Pakistan Aspirin Foundation which he chaired along with Prof. Mahmood Ali Malik another noted physician and former Principal of King Edward Medical College, Prof. Khawaja Saadiq Hussain said that Aspirin was very economically priced, safe and effective drug which is easily available everywhere. This conference was held at FJMC Lahore on October 5th and it attracted a large number of members of the medical and nursing profession while many medical students from Azra Naheed Medical College and few  postgraduates were also present.

Prof. Kh. Saadiq Hussain along with Prof.Mahmood Ali Malik chaining the
 first scientific session of National Conference of Pakistan Aspirin Foundations
held at FJMC on October 5th2013. Also sitting on the dais along with them are
speakers of this session Prof. Saulat Siddique, Prof. Naeem Qasuri,
Prof. M. Akbar Chaudhry and Prof. Muneeza Qayum.

Prof. Khawaja Saadiq Hussian further stated that according to reports over one hundred billion tablets of Aspirin are used daily all over the world for various indications. It has been in clinical use for now over hundred years and its use was now being seen more and more ever since itís antiplatelet activities were discovered proving it to be a life saving drug in acute myocardial infarction. It is useful in a wide variety of medical disorders including cardiovascular diseases but he cautioned that one must be careful if its side effects as well. It is advisable to look at individual patient, take proper detailed history and do comprehensive clinical examination before prescribing any medication. Patient education was also extremely important he added.

Prof. Kh. Saadiq and Prof.Mahmood Ali Malik being present flower
Bouquet on arrival at FJMC for the Aspirin Conference. Also seen on
right is  Prof. Sardar Fakhar Imam Principal FJMC and Chairman
of the organizing committee of the conference.

Prof. Muneeza Qayum Prof. of Pharmacology at FJMC was the first speaker in this session which was moderated by Prof. Zubair Akram.  In her most comprehensive presentation Prof, Muneeza Qayum discussed the historical perspective as well as mechanism of action and pharmacokinetics of Aspirin. She dealt at length how this wonderful molecule was discovered by Dr. Felix Hoffman and first used by various people for different conditions including arthritis.  Since then its antiplatelet properties have been further highlighted and now it is extensively used to treat a variety of medical disorders where it has proved to reduce morbidity and mortality.


Prof. Bilal Zakariya along with Prof. Sardar Fakhar Imam
Principal JMC and Prof. Abdus Samad chairing one of
the scientific sessions during the Aspirin Conference. On extreme
left is Prof. Maryam Malik moderator of the session.

Prof. Zubair Akram Prof. of Cardiology at Allama Iqbal Medical College gave an update on use of Aspirin in cardiovascular diseases with particular reference to Acute Coronary Syndrome and secondary prevention of cardiovascular diseases. It has proved its life saving properties in acute myocardial infarction and studies have shown upto 30% reduction in mortality. However, if it was combined with clopidogrel, the mortality reduction is increased upto 43%.




Members of the Experts Panel during the Panel Discussion at Aspirin Conference held at JMC on October 5th from
 (L to R) are Prof Sardar Fakhar Imam, Prof.Nazeer Memon, Prof.Abdus Samad, Prof. Zaman Sheikh, Mr. Lateef Sheikh,
Prof. Akbar Chaudhry, Prof. Javed Akram, Prof.Tujamal, Prof. Maryam Malik, Dr.Shahid Karim and Prof. S.H.Shafqat.

Prof. Naeem Qasuri Prof.of Neurology at King Edward Medical University gave an update on use of Aspirin in cerebrovascular diseases and highlighted the safety and efficacy of Aspirin in acute ischaemic stroke, TIAs besides secondary prevention of stroke. Prof. Naeem Qasuri suggested that it was advisable to go for the option of managing various risk factors and removal of potential causes. Judicious use of anti-coagulants and antiplatelet can be extremely helpful.  He also referred to various markers and contra indications for the use of these medications.  He also gave details of International Stroke Trial and CAST stroke trial in China which showed 36% reduction in mortality in stroke. CAST trial included 21,106 patients and it also showed the beneficial effects of Aspirin. In both these trials which included over forty thousand patients, there was mortality reduction of seven per thousand and four per thousand respectively. It also showed further reduction in stroke and death. Speaking about secondary prevention he highlighted the results of ESPS2 trial. Some studies have showed that there was no benefit of Aspirin in primary prevention of stroke but other studies like ATC trial showed 25% risk reduction in secondary prevention. Dual antiplatelet therapy did not show any significant reduction in stroke but it was associated with 7% increase in hemorrhagic stroke. The risk of bleeding was 1% to 2.1%.  Combined use of Aspirin and Clopidogrel increases the risk of hemorrhagic stroke. For secondary prevention a dose of 75-150mg a day is recommended but it is twice as effective in a combination of extended release form. He also referred to Aspirin resistance and non-responders and said that as per some studies one third of patients may not respond to Aspirin. Further studies have showed that use of Aspirin results in 22% relative risk reduction whiles with the use of Warfarin the relative risk reduction is increased upto 68%, he added.




Prof. Aamar Zaman Khan, Mr.Lateef Sheikh, Prof. Maryam Malik, Dr.Rehan Umar and Dr.Abbas Raza
speaking at the 6th National Conference f Pakistan Aspirin Foundation held at FJMC on October 5th2013.

Prof. Akbar Chaudhry in his presentation on use of Aspirin in primary prevention of Ischaemic Heart Disease and Stroke said that cardiovascular diseases will remain the number one cause of death globally and by 2030 it is estimated that 23.6 million people will die from CVD mainly from heart diseases and stroke. The largest percentage of increase of these deaths will be in Eastern Mediterranean Region in which Pakistan is located. Speaking about the risk factors he mentioned hypertension, diabetes mellitus, dyslipidemia, obesity, metabolic syndrome and smoking etc. For countries like Pakistan it is not curative but preventive strategies which is the solution. As regards guidelines for primary prevention it includes risk intervention like smoking cessation, physical activity, diet therapy, weight control, blood pressure control, lipid control, diabetes control besides Aspirin therapy.

Currently Aspirin is extensively used in cardiovascular diseases followed by arthritis, headache, body aches and as antipyretics. The established uses of Aspirin include Acute Myocardial Infarction, Acute Coronary Syndrome, Secondary prevention of MI, Primary prevention of CAD, TIAs and Stroke, Hypertension and diabetes. Elaborating the use of Aspirin in primary prevention of CAD, he said that if the absolute ten years risk is less than 6%, there is no need for Aspirin therapy but if it is upto 9%, it should be left at patientís choice but if the ten years risk is more than 10%, these patients must be put on low dose Aspirin Therapy, he added. Women Health Study showed that it reduced 17% stroke, reduction of ischaemic stroke was 24% but what was more important was the fact that it reduced non-fatal stroke by 19% in women besides 22% reduction in TIAs. Meta analysis of six studies also showed that Aspirin lead to 17% stroke reduction in women as compared to 14% reduction of stroke in men. Referring to the Aspirin Awareness and Usage Study (AAUS) conducted in Pakistan, Prof. Akbar Chaudhry said that at the time of discharge only 50% of ACS patients were prescribed Aspirin, only 20.8% of patients were prescribed Aspirin by their Family Physicians while only 16%   patients took Aspirin at home when they suffered from chest pain.  This is a very dismal picture but these figures are six years old and over these years use of Aspirin has increased due to the CME activities by Pakistan Aspirin Foundation. Summing up the overall benefits of low dose Aspirin Therapy Prof. Akbar Chaudhry said that  risk of serious vascular events is reduced by 46% in unstable angina, 33% in stable angina,  23% in peripheral arterial diseases and 53% in patients undergoing angioplasty.  Aspirin with its life saving properties in cardiovascular diseases does not fail to surprise us all as a miracle chemical. With the every passing day, we see a variety of new indications emerging for the use of Aspirin but we need more data to start their routine use in those indications, Long term use of low dose aspirin therapy is extremely safe, effective and could go a long way in reducing morbidity and mortality. To prevent significant number of first MIs in men and Stroke in women and premature deaths, low dose aspirin should be used while in high risk individuals, Statins should be added to Aspirin.




On left a group of medical students from Azra Naheed Medical College photographed with
 Prof. M. Akbar Chaudhry Principal ANMC during the national conference of
Pakistan Aspirin Foundation held at FJMC while on right the picture shows
Prof. S. H.Shafqat, Prof.Abdus Samad and Prof.Kh.Saadiq Hussain.

Use of Aspirin in Hypertension

Prof. Saulat Siddique Prof. of Cardiology at Shaikh Zayed Postgraduate Medical Institute Lahore highlighted the use of Aspirin in Hypertension.  He first described the complications of hypertension which is a risk factor for TIAs and Stroke, retinopathy, peripheral vascular disease, LVH, CHD, HF and renal failure. A large number of meta analysis have shown that antiplatelet treatment is highly beneficial in secondary CV prevention but in patients with low risk,  antiplatelet treatment is associated with only a very little excess of benefits over harm. Some trials have also shown that bed time use of Aspirin lowers the blood pressure but some other studies have also showed increase in risk of developing hypertension in Aspirin users. In Pakistan only about 3% of hypertensiveís have controlled their blood pressure and as we know hypertension is a major risk factor for not only stroke but myocardial infarction, heart failure, chronic kidney disease, cognitive decline and premature death. Untreated hypertension can cause vascular and renal damage leading to treatment resistant state. Low Dose Aspirin therapy is useful in control of hypertension and primary CV events, he added.

Benefits of Aspirin in Diabetes

Prof. Mahmood Ali Malik highlighted the benefits of Aspirin in Diabetes Mellitus. He pointed out that people with Type-2 diabetes are at high risk of cardiovascular events from the time of diagnosis and this risk is often present in the pre-diabetic phase of the disease. Hence an approach that focuses on early risk factor identification and management to prevent or delay accelerated atherosclerosis and thrombosis in diabetes is an attractive strategy.  Atherosclerosis can be prevented or delayed by controlling hyperglycemia, hypertension and dyslipidaemias while for thrombosis the use of Aspirin is recommended. Low dose aspirin therapy, Prof. Mahmood Ali Malik stated is indicated as a preventive strategy in all high-risk diabetic patients regardless of blood pressure or blood lipid level.   All diabetic patients who have had one major vascular event like myocardial infarction, stroke or TIA, history of angina, vascular surgery, atrial fibrillation and valvular heart diseases are high risk individuals, he added. Continuing Prof. Mahmood Ali Malik said that prolonged Aspirin therapy has been shown to offer significant protection against myocardial infarction, stroke, and vascular death in patients with clinically apparent vascular disease.  Effects of Aspirin treatment on survival in non-insulin dependent diabetic patients with CAD were studied which showed that it was associated with a significant reduction in cardiac and total mortality among NIDDM patients with CAD. Absolute benefit of Aspirin was greater in diabetic patients as compared to those without diabetes. Use of Aspirin in patients with diabetic retinopathy is safe as EDRTS study has shown that there was no significant increase in gastrointestinal bleeding or hemorrhagic stroke. The recommended dose is 75-325mg and all of them are equally effective. There is some advantage of initial loading dose and for long term safety one should use enteric coated aspirin tablets. However, aspirin is contra indicated in patients who have allergy to Aspirin, have bleeding tendency, are on anticoagulant therapy, have recent gastrointestinal bleeding or have clinically active hepatic disease.

The presentations were followed by lively discussion. Responding to one of the questions Prof. Javed Akram remarked that in Dengue Fever patients, one should not use Aspirin but paracetamol. Similarly patients with ulcer should also not be put on Aspirin therapy.


 
   

 
   

 

 
   

Stopping use of Aspirin three to five days before
surgery or endoscopic procedures is ideal in
most of the cases - Prof. Aamer Zaman Khan

Aspirin therapy is useful in colorectal cancer prevention
but in low risk patients, it offers no benefits - Dr. Abbas Raza

 
       
   

LAHORE: Prof. Abdus Samad along with Prof. Sardar Fakhar Imam and Prof. Bilal Zakariya chaired the second scientific session during the 6th National Conference of Pakistan Aspirin Foundation held at FJMC on October 5, 2013. Prof.Maryam Malik was the moderator of this session.   Dr. Abbas Raza from AIMC was the first speaker who talked about Aspirin and Gastrointestinal Tract. He discussed in detail the spectrum of Aspirin induced mucosal injury, NSAIDs induced ulcerations, use of NSAIDs leading to gastric lesions and pointed out that it is associated with 15% gastric ulcer, 5% duodenal ulcer and 2% chronic rectal ulcers. Dual antiplatelet therapy Dr. Abbas Raza stated increases the risk while toxicity is also increased with increased dose. During the first month use, the patients may have higher complications. Its use is beneficial in colorectal cancer but in low risk patients, use of Aspirin may not have any benefits.




Prof.M.Akbar Chaudhry, Prof. Ejaz Ahmad Vohra, Prof.Saulat Siddique, Prof. Naeem Qasuri, and Prof.Zubair Akram
speaking at the 6th National Conference f Pakistan Aspirin Foundation held at FJMC on October 5th 2013
.

Continuing Dr. Abbas Raza said that the risk of overt bleeding can increase with dual antiplatelet therapy. Studies have also shown that while use of low dose aspirin was associated with prevention of heart attacks but it also increased the risk of major GI bleeding. In case the use of Aspirin is essential, one must identify the risk factors of NSAIDs gastropathy, use gastro protective drugs, safer NSAIDs or alternative drugs if possible. The risk UGI bleeding with different formulations of Aspirin varies from 2.6% to 3.2%. It is suggested that one should reintroduce use of Aspirin after eight weeks of treatment with proton pump inhibitors (PPIs). It may not be possible in high risk CVD patients. CAPP2 study showed almost 60% decrease in colorectal cancer incidence among men who took 600mg of Aspirin daily.  It is still not sure whether this benefit of prevention extends to other cancers as well, what dose to be use and for how long? He concluded his presentation by stating that absolute benefits of aspirin outweigh risks of major GI bleeding in patients with moderate to high risk coronary heart disease. Use of PPIs allows patients to get most benefit from their NSAID therapy by reducing GI risks. Aspirin-Lipoxin agonist combination therapy trials are only at animal experimental stages and it may hold promise in the days to come, he remarked.




Some founder members, life members of Pakistan Aspirin Foundations
photographed after the business meeting held on October 4th2013.
Prof. Sardar Fakhar Imam Principal FJMC is also seen
second from right in the first row.

Aspirin and Surgery

Prof. Muhammad Aamer Zaman Khan Prof.of Surgery at FJMC discussed the role of Aspirin in surgery. He pointed out that one should stop the use of aspirin seven to ten days before surgery or undertaking any endoscopic procedure. However, three to five days before surgery is the ideal time to stop Aspirin. In moderate to high risk patients, one can continue Aspirin therapy till the time for surgery. American College of Surgeons recommends that one should try to continue aspirin as much as possible and have platelets available for transfusion during emergency procedures both pre and post operatively. Current guidelines are that in semi-elective or urgent surgery stop one of the agents but in emergency surgery one does not have a choice, hence platelets must be available. There is no benefit of increasing aspirin dose above 100mg for most patients and it seems reasonable to use 75-81mg as periopertive dose. For non-cardiac surgery, apart from low coronary risk situations, patients on aspirin should continue their treatment throughout surgery, except when bleeding might occur. One of the studies has recommended that Aspirin is a lifelong therapy and should never be stopped before surgery when prescribed as a secondary prevention after stroke, acute coronary syndrome, MI or coronary revascularization except for surgery in closed cavities. 




Group photograph of speakers and chairpersons of the second scientific
session of Aspirin Conference held at FJMC Lahore from (L to R) are
Prof. Maryam Malik, Prof. Aamar Zaman Khan, Mr. Lateef Sheikh,
Prof. Sardar Fakhar Imam, Dr. Shahbaz Kureshi, Prof.Abdus Samad,
Prof. S.H. Shafqat, Prof.Ejaz Ahmad Vohra, Prof. Bilal Zakariya
and Prof. Muneeza Qayum
.

Continuing Prof.Aamer Zaman Khan said that the new exciting possible indications for Aspirin are its chemo preventive characteristics. Many studies have shown significant decrease in tumor genesis with Aspirin.  Long term use of Low Dose Aspirin appears to be associated with lower incidence of colorectal carcinomas in patients with high cardiovascular risk. For chemoprevention, studies recommend dose of 325mg every other day while Womenís Health Study has recommended 100mg every other day. At present it is advisable to give Aspirin after discussing its potential benefits with the patients, he added. Regular use of Aspirin is also associated with reduction in incidence of venous thromboembolism in cancer patients besides prevention of recurrence of VTE.

Emerging issues and Resistance to Aspirin, other antiplatelet

Dr.Shahbaz Kureshi consultant cardiologist from Islamabad highlighted the emerging issues of Aspirin resistance as well as non-responders.  Non-responders, he stated, are a sub-group of patients taking therapeutic doses of Aspirin and not responding. Congestive Heart Failure patients are resistant to Aspirin. Similarly End Stage Kidney Disease patients may also not respond to Aspirin therapy. Aspirin resistance is significantly associated with major adverse events during long term follow up. Aspirin non-responders have increased stiffness of elastic type arteries. Treatment of aspirin resistant patients by adding omega-3 fatty acids or increasing the aspirin dose seems to improve the response to aspirin and it effectively reduces platelet reactivity.

Prof. Ejaz Ahmad Vohra in his presentation stated that the physicians should know in which patients to use Aspirin therapy and how to use it and which are the patients who will benefit with long term use of low dose aspirin therapy. One should be aware of the fact that aspirin is known to cause hemolytic anemia in G6PD deficiency. Aspirin is the most cost effective antiplatelet agent with proven safety and efficacy. Referring to long term safety of Aspirin use, he referred to a study published in Lancet which reported that more than seventy thousand people fond 46% reduction in risk for adenocarcinoma, common malignancy of lung, colon and prostate.  Oxford review of fifty one studies showed that taking aspirin for five years reduces the risk of death from cancer by 37% and developing cancer by 25% as compared to those who did not use aspirin. He was of the view that we should encourage middle age people with high risk of CVD to start taking low dose aspirin on regular basis.




Mr. Asif Sattar presenting a mementoe to the outgoing President of
Pakistan Aspirin Foundation at the business meeting of the
Foundations held on October 4th2013 at Lahore.

Dr.Rehan Umer from KIHD Karachi talked about Antiplatelet therapy and pointed out that managing antiplatelet therapy for patients for ACS is complex. Current therapeutic options and approaches are suboptimal and recurrence rate is high, bleeding remains an issue. Prevention of bleeding is as important as prevention of ischemia.  ACS patients who can benefit most from antiplatelet therapy also have the greater risk of bleeding complications. An ideal antiplatelet drug  should be effective without risk of bleeding,  have no resistance, offer simple dosage, no side effects, no drug interactions and available at reasonable price. It is important for healthcare professionals to be aware of drug interactions and bleeding.

Prof. Javed Akram President of Pakistan Aspirin Foundation was the last speaker in this session who talked about the use of Statins. He pointed out that studies have suggested that decrease in CHD related mortality rates was associated with the reduction in modifiable risk factors and improvements in evidence based therapies. Statins play an important role in stabilizing the arteriosclerotic plaques and in atherosclerosis regression.  The use of Statins as a primary prevention is still ambiguous because of inconsistent findings in various research studies. In patients without established cardiovascular disease but with cardiovascular risk factors, Statins use was associated with significantly improved survival and large reductions in the risk of major cardiovascular events. He concluded his presentation by stating that Statins play an important role in reducing clinical relevant cardiovascular outcomes across broad populations most likely by reducing the LDL-C levels. The current guidelines aim to establish target LDL-C reductions to improve a patients long-term reduction in clinical events.  Statins are effective for primary and secondary prevention of cardiovascular events. In addition Statins also show reduction in all cause mortality. Statins are relatively safe to use with low incidence of major adverse events.

Prof. Bilal Zakirya who was chairing the session in his concluding remarks said that Aspirin remains the most used drug in cardiovascular field and it has also been found to be effective in primary prevention. Prof. Abdus Samad the other chairperson opined that Aspirin was not an old drug but has emerged as a gold standard for antiplatelet therapy. Cardiologists use Aspirin a lot. It is useful in primary prevention in patients with higher risk of developing any cardiac events. We have been working with PharmEvo to develop a risk calculation formula.  If the GPs learn to calculate this risk, it will enhance their practice as patients are very much interested to know their risk of developing a heart disease.  He had a word of advice for the speakers and asked them to avoid repetition which is not at all liked by the participants.




A group of medical students of Azra Naheed Medical College photographed with members of the experts panel
 during the panel discussion at National Conference of Pakistan Aspirin Foundation held at FJMC on October 5th 2013
.

Panel Discussion

In the afternoon session the panel discussion on the use, safety and efficacy of antiplatelet agents with special reference to Aspirin was chaired by Prof.Abdus Samad. This session was moderated by Dr.  Bilal Mohayudin. Members of the Experts Panel included Prof. Sardar Fakhar Imam, Prof. S.H.Shafqat,   Prof. Nazeer Memon, Prof. Zaman Sheikh, Mr.Lateef Sheikh, Prof. M.Akbar Chaudhry, Dr.Shahid Karim, Prof. Maryam Malik and Prof. Tujamal.  Dr. Bilal Mohayudin pointed out that so far Pakistan Aspirin Foundation has failed to convince the laboratories to start testing antiplatelet agents. It is important that these tests should be done.  Prof. Abdus Samad responded by saying that what we see is mostly industry driven research.  It is time that we should tell them what they should be doing but another panelist remarked that the industry can also push physicians for research which suits their own requirements. However, it was emphasized that tests for antiplatelet agents should be available.  The patients need to be educated how to safely use this antiplatelet and justify the use of various devices, implants. Prof. Samad further stated that the recent European Guidelines suggest that the antiplatelet tests should be done only in high risk cases i.e in patients who have had acute myocardial infarction or Acute Coronary Syndrome and are going to have stents inserted. These tests are not required for every patient, he remarked.

Responding to another question it was stated that we will use any new drug only if we have some studies reporting its safety and efficacy. Mr. Lateef Sheikh said that what we saw at Punjab Institute of Cardiology leading to numerous deaths was a total system failure. We need to supervise the supply chain management. We need to look at the way drugs are handled by healthcare facilities.  If a drug is not working, it is known as non-responders but it is not an adverse drug reaction, he remarked.

Prof. Nazeer Memon opined that low dose aspirin is available in various dosages i. e, 75mg, 81mg and 100mg and all of them are effective.  Sometimes patients complain that they are suffering from indigestion and stop taking Aspirin though it is not related to this drug. It is difficult to say if the drug is not working. It was further suggested that healthcare professionals should take proper history, clinical examination and order essential investigations, take ECG and if need be one can increase the dose of one of the antiplatelet agents. Prof.Zaman Sheikh said that it is difficult to see the response of Aspirin. To the best of his knowledge there has been no study of Aspirin in Type one or Type two diabetics. Prof.S.H.Shafqat referred to the availability of counterfeit drugs which look alike but are not at all effective. Hence we must advise the patients to be careful of these counterfeits. Mr. Lateef Sheikh opined that how drugs are handled in pharmacies and hospitals also matters.  Prof. Shafqat also stated that he had seen one patient who developed renal failure with prolonged use of Aspirin. Prof. Akbar Chaudhry said that we must calculate the risk before starting the patient on low dose aspirin therapy for long term use.

Prof.Samad opined that the political problems need political answers and it is upto the administration to solve them to improve the patient care and ensure patient safety. Risk evaluation was also essential for use of Aspirin and Statins for primary prevention. He also narrated a story that one of his patients said that ever since he has started taking these drugs, he has become handsome. His wife also confirmed this.  I asked him to get his hemoglobin which was 7.5, which meant he was not aware of the blood loss due to bleeding. Hence we must educate the patients and be careful of such incidents. Prof. Maryam Malik said that in most cases the family physicians know the patient and their family and are also aware of their disease, but at times they do have their limitations. Prof. Javed Akram said that for long term use, a dose of 75mg of enteric coated aspirin is quite safe and effective in ACS patients but in diabetics the recommended dose is 150mg. Asthma and active ulcer disease are some of the contra indications for use of Aspirin. When we need blood donors, and if the entire population is taking antiplatelet agents, it will become a problem. People should be asked to stop taking aspirin or any other antiplatelet agent ten days before they donate blood. The people should be educated to take a 300mg soluble Aspirin or chew it in case of chest pain. During the deliberations it was also emphasized that Pakistan Aspirin Foundation should convince the laboratories to start antiplatelet tests. Sometimes the patients spend more on investigations than on drugs. It is important that basic investigations must be done but one should avoid un-necessary investigations. Prof. S.H.Shafqat remarked that almost about 80% of diseases can be diagnosed with good detailed history and clinical examination and investigations are needed just to confirm those.

Press Briefing

       On Sunday 6th October a session with the media was also organized at Lahore Press Club where Prof. Javed Akram President of Pakistan Aspirin Foundation, Prof. M.Akbar Chaudhry, Prof.Zaman Sheikh and Mr.Shaukat Ali Jawaid highlighted the aims and objectives of the Foundation. They called upon the media personnel to play their role in educating the public on the use of Aspirin. The public should be informed to immediately take a soluble Aspirin tablet when they have chest pain as it could prove life saving and always keep Aspirin with them at home and in office. Long term use of Low Dose Aspirin therapy they were told is extremely safe and effective in reducing the morbidity and mortality in a variety of medical disorders which has been proved in numerous research studies.  

 
   

 
       
   

Pakistan needs to introduce culture of patient
safety and medication safety Ė Mr. Lateef Sheikh

Pakistanís total pharmaceutical market is over
200B rupees and there is no supervision at all

 
       
   

LAHORE: Pakistan has a total pharmaceutical market of over two hundred billion rupees and most of it was not being monitored at all. In Pakistan it is estimated that over one million patients use Aspirin daily for prevention of cardiovascular diseases.  Pakistanís Pharma market consists of 85% retail pharmacy and 15% institutional pharmacy and none of them was being supervised. Had there been some supervision, the incidents which took place at Doctorís Hospital and Punjab Institute of Cardiology at Lahore would not have occurred. This was stated by Mr. Abdul Latif Sheikh Director Pharmacy Services at Aga Khan University Hospital Karachi. He was making a presentation on pharmacists monitoring parameters in Aspirin use, efficacy and compliance at the 6th National Conference of Pakistan Aspirin Foundation held at Fatima Jinnah Medical College Lahore on October 5th 2013. This conference was very well attended by members of the medical and nursing procession besides some medical students. At present   major consumption of Aspirin was in cardiac patients, he added.

 Mr. Lateef Sheikh further stated that for monitoring and supervision of pharmacy services, a team approach is needed. We must select a team.  It is the physicians who prescribe drugs, dispensing and monitoring should be done by pharmacists and nurses administer drugs. Referring to the global scenario as regards medication usage and safety, Mr. Lateef Sheikh said that upto 20% of drugs administered in hospitals were given in error. There were many potential Adverse Drug Events which included 1% fatal, 12% life threatening and 56% of preventable ADRs occurred when the drugs were ordered. A review of 14,179 admissions in Australia showed that ADEs occurred in 16.6% of patients, 10.7% had permanent disability, 4.9% had death and almost 54% of these ADRs were preventable.

Continuing Mr. Lateef Sheikh said that 15-25% of medication errors are due to confusing names while other 20-30% medication errors are associated with look-alike and sound alike names. The global burden of unsafe medical care is enormous. He also showed medication errors related to Beta Blockers and Aspirin at admission and discharge in various hospitals and highlighted the roadmap to medication safety as regards adverse drug events. While use of Low Dose Aspirin daily offers many benefits as regards cardiovascular diseases but it also has some risks. Hence one must speak to the physician first before starting to take Aspirin. What we need is to give importance to issues like patient safety and medication safety and establish multidisciplinary teams to promote medication safety. Senior consultants should undertake monitoring while clinical pharmacists should assist physicians and help the patients, Mr. Lateef Sheikh concluded.


 
   

 
       
   

Prof. Javed Akram elected President
of Pakistan Aspirin Foundation
Prof. Akbar Chaudhryís services to promote the aims
and objectives of the Foundation commended

 
       
   

LAHORE: Prof. Javed Akram FRCP, an eminent physician and former Principal of Allama Iqbal Medical College was unanimously elected as the new President of Pakistan Aspirin Foundaiton at the business meeting held on Friday October 4th 2013 for a two years term. The meeting was chaired by Prof. Mahmood Ali Malik founder President of Pakistan Aspirin Foundation along with Prof. M. Akbar Chaudhry the outgoing President. Those who attended the business meeting included Prof. Ejaz Ahmad Vohra, Major Gen.Ashur Khan, Mr. Lateef Sheikh, Dr. Shahbaz Kureshi, Prof. Nazir Memon,Prof. S. H.Shafqat, Mr. Shaukat Ali Jawaid. Prof. Sardar Fakhar Imam Principal of Fatima Jinnah Medical College, Mr. Asif Sattar from Atco Laboratories who are sponsoring academic and CME activities of the foundation for the last many years attended the meeting on a special invitation.

Addressing the participants Prof. M.Akbar Chaudhry said that during his tenure, he tried his best to promote the aims and objectives of the Foundation which are to promote the use of Aspirin in its well established indications besides creating awareness about its safety and efficacy among the healthcare professionals as well as public. For this purpose we travelled to many small and big cities all over the country in Punjab and Sindh provinces but could not visit Baluchistan and Khyber KPK due to security concerns. He specially thanked M/s Atco Laboratories for their generous help and assistance in sponsoring these CME activities of the foundation. He hoped that his successor who is a young dynamic personality will carry our mission forward with greater zeal and devotion.

Prof. Javed Akram thanked the members for their confidence in electing him as the new President and promised to do his best to come upto the expectations of the members.  I look forward to the support of my seniors and other founder members in this regard, he added.

Prof. Mahmood Ali Malik and all the members present commended the services rendered by Prof. M.Akbar Chaudhry and hoped that the new President will carry this message forward in the days to come.  Participating in the discussion Mr. Lateef Sheikh said that there is much more to do and apart from physicians, we also need to have healthcare professionals from other disciplines of medicine as use of Aspirin is indicated in a wide range of disorders which needs to be discussed and promoted.  Gen. Ashur Khan, Prof. S. H. Shafqat, Dr. Shahbaz Kureshi also briefly addressed the meeting and expressed their satisfaction with the activities of the Foundation. Prof. Nazeer Memon said that it is for the first time that he was attending the business meeting. We appreciate the work being done and offered his whole hearted cooperation.

Prof. Sardar Fakhar Imam Principal FJMC addressing the participants thanked them for selecting Fatima Jinnah Medical College as a venue for their 6th National Conference which was a great honour and privilege for the institution. On behalf of the faculty he reiterated that all possible help and assistance will be provided to Pakistan Aspirin Foundation for its academic activities in future as well.

Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation in his introductory remarks thanked the members for tolerating him ever since the Foundation was established in 1996 and expressed the wish that it is better if the members could elect someone else as the General Secretary and promised that he will continue to work with the same zeal and dedication for the Foundation .However, the members  did not accept his suggestion and asked him to continue working as the General Secretary. He also informed the participants that Guidelines on Medical Uses of Aspirin have been revised and updated and published on the Foundationís website.(www.pakaspirin.org.pk) He specially thanked Prof. Abdus Samad, Prof.Ejaz Ahmad Vohra, Prof. Khawar Kazmi, and Major Gen.Ashur Khan for their useful suggestions. Lt. Gen.Mahmud Ahmad Akhtar former Surgeon General of Pakistan Army who is an expert in clinical pharmacology, he said, deserve special mention for his valuable contribution in preparation and finalizing the guidelines. The members were requested to visit the website and have a look at these guidelines and forward if they have any suggestions in the next two to three weeks after which these guidelines will be sent for printing and distribution among the healthcare professionals. Members also expressed their sincere thanks to M/s Atco Laboratories for sponsoring the academic activities of Pakistan Aspirin Foundation for the last many years and requested Mr. Asif Sattar to convey their gratitude and appreciation to Mr. Saeed Allawala Chief Executive  of Atco Laboratories.

 Later Mr. Asif Sattar on behalf of Atco Laboratories presented a memento to the outgoing President of Pakistan Aspirin Foundation Prof. Akbar Chaudhry in recognition and appreciation of his services.  Prof.Akbar Chaudhry was also presented a gift on behalf of the Foundation by Prof. Mahmood Ali Malik. Mr. Akhtar Tahir GM Marketing and Mr. Farhan Raza Product Manager from Atco Laboratories who are also members of the Foundation were also present on this occasion.


 
   

 
   

 

 
   

FAMILYCON Lahore celebrates Aspirin Day
Regular use of Low Dose Aspirin reduces
Myocardial Infarction, Acute Coronary Syndrome
by 33% in men and 17% of strokes in women
We must emphasize on prevention and modifiable risk
factors to reduce morbidity and mortality from
cardiac diseases - Prof. Akbar Chaudhry

 
       
   

LAHORE: Pakistan is a poor country hence our major efforts in the health sector should be on prevention of cardiovascular diseases since curative services are extremely expensive. This is possible by intervention in the modifiable risk factors i.e. stop smoking, control diabetes, hypertension, lipids, weight and in addition prescribe low dose Aspirin for primary & secondary prevention unless contra indicated. This was stated by Prof. M. Akbar Chaudhry President of Pakistan Aspirin Foundation who is also Principal of Azra Naheed Medical College, Lahore. Hew was the guest speaker at Aspirin Day celebrated by Familycon, a group of family physicians here recently. It was very well attended by their members.


Prof. M. Akbar Chaudhry President Pakistan Aspirin Foundation speaking on Aspirin Ė a wonder drug at a meeting organized by Familycon for family physicians at Lahore recently. Picture also shows Dr. M. Sarwar Chaudhry
 participating in the discussion besides a view of the participants.

The theme of the lecture was ďAspirin: A Wonder DrugĒ. Prof. Chaudhry said that the real threat to the urban health is the cardiovascular diseases, which is more common in the urban areas as compared to rural areas. It is estimated that 17.1 million people died of CVD in 2004 representing 29% of all global deaths and by 2030 it is expected that 23.6 million people will die from heart disease and stroke annually. The major disease burden (82%) is in the low & middle income countries affecting the men and women equally.
Prof. Chaudhry presented data from many international studies with the clear benefits of Aspirin in the primary & secondary prevention of cardiovascular and cerebrovascular diseases. He heighted the fact that Aspirin in low doses 75 Ė 100mg as Primary prevention reduced the incidence of MI, ACS by 33% in men and 17% of strokes in women. He recommended that all healthy individuals over the age of 45 with 10 years global risk of 10% or more of developing CVS & Strokes should be prescribed Aspirin.
He also discussed the recommendations of US Prevention Services Task Force and American Heart Association and also spoke about the benefits of combination treatment of Aspirin & Clopidogrel. One must ensure that blood pressure is under control before these hypertensive patients are prescribed low dose Aspirin therapy, he remarked.
Prof. Akbar Chaudhry also highlighted the aims and objectives besides accomplishments of Pakistan Aspirin Foundation ever since its inception. It has a very democratic set up and all the former Presidents of the Foundation as well as founder members have played an important role in creating awareness about the use of Aspirin in its well established indications besides CME programmes organized all over the country on regular basis for the last many years.
The presentation was followed by lively discussion. Responding to various questions Prof. Akbar Chaudhry said that for cardiac patients, the recommended dose is 75-150mg daily and all are equally effective. For cerebro vascular diseases the recommended dose is 150 Ė 300mg. He also stressed that in case of Acute MI, ACS, Soluble Aspirin should be given to the patient immediately dissolved in water or sublingually and if given within six hours, is as effective as Streptokinase. Side-effects of Aspirin and recommendations to stop Aspirin before elective surgery were also discussed in detail. Enteric coated Aspirin, he said, is preferred because of its safety in long term use, he added
At the end Prof. Akbar Chaudhry paid special thanks and tribute to the management of Atco Laboratories who have been sponsoring all the Academic Activities of Pakistan Aspirin Foundation for the last 12 years. We are extremely grateful to them. However, keeping up the professional ethics, we do not patronize or recommend any particular brand of Aspirin and it is up to the treating physician to make a choice. He also commended the local Atco team for organizing such a useful academic activity for the family physicians in Lahore. The session was moderated by Dr. Farrukh Mahmood.


 
   

 
       
   

 
   

Aspirin Update seminar at PHL Symposium
Speakers highlight the efficacy of Low Dose Aspirin
therapy in various well established indications
This economically priced anti-platelet agent reduces morbidity
and mortality in many medical disorders

 
       
   

HYDERABAD: As a part of its Continuing Medical Education programme, Pakistan Aspirin Foundation organized a breakfast session during the recently held 16th annual symposium of Pakistan Hypertension League at Hyderabad on February 9th 2013. It was chaired by Prof. Nazeer Ahmad Memon along with Dr. Fazalur Rehman Memon and Dr. Shahbaz Kureshi, consultant cardiologist at Red Crescent Institute of Cardiology at Hyderabad and Central Government Polyclinic at Islamabad respectively. Prof. Mohammad Akbar Chaudhry an eminent physician/cardiologist and President of Pakistan Aspirin Foundation who is also Principal of Azra Nahid Medical College Lahore was the main speaker.

Pakistan Aspirin Foundation organized an Update on Aspirin at the recently
held annual symposium of Pakistan Hypertension League at Hyderabad.
Picture shows Prof. Nazeer Memon along with Dr. Fazalur Rehman Memon
and Dr. Shahbaz Kureshi chairing a session.

In his brief introductory presentation, Prof. Akbar Chaudhry talked about the burden of diseases in the world in general and Asia in particular. Apart from communicable diseases, non-communicable diseases, he said, have also assumed epidemic form. Cardiovascular diseases and diabetes mellitus apart from Cancer account for millions of deaths worldwide. Most of the deaths in Asia and developing countries, he said, were due to hypertension and diabetes which are both preventable to a great extent if we adopt healthy lifestyle and use balanced diet. He laid emphasis on control of modifiable risk factors like low intake of salt, control of high blood pressure, reduction in cholesterol, TGs, controlling obesity and avoiding smoking etc. Safety and efficacy of Low Dose Aspirin therapy has been documented in numerous studies which shows that it is reduces morbidity and mortality. Some of the well established indications for Aspirin therapy include Acute Myocardial Infarction, Acute Coronary Syndrome, Secondary prevention of AMI, Primary prevention of CAD, Acute Ischemic Strokes, Transient Ischemic Attacks, Primary and secondary prevention of strokes, hypertension, diabetes mellitus, prophylaxis against deep vein thrombosis and pulmonary embolism. In addition there are numerous emerging indications for use of Aspirin like colorectal cancer etc.
A study conducted by Pakistan Aspirin Foundation many years ago had showed that only 50% of ACS patients were prescribed Aspirin at discharge, only 20.8% of Family Physicians prescribed aspirin to their patients while 16% got aspirin at home when they had chest pain. However, ever since the awareness campaign and CME programmes started by Pakistan Aspirin Foundation, the use of Aspirin has increased to a great extent. Enteric coated Aspirin tablets, it was stated are safe in long term use.

Pakistan Aspirin Foundation organized an Update on Aspirin during the recently held PHL symposium
at Hyderabad on February 9th 2013. Picture taken on this occasion shows from (L to R) Dr. Shaukat
Malik presenting mementoe to Prof.Nazeer Memon, Prof. M. Akbar Chaudhry President of PAF
(keynote speaker) and Prof.M. Ishaq presenting mementoe to Dr. Shahbaz Kureshi.

Participating in the discussion Dr. Shaukat Malik from Islamabad stated that he was taking Aspirin for the last twenty five years. He advised his colleagues to promote the use of Aspirin therapy in its well established indications. Prof. M. Ishaq President of PHL and Director of KIHD opined that it was a pity that despite its usefulness, Aspirin was still under used. It can be life saving if the patient takes one full tablet of Aspirin 325mg or uses soluble Aspirin immediately when they experience chest pain. Prof. Feroze Memon pointed out that Aspirin was an effective therapy in acute coronary syndromes and its use need to be promoted. One of the family physicians referred to its anti-analgesic and anti-pyretic properties. At this it was stated that in the beginning it was used as anti-pyretic, analgesic agent but Aspirin became more popular when its anti-platelet activity was proved and now it is widely used all over the world. Prof. Waris Qidwai Head of the Dept. of Family Medicine at Aga Khan University said that the Family Physicians are the first one who come in contact with the patients, it is essential that they prescribe this extremely useful and life saving drug to their patients when indicated.
Dr. Shahbaz Kureshi referred to the use of low dose Aspirin therapy after interventional cardiac procedures, angioplasty, stenting where it is very useful. He also remarked that Aspirin has shown to reduce colorectal cancer in numerous new studies as well. Dr. Fazalur Rehman Memon also highlighted the usefulness of Aspirin therapy. Prof. Nazir Ahmad Memon in his concluding remarks thanked the guest speaker Prof. Akbar Chaudhry for his excellent review and presentation on use of Aspirin therapy. He also commended the efforts of Pakistan Aspirin Foundation to educate the healthcare professionals in the use of this extremely useful anti-platelet agent.
Earlier Mr. Shaukat ĎAli Jawaid Secretary General of Pakistan Aspirin Foundation who moderated the session stated that Guidelines on the use of Aspirin were now being revised. It has major emphasis on assessment of risk factors. A draft has already been prepared by Prof. Abdus Samad and Prof. Ejaz Ahmad Vohra and Prof. Akbar Chaudhry. We have had very useful comments and suggestions from Prof. Mahmud Ahmad Akhtar former Surgeon General of Pakistan Army. The draft guidelines have also been reviewed by Prof. Khawar Kazmi Head of the dept. of cardiology at Aga Khan University. It has also been forwarded to Dr. Basheer Haneef consultant cardiologist at Taba Heart Institute for his input. We hope to finalize these guidelines in a monthís time when it will be upload on the Pakistan Aspirin Foundation website. As regards use of Aspirin in Primary prevention, he said the results of ARRIVE study which has enrolled over twelve thousand patients in five countries will be available by the end of this Year. It will provide an evidence based information on its use in primary prevention. He also thanked M/s Atco Laboratories who have been sponsoring these CME programmes all over the country for the last many years. However, upholding professional ethics, we do not patronize or promote any particular brand of Aspirin, he remarked.


 
       
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Aspirin Session at Cardiology conference
Revised Guidelines on Use of Aspirin by
Pakistan Aspirin Foundation to be finalized soon

All individuals at 10% of more risk of developing CAD
must be put on Low Dose Aspirin therapy

ISLAMABAD: As a part of its Continuing Medical Education programme, Pakistan Aspirin Foundation organized a panel discussion on Medical Uses of Aspirin at the recently held International Cardiology conference at Islamabad on December 22nd 2012. The session was chaired by Major Gen. Ashur Khan former President of Pakistan Aspirin foundation along with Prof. Khawar Kazmi from AKUH and Dr. Shaukat Malik from Islamabad. Prof. M. Akbar Chaudhry Principal Azra Nahid Medical College from Lahore who is the current President of PAF was the main speaker.
In his brief introductory remarks, Prof. Akbar Chaudhry highlighted the well established indications for the use of Low Dose Aspirin Therapy besides its new and emerging indications. Speaking about the efficacy of antiplatelets and cardiovascular diseases, he said that as per WHO estimates by 2030 as many as 23.6 million deaths will take place in the world due to cardiovascular disease and most of these deaths will be in developing countries which are already faced with the problem of communicable diseases. Cardiovascular disease is also on the increase in low income countries. CAD is very high in countries like China, India as well as Pakistan where it has become an epidemic.
According to National Health Survey by PMRC about 18% of our adult population suffers from hypertension. We need to do something about modifiable risk factors like hypertension, diabetes mellitus, dyslipidemia, obesity, metabolic syndrome and smoking. According to reports we have 17% male smokers while in female the prevalence of smoking was about 3%. It is recommended that all healthy individuals at risk of cardiovascular diseases should be prescribed Low Dose Aspirin therapy and enteric coated tablets of Aspirin should be preferred as they are safe in long term use. Aspirin prevents myocardial infarction while it also reduces the risk of secondary MI and stroke. As regards primary prevention, all those patients who have a risk of more than 10% of developing cardiovascular diseases should be prescribed Aspirin therapy. In case the risk is less than 10%, then one must discuss with the patient and then take a decision. Risk factor screening was suggested at the age of thirty years. Diet therapy, weight control, lipid control, control of hypertension along with Aspirin therapy will be quite helpful.
Studies have revealed that use of Aspirin in primary prevention results in 33% risk reduction of Myocardial Infarction, it reduces the risk of stroke by 25% and other cardiovascular events by 17%. During the discussion Prof. Khawar Kazmi referred to the Aspirin resistance which has been noted. Mr. Shaukat Ali Jawaid pointed out that like all other drugs, apart from resistance; there are some non-responders as well. Dr. Basheer Haneef from Taba Heart Institute Karachi talked about indications for use of Aspirin in primary prevention. He also stated that some time back Dr. Naveed Akhtar from Islamabad was conducting a study and he had noticed Aspirin resistance as high as 22%. It was pointed out that there are conflicting reports but now one of the largest primary prevention study with Aspirin (ARRIVE) which has enrolled over twelve thousand patients in five countries including Germany and China is underway. The results will be available by the end of 2013 and it will give us the clear cut answer on this issue. Dr. Shaukat Malik also raised the issue of Aspirin resistance. He further stated that it was a very economically priced drug, hence no manufacturer can add anything in this as it was already quite cheap. Some of the participants raised the issue of quality of locally manufactured drugs. They were informed that most of the national pharmaceutical companies were producing quality drugs. Mr. Shaukat Ali Jawaid Secretary General of Pakistan Aspirin Foundation informed the audience that at present the Foundation was revising the guidelines on use of Aspirin. Prof. Abdus Samad and Prof. Ejaz Ahmad Vohra have prepared the draft guidelines and they have been sent to some eminent cardiologists and physicians for their input. The main emphasis in these revised guidelines is on risk assessment score for which the formula used in Framingham study has been used. The physicians will be educated on how to do this risk assessment score before prescribing Aspirin therapy. Once the input is received from others, then these guidelines will be finalized, he added.
Summing up the discussion Major Gen. Ashur Khan said that enteric coated aspirin tablets provide safety in long term use. All healthcare professionals particularly the Medical Officers in the hospitals should be educated to prescribe Aspirin along with other medications while the cardiac patients are discharged unless there are some contraindications. He also referred to the indiscriminate use of PPIs and H2 blockers. In case of MI, one full dose tablet of Aspirin 325mg should be used. Previously Aspirin despite lot of useful studies was quite underused but now ever since the CME programmes started by Pakistan Aspirin Foundation, usage of Aspirin has increased in its established indications.
The programme was sponsored by Atco Laboratories who are taking care of all CME pogrammes organized by Pakistan Aspirin Foundation. However, Prof. M. Akbar Chaudhry did point it out that the Foundation keeping up professional ethics, does not endorse the use of any particular brand name and it is up to the physicians to select a suitable Aspirin preparation.


Aspirin Update Seminar at Rahim Yar Khan
Aspirin prevents one third of heart attacks in
men and 17% strokes in women
Prof. Akbar Chaudhry urges healthcare professionals to use LDA therapy in
its well established indications to reduce morbidity and mortality

From Farhan Raza

RAHIM YAR KHAN:  Aspirin is a wonder drug which prevents at least one third of heart attacks in men and 17% strokes in women; hence Low Dose Aspirin therapy should be prescribed to all men over the age of thirty five years and women over the age of forty five years particularly those in high risk group. This was stated by Prof. M. Akbar Chaudhry a well known physician and President of Pakistan Aspirin Foundation. He was making a presentation on Aspirin the Wonder Drug at a seminar organized by Pakistan Aspirin Foundation here on March 21st 2012. The meeting was very well attended by family physicians besides faculty members of Sheikh Zayed Medical College Hospital Rahim Yar Khan. It was jointly chaired by Prof. M. Saeed Principal of SZMC and Prof. M.Naeem Aslam Prof. of Cardiology at SZMC Hospital.  Members of the Experts panel included Dr. Faizul Hassan Associate Prof.of Cardiology at SZMC, Dr. Irfan Ahmad Head of the Dept. of Medicine, and Dr. M. Ali Bukhari Head of Dept.of Neurology. The meeting was moderated by Dr. Zafar Majeed.

Picture on right shows Prof. M. Saeed Principal Sheikh Zayed Medical College presenting Bouquet to Prof. M. Akbar Chaudhry the guest speaker at the seminar on Aspirin Update organized by Pakistan Aspirin Foundation at Rahim Yar Khan on March 21st while on right a bouquet is being presented to Prof. Naeem Aslam Prof. of Cardiology at SZMC.

Continuing Prof. Akbar Chaudhry said that the physicians should also be careful particularly in elderly patients who are on dual antiplatelet therapy. These patients should have their haemoglobin and stool checked for occult blood loss every six months.   However, after the age of eighty years one has to be extremely careful while using Aspirin. Use of Aspirin is now well established in a wide range of diseases including Acute Myocardial Infarction, Acute Coronary Syndrome and secondary prevention of MI, Primary prevention of CAD, TIAs and Stroke, prophylaxis for thrombo embolism, hypertension and diabetes mellitus. Despite the fact that there has been lot of data supporting the use of Aspirin in primary prevention of CAD but the largest trial in primary prevention (ARRIVE study)  which has enrolled twelve thousand patients in five countries started in 2009 and the results will be available in 2013. This will conclusively prove the benefits of Aspirin therapy in primary prevention which it is hoped will clear all doubts and accelerate the use of Aspirin in this era of Evidence Based Medicine. He discussed the disease burden of IHD in poor developing countries in detail and suggested how to prevent it. He also talked about the risk factors and laid stress on prevention the modifiable risk factors in particular.

Prof. M. Saeed Principal Sheikh Zayed Medical College presenting bouquet to members of the experts panel and others at the Aspirin seminar from (L to R) Dr. Faizul Hassan, Dr. M. A. Bukhari, Dr. Irfan Ahmad, Dr. Idrees and Dr. Zaka Ashraf.

Prof. Akbar Chaudhry then quoted numerous studies to prove usefulness of Aspirin in acute myocardial infarction, acute coronary syndrome, secondary prevention of MI and  Stroke.  Speaking about the new and emerging indications for Aspirin therapy he mentioned colonic cancer, oesophageal cancer, breast and lung cancer, dementia, eclampsia and prostatic cancer. He then talked about the recent controversies regarding the use of Aspirin in primary prevention in diabetics and peripheral arterial disease. He quoted various guidelines of American Heart Association and American Task Force for prevention of cardiovascular diseases and stroke which recommend the use of Aspirin therapy. He concluded his presentation by stating that Aspirin has proved to be poor manís streptokinase and then took out a tablet of Aspirin from his pocket and said that he always keeps it with him so that it   may be used in emergency by himself, his near or dear ones, fellow travelers and recommended that all of us should keep Aspirin at home, in our bags, at clinics and offices.

Earlier he talked about the aims and objectives of Pakistan Aspirin Foundation and referred to its achievements so far. The main objective of the foundation, he said, is to create awareness about the use of Aspirin among public as well as healthcare professionals and promote the use of Low Dose Aspirin therapy in its well established indications. He further stated that they have been holding such seminars in different cities of Pakistan for the last many years as a part of our CME programme. Rahim Yar Khan is an important city having a medical college and well equipped hospital and it had been their desire to organize this meeting here since long. He was happy that at last they have been successful to have this meeting here and thanked Prof. Naeem Aslam, Prof. M. Saeed Principal of SZMC, its faculty members for the warm welcome and kind hospitality. He particularly thanked Prof. Saeed Principal of SZMC and said that they will be too glad to organize academic activities at SZMC Hospital in future as well.

Pakistan Aspirin Foundation organized a seminar on Medical Uses of Aspirin at Rahim Yar Khan on March 21st 2012 which was largely attended by family physicians and faculty members of SZMC. Picture shows Prof. M. Akbar Chaudhry President of the Foundation speaking on the occasion. On extreme left is Dr. Zafar Majeed who moderated the session while on extreme right Dr. Abdul Karim is participating in the discussion.

The presentation was followed by lively discussion.  Prof. Akbar Chaudhry  responded to various question from the audience regarding Aspirin resistance, contra indications and when not to use it besides its side effects.  For ACS the recommended dosage for long term use, he said, was 75mg though 81mg and 100mg are also used but it has the same effect. For type 2 diabetics the dose recommended is 150mg but in case of emergency i.e. AMI, Stroke one tablet of 325mg should be used immediately.  One can safely use Aspirin in severe ischaemic stroke before a CT Scan. In case of resistance or contra indications one can use other antiplatelet agents like Dipyridamol, Ticlodipine, Clopidogrel, GPIIb IIIa and Abciximab.  Before prescribing aspirin therapy to hypertensive patients make sure to control the blood pressure first, he remarked.

Dr. Faizul Hassan speaking at the occasion referred to the study  being conducted by Dr. Zafar Majeed in rural areas to assess the risk factors i.e. gender, smoking, family history, inactive life style etc. which was  just nearing completion. Results of this study will soon be published. He also commented on the results of Aspirin Awareness and Usage Study (AAUS) and said they were prescribing Aspirin to all the patients suffering from cardiovascular diseases except those where it is contra indicated. Dr. Irfan Ahmadopined that one should keenly observe all the side effects of Aspirin therapy particular the risk of GI bleeding which could be very serious. Dr. M. Ali Bukhari said that they usually receive haemorrhagic stroke patients. At present they are also conducting a study on these patients and once it is completed he will be in a better position to comment on the use of Aspirin therapy.

Group photograph taken after the seminar on Aspirin Update organized by Pakistan Aspirin Foundation at Rahim Yar Khan on March 21st shows Prof. M. Akbar Chaduhry (guest speaker) along with Prof. M. Saeed Principal SZMC, Prof. Naeem Aslam, Dr. Faizul Hassan, Dr. M. A. Bukhari, Dr. Idrees and others.

Dr. Idrees from the department of surgery SZM Hospital Complex pointed out that Aspirin is a very useful drug as prophylaxis in thrombo embolism but he did not find any strong recommendation regarding its use in deep vein thrombosis prevention in high risk surgical patients.

Prof. M. Saeed Principal SZMC in his concluding remarks stressed the importance of life style modification. We as healthcare professionals should discourage the use of un-necessary drugs but advocate use of healthy diet. He thanked Prof. Akbar Chaudhry for his visit to Rahim Yar Khan and enlightening them on the use of Aspirin therapy.

Cardiology Dept. at SZMCH

Earlier Prof. Naeem Aslam in his welcome address also gave a brief introduction of the department of cardiology at SZMCH Complex which organizes such CME programmes regularly.  So far, he said,  we have conducted five workshops, four ECG workshops besides one survey. The department has a well equipped 76-bed CCU which has almost 100% occupancy. Last year we performed four thousand two hundred echocardiograms and thirty angioplasties. The department has also started a unique cardiac clinic for pregnant and Gynae patients.  He also talked about the history of Aspirin and said that after the incidence at PIC Lahore, many people have asked him about the use of Aspirin. I have assured them that Aspirin is a very safe and effective anti platelet agent and was really a wonder drug.

As usual the meeting was sponsored by M/s Atco Laboratories who are sponsoring the CME programme of Pakistan Aspirin Foundation for the last many years.


Breakfast Session on Aspirin Update during PHL Symposium
Prof. Akbar Chaudhry urges doctors not to deprive their 
patients of benefits of Low Dose Aspirin Therapy

We put our all ACS patients on Aspirin, Beta Blockers,
Statins and ACE Inhibitors - Prof. Ijaz

 

MULTAN: Pakistan Aspirin Foundation organized a Breakfast session on Aspirin Update during the recently concluded Pakistan Hypertension League annual symposium at Multan on February 25th 2012. It was chaired by Prof. M. Ishaq President of PHL while the main speaker was Prof. M. Akbar Chaudhry President of Pakistan Aspirin Foundation and Principal of Azra Naheed Medical College, Lahore. His presentation was followed by an interactive session in which a large number of cardiologists were invited to share their knowledge and experience on use of Aspirin therapy.
In his brief introductory remarks, Prof. M. Akbar Chaudhry pointed out that Aspirin is a wonder drug which reduces morbidity and mortality in many diseases particularly CAD, ACS and is life saving in Acute Myocardial Infarction. He urged the health care professionals not to deprive their patients of the benefit of Low Dose Aspirin Therapy keeping in view its well established indications.

Pakistan Aspirin Foundation organized a Breakfast Session on Aspirin Update during the PHL Symposium at Multan on February 25th 2012. Group photograph taken on the occasion shows Prof. Ijaz, Prof. M. Ishaq President PHL, Maj. Gen. Ashur Khan and Prof. M. Akbar Chaudhary President of the Foundation along with Prof. Mansoor Ahmad, Prof. Feroz Memon, Dr. Rashid, Mr. Akhtar, Mr. Waqar, Mr. Farhan Raze from Atco and Mr. Shaukat Ali Jawaid.

Referring to the AAUS Study which enrolled over fourteen hundred ACS patients from seventeen CCUs from all over the country and was conducted by Pakistan Aspirin Foundation many years ago, he said that it showed only 16% patients got Aspirin when they had chest pain at home, only 20.8% of family physicians prescribed Aspirin while 60% patients in Emergency room got Aspirin and in ward it further increased to 71%. However, on discharge unfortunately only 50% were prescribed Aspirin which was because when the discharge slips were made by the junior doctors, they did not give importance to Aspirin. Keeping all this in view, Pakistan Aspirin Foundation started its CME programme for the healthcare professionals and during the last few yeas we have organized seminars, Update meetings , discussions all over the country which has greatly helped to increase awareness among public as well as the doctors community with the result that now Aspirin use has increased a lot.

Dr. Rashid, Mr. Akhtar Business Unit Head at Atco, Prof. M. Akbar Chaudhary President of Pakistan Aspirin Foundation photographed along with some members of marketing team from Atco Laboratories which are sponsoring CME programmes of Pakistan Aspirin Foundation. The photograph was taken during the breakfast session on Aspirin ĎUpdate held at Multan on February 25th 2012.

Prof. Ijaz Ahmad from CPE Institute of Cardiology Multan said that they put all their ACS patients on Aspirin, Beta Blockers, Statins and ACE Inhibitors. Prof. Feroz Memon from Hyderabad said that patients should be advised to immediately take a tablet of soluble Aspirin or chew the enteric coated tablets of Aspirin when they have chest pain at home. It is life saving and can be termed as poor manís Statin. Prof. Ishaq opined that all patients coming in emergency should immediately get soluble Aspirin and first time they should be given full dose of 325 mg and then they can be put on low dose aspirin therapy. In literature many doses are listed i.e. 75mg, 81mg and 100mg and they are all effective. He was of the view that we need to redo the study on Aspirin Awareness and Usage as now the figures which we earlier had must have changed as the situation has improved a lot. Prof. Mansoor Ahmad from Karachi said that make sure to control the blood pressure before putting hypertensiveís on Low Dose Aspirin therapy. Dr. Rashid Ahmad from Abbasi Shaheed Hospital Karachi also highlighted the importance of Aspirin therapy in IHD and in chest pain in emergency, just one tablet of 325mg of Aspirin can prove to be life saving, he added.
Dr. Naeem opined that in primary prevention of CAD, the use of Aspirin is still being debated at which Mr. Shaukat Ali Jawaid Secretary General of Pakistan Aspirin Foundation pointed out that ARRIVE study which has enrolled twelve thousand patients in five countries including UK, USA, Germany and China started in 2009 and final results will be available in 2013. This is by far the biggest study on use of Aspirin in primary prevention and though lot of evidence in favour of its use in primary prevention is accumulating, but final answers will be available from ARRIVE study in 2013. Dr. Abu Bakar Sheikh from Karachi remarked that we need to develop posters, cards for display in Emergency Rooms for creating awareness among the public about the safety and efficacy of Aspirin. Another participant said that small booklets on Aspirin in Urdu should be prepared which can be distributed among the patients when they are waiting in the hospitals, clinics and in Emergency. Dr. Abu Bakar Sheikh further remarked that enteric coated tablets of Aspirin should be used to avoid chances of G.I. Bleeding. Major Gen. Ashur Khan former President of Pakistan Aspirin Foundation felt that at times patients complain of epigastric pain which has nothing to do with chest pain and it should be kept in mind. Dr. Fazalur Rehman from Red Crescent Hospital Hyderabad said that they were the first one in Pakistan to start giving Aspirin to all patients coming in emergency with chest pain.
Prof. M. Ishaq in his concluding remarks urged the healthcare professionals to use the low dose aspirin therapy judiciously in its well established indications. In case of Aspirin resistance, one can use other antiplatelet agents. Earlier Mr. Shaukat Ali Jawaid Secretary General of Pakistan Aspirin Foundation pointed out that they were extremely grateful to M/s Atco Laboratories who have been sponsoring our CME activities for the last many years. It is because of their financial help and support that we have been able to continue this awareness programme. However, keeping up the professional ethics, we in Pakistan Aspirin Foundation do not promote or patronize any particular brand of Aspirin. As usual this CME meeting was also sponsored by Atco Laboratories and Mr. Farhan Raza their Product Manager along with his team had worked hard for its success. Mr. Akhtar Business Unit Head in Atco Laboratories, Mr. Waqar from the marketing department and others were also present on this occasion
.


 

Aspirin Update seminar at Dera Ghazi Khan
People with high risk of CAD, those with family history of
heart disease and Type-2 diabetics should be put on
Low Dose Aspirin therapy-Prof. Akbar Chaudhry

Blood Pressure should be controlled before prescribing
hypertensiveís LDA - Dr. Yousuf
Low Dose Aspirin 75mg daily is quite useful in
recurrent miscarriages - Dr. Humaira Shakeel

 

DERA GHAZI KHAN: All people with high risk of coronary artery disease, those with family history of heart disease and all type 2 diabetics should be put on Low Dose Aspirin therapy if there are no contra indications. Enteric coated aspirin should be preferred because of its safety in long term use and any dose 75mg, 81mg and 100mg is equally effective. This was stated by Prof. M. Akbar Chaudhry a noted physician, President of Pakistan Aspirin Foundation who is Principal and Prof. of Medicine at Azra Naheed Medical College, Lahore. He was making a presentation at a seminar organized by Pakistan Aspirin Foundation in collaboration with Pakistan Medical Association Dera Ghazi Khan here on February 23rd 2012. Other speakers who shared their views on medical uses of Aspirin on this occasion included an eminent local physician Dr. Mohammad Yousuf and Dr. Humaira Shakeel consultant obstetrician and gynaecologist. Dr. Tahir Farid Turk General Secretary of PMA Dera Ghazi Khan and his team and worked hard and made excellent arrangements to organize this meeting which was very well attended and the participants showed keen interest in this academic activity by actively participating in the discussion.

Dr. Gul Mohammad Shamsi senior most physician of Dera Ghazi Khan presenting flower bouquet to Dr. Mohammad Yousuf and Prof.M. Akbar Chaudhry at a seminar on Medical Uses of Aspirin organized by Pakistan Aspirin Foundation in collaboration with PMA Dera Ghazi Khan here on February 23, 2012.

Prof. Akbar Chaudhry in his presentation first talked about the burden of high prevalence of cardiovascular disease in the world and in Asia in particular and then traced the history of discovery of Aspirin in early 19th century. Speaking about the known risk factors for CAD he mentioned dyslipidemia, obesity, metabolic syndrome, smoking, high blood pressure, etc. He laid emphasis on preventive measures starting with prevention of smoking, regular exercise, use of healthy diet, weight control, blood pressure control, lipid control and control of blood glucose and finally highlighted the safety and efficacy of low dose Aspirin therapy.
Aspirin is being used for a variety of diseases but its major use these days is in cardiovascular disease which accounts for 37.6%. Aspirin is also referred to as Poor Manís Statin. A single tablet of 325mg soluble aspirin can prove life saving in heart attacks as it reduces the mortality by almost 23%. Enteric coated tablets can also be chewed if need be. If Aspirin is combined with clopidogrel, the reduction in mortality is reported to be up to 44%. However, if Aspirin is contra indicated, other anti platelet agents can be used. Aspirin, Prof. Akbar Chaudhry remarked remains the mother antiplatelet which is the most cost effective therapy and reduces morbidity and mortality in CAD. There have been numerous studies to prove this but even then Aspirin remains underused all over the world Pakistan being no exception. That is why Aspirin Foundations around the world including Pakistan Aspirin Foundation has started this awareness campaign to educate the healthcare professionals and promote its use in well established indications. Todayís meeting, he said, was a part of the CME programme which the Pakistan Aspirin Foundation has been running for the last many years. Apart from secondary prevention of CAD, Aspirin use in prevention of stroke is also well established. To prevent recurrent attacks of Stroke, the patient should be put on 150mg enteric coated Aspirin therapy indefinitely. However, after the age of eighty years its use is not advocated. Since in Pakistan life expectancy is about ten years less, hence here it should be used with caution after the age of seventy years.

Dr. Tahir Farid Turk General Secretary PMA D. G. Khan, Dr. Yousuf, Prof. M.Akbar Chaudhry, Mr. Akhtar Business Unit Head in Atco, Mr. Waqar from Atco Labs and others photographed at the Seminar on Medical Uses of Aspirin held here recently which was sponsored by Atco Laboratories.

Regular use of Aspirin has more protective effect in women as regards stroke. So far well established uses of Aspirin has been confirmed in Acute Myocardial Infarction, Acute Coronary Syndrome, secondary prevention of MI,TIAs and Stroke, prophylaxis for thrombo embolism following different interventional procedures, surgery, hypertension and diabetes. A large primary prevention trial in CAD known as ARRIVE which has enrolled twelve thousand patients in five countries started in 2009 and the final results will be available in 2013. He then referred to various studies which have shown reduction in non-fatal MI, Non-fatal stroke, and reduction in total cardiovascular mortality besides other important vascular events. He also referred to the results of AAUS study conducted by Pakistan Aspirin Foundation many years ago which showed that Aspirin was very much underused, even 50% of ACS patients on discharge were not prescribed Aspirin therapy. He also referred to some recent reports which say that Aspirin fails in primary prevention of asymptomatic peripheral disease and diabetes. A Meta analysis has showed that Aspirin reduced the risk of MI in men by 43% with no significant effect in women. Some studies say that the expected benefits of aspirin in diabetes might not exceed the risk of major bleeding; hence its role in such patients is controversial. All this shows that the physicians have to make choice of use of low dose aspirin therapy by looking at the individual patients keeping in view his medical history. Replying to a question, he said that aspirin therapy should be stopped a week before expected surgery.
Finally he referred to the new and emerging indications of Aspirin in Dementia, Alzheimerís disease, colorectal cancer, insulin resistance, pulmonary embolism, gastric cancer and so on. Hence, this drug which is over hundred years old keeps us surprising with the new and more indications being reported by research scientists all over the world.
Earlier Dr. Mohammad Yousuf, Consultant Physician in his brief presentation on Aspirin therapy talked about the use of Aspirin as antipyretic, for relief of body aches, pain, fever, arthritis tough it does not alter the disease process in arthritis. He also referred to its use in CAD, prevention of MI, colorectal cancer, and pregnancy induced hypertension etc. While using Aspirin one must be careful of its side effects like urticaria, edema, about 10% of asthamatics might become worse hence avoid it in these patients, allergic rhinitis. Major side effects are gastric, nausea vomiting, bleeding. Hence it should be avoided in patients with known peptic ulcer, bleeding ulcers. It should also be avoided in children because of Ryeís syndrome. Aspirin remains a good therapy in tension type headaches, body aches, it is an effective anti-inflammatory in rheumatoid arthritis, and it remains a gold standard in CAD and ischaemic strokes. Before using Aspirin in hypertensives, one must control the blood pressure first, he remarked.
Dr.Humaira Shakeel consultant obstetrician and gynaecologist in her brief presentation highlighted the safety and efficacy of low dose aspirin therapy in recurrent miscarriages. She also talked about its pathophysiology. It can be used in combination with LMWH. Pregnant women treated with low dose aspirin therapy had no eclampsia and they had no PPH, she added.
Mr.Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation talked about the history and accomplishments of the Foundation since its inception and also highlighted its CME activities. Dr. Tahir Farid Turk General Secretary of PMA welcomed the guest speakers and the participants to the meeting. He asked them to be punctual and promised that as today, in future too they will start their programme in time and wonít take more than two hours, hence they should try to be in time. He also thanked M/S Atco Laboratories and their management for providing this opportunity to update their knowledge on Aspirin and from today I will be using enteric coated low dose Aspirin therapy regularly and he advised all his colleagues as well to do the same to avail its benefits
.


 

Aspirin Update seminars at Burewala and Leyyah
Low Dose Aspirin Therapy being increasingly used by
high risk group for Primary prevention of CAD, ACS

Healthcare professionals commend efforts of Pakistan Aspirin Foundation
to promote the use of Aspirin in its well established indications

 

BUREWALA: Pakistan Aspirin Foundation continues its Continuing Medical Education programme for healthcare professionals to create awareness and promote the use of Aspirin in its well established indications by organizing seminars in various cities all over the country. The latest in this series of seminars was the meetings organized at Burewala and Leyyah. Prof. M.Akbar Chaudhry FRCP, FCPS, Principal, Azra Naheed Medical College Lahore who is also President of Pakistan Aspirin Foundation was the guest speaker. The meeting held at Burewala on May 11th was organized in collaboration with Pakistan Medical Association Burewala which was largely attended. It was chaired by Dr. Naseeer Mansoor along with Dr. Munir Ahmad Sindhu President of local PMA.

Prof.  M. Akbar Chaudhry President Pakistan Aspirin Foundation, Mr.Shaukat Ali Jawaid, Dr. Imran Samiullah, Dr. M. Yousuf and Dr. Zafar Iqbal speaking at the seminar on Aspirin organized by Pakistan Aspirin Foundation in collaboration with PMA Burewala  on May 11th2011.

The meeting was conducted by Dr. Zafar Iqbal Mirza, General Secretary PMA Burewala. It started with recitation from Holy Quran by Dr. M. Yousuf consultant paediatrician. Prof. M. Akbar Chaudhry in his presentation discussed in detail the well established indications as well as the emerging new indications for use of low dose aspirin therapy. He pointed out that Aspirin despite being the most economically priced antiplatelet agent whose safety and efficacy has been well documented remains underused all over the world and Pakistan was no exception. However, recent reports suggest that because of the efforts being made by the Foundation, use of low dose Aspirin Therapy has increased among the high risk group of patients for primary prevention of Coronary Artery Disease, Acute Coronary Syndrome, control of hypertension, primary and secondary prevention of acute myocardial infarction as well as Stroke and TIAs.

Pakistan Aspirin Foundation organized a seminar on An Update on Aspirin at Leyyah on May 12th 2011. Pictures taken on the occasion shows from (L to R) Dr. Mohammad Sadiq MS DHQ Hospital presenting gifts to Dr. Afzal Dhandla (Chief Guest) and Prof. M. Akbar Chaudhry President of Pakistan Aspirin Foundation. On right the group photograph shows Mr. Farhan Raza Group Product Manager Atco, Dr. Zafar Iqbal Malkani, Mr.Shaukat Ali Jawaid, Prof.Akbar Chaudhry, Dr. Afzal Dhandla and Dr. Shafiqur Rehman Chishti consultant cardiologist who was the local co-coordinator of this CME programme.

Cardiovascular diseases, he pointed out, remains the No. 1 cause of death globally and there is higher prevalence of CAD in urban areas as compared to rural areas. By 2020 it is feared that CAD will become the leading cause of death in developing world causing 7.8 million deaths annually. As regards CVD deaths in Pakistan, it is estimated that in 2010 it must have accounted for 675 thousand deaths. While some of the risk factors like gender etc., cannot modified but there are modifiable risk factors which include Hypertension, diabetes mellitus, dyslipidemia, obesity, metabolic syndrome, smoking etc. Aspirin is recommended by American Heart Association for all apparently healthy individuals at risk of CAD for primary and secondary prevention of myocardial infarction. Risk interventions include smoking cessation, physical activity, diet therapy, weight control, blood pressure control, and lipid and diabetes control.
Speaking about the benefits of Aspirin, Prof. Akbar Chaudhry said that it reduces the risk of MI by 33%, risk of first stroke by 25% and risk of CVD death by about 17%. As regards secondary prevention, serious vascular events are reduced by 46% in unstable angina, 33% in stable angina, 23% in peripheral arterial disease and 53% in patients undergoing angioplasty. However, the irony is that the Aspirin Awareness and Usage Study (AAUS) conducted by Pakistan Aspirin Foundation a few years ago at 17 Coronary Care Units all over Pakistan which involved over fourteen hundred patients had revealed that only 16% of patients took Aspirin at home when they had chest pain, 20.8% of these patients were prescribed Aspirin by their family physicians and only 50% of the ACS patients were prescribed Aspirin at the time of discharge. After these results we in the Pakistan Aspirin Foundation intensified our efforts to educate and update the healthcare professionals on the safety and efficacy of Aspirin by organizing such seminars. Now latest reports suggest that the situation is improving and use of Low Dose Aspirin therapy has significantly increased.

Pakistan Aspirin Foundation in collaboration with PMA Burewala organized a seminar on Aspirin Update on May 11th 2011. Picture taken on the occasion shows from (L to R) Dr. Zafar Iqbal, Mr.Shaukat Ali Jawaid, Dr. Imran Samiullah, Dr. Munir Ahmad Sindhu President PMA Burewala, Prof Akbar Chaudhry and Dr. Naseer Mansoor.

It is extremely useful and can prove life saving if just one tablet of 325 mg Aspirin is taken within six hours of acute myocardial infarction. In acute emergency either the patients should be advised to use soluble aspirin or chew at least four enteric coated tablets of Aspirin if it is in 75mg. It is as effective as streptokinase and will prevent over 20% deaths. If Aspirin is used in combination with clopidogrel, the risk reduction is further increased by 20%. Dual antiplatelet therapy is usually used after interventional procedures, angioplasty and stenting. For secondary prevention of stroke the recommended dose of Aspirin is 150mg daily. Similarly all Type-2 diabetics should also be put on low dose aspirin therapy if there are no contraindications. If aspirin is contra indicated, other antiplatelet agents can be used. It also helps prevent stent thrombosis. Talking about the emerging indications for use of Aspirin therapy Prof. Akbar Chaudhry mentioned colorectal cancer, dementia, Alzheimerís disease, pulmonary embolism, DVT, insulin resistance, renal cancer besides gastric cancer etc.
The presentation was followed by lively discussion. Responding to various questions Prof. Akbar Chaudhry said that in case of minor surgery, Aspirin therapy can be stopped five days before but in case of major surgery, stop aspirin therapy at least seven days before planned surgery. There are no reports of its efficacy in breast cancer, it is not recommended for use in children.

Picture from (L to R) shows Dr. Naseer Presenting shield to Prof. Akbar Chaudhry and Dr. Saeed presenting shield to Dr. Naseer while on extreme right Dr. Imran Samiullah is presenting shield to Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation at the seminar on An Update on Aspirin organized by PAF in collaboration with PMA Burewala on May 11th 2011.

Earlier Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation highlighted the aims and objectives besides the accomplishments of the Foundation so far. He also pointed out that though still there is some controversy regarding use of Aspirin for primary prevention of CAD but the largest every trial in Primary Prevention ARRIVE which has enrolled twelve thousand patients in five countries including China and USA was initiated in 2009. Its findings will be available by 2013 which will give answer to this question.
Dr. Imran Samiulllah consultant cardiologist who was the local organizer and co-coordinator in his welcome address thanked Pakistan Aspirin Foundation for holding this informative meeting in Burewala. He also briefly highlighted the safety and efficacy of Aspirin. Later mementoes to the guests were presented by Dr. Naseer and Dr. Munir Ahmad Sindhu. PMA Burewala, it may be mentioned here is quite active and regularly holds such academic sessions to keep its members informed and update on latest developments in medicine thereby improving the patient care.

Dr. Munir Ahmad Sindhu President Pakistan Medical Association Burewala presenting an appreciation letter to Mr.Farhan Raza Group Product Manager Atco for sponsoring the CME programme on An Update on Aspirin held on May 11th 2011.

Meet at Leyyah

The seminar at Leyyah was organized on May 12th and it was jointly chaired by Dr. Zafar Iqbal Malkani Consultant Physician at the local DHQ Hospital, Dr. Afzal Dhandla a well known skin specialist who hails from a very influential political family in the area and Dr.Shafiqur Rehman Chishti consultant cardiologist who was also the local organizer and co-coordinator. Presentations by the guest speakers Prof. M.Akbar Chaudhry and Mr. Shaukat Ali Jawaid were followed by lively discussion.

Responding to various questions Prof.Akbar Chaudhry said that Clopidogrel can be used for one year and then the patients should be continued on low dose Aspirin 75-100ng daily indefinitely. Since most of the strokes are ischaemic and not haemorrhagic, even in case CT scan is not available, one tablet of Aspirin in case of chest pain would not do much harm but it might save the patients life. However, when you are using Aspirin in combination with clopidogrel, be mindful of the side effects as there are increased chances of bleeding. For hypertensiveís, they must control their blood pressure first and then start using Aspirin, he added. Proton Pump Inhibitors do have some problems with clopidogrel as regards drug interactions but no such problems are seen with Aspirin, he remarked.
Dr. Shafiqur Rehman Chishti in his welcome address highlighted the life saving properties of Aspirin if taken immediately within six hours of chest pain. It is extremely useful in primary and secondary prevention of AMI, CAD, Stroke and TIAs. Dr. Zafar Iqbal Malkani thanked Prof. Akbar Chaudhry and Pakistan Aspirin Foundation to have come all the way to Leyyah to hold this informative meeting which has benefitted us all. Many of the participants felt that before this they were not aware of the fact that Aspirin is so useful in a wide range of diseases.
Dr.Afzal Dhandla in his concluding remarks said that he himself will start taking low dose aspirin therapy from today and will recommend it to all his patients, friends and well wishers. This is a wonderful drug which is economically priced but offers a lot of benefits. He advised the participants to advise their patients to stop smoking, reduce weight, control their blood pressure and start taking low dose aspirin therapy on regular basis.
Organizers at Burewala as well as Leyyah expressed their thanks to Atco Laboratories for sponsoring these meetings. PMA Burewala also presented a letter of appreciation to Mr.Farhan Raza Group Product Manger in Atco laboratories as a token of appreciation
.


 

Prevention of CAD, MI and Stroke
Physicians advised not to deprive deserving
patients of benefits of Low Dose Aspirin therapy

 

KARACHI: Eminent cardiac physicians participating in the panel discussion in the Break Fast session on Aspirin during the Pakistan Hypertension League annual seminar held on Sunday January 16th advised the physicians not to deprive the deserving patients of the benefits of Low Dose Aspirin Therapy. There is lot of data now available to prove that regular use of low dose Aspirin 75-100mg per day significantly reduces morbidity and mortality in cardiovascular diseases besides preventing CAD, Myocardial Infarction and stroke. Hence, all high risk patients should be put on Aspirin therapy unless there is some contra indication.

Pakistan Aspirin Foundation organized a Breakfast session on Aspirin update during the recently held annual symposium of Pakistan Hypertension League on January 16th 2011. Group photograph taken on this occasion shows from (L to R) Mr. Farhan Raza Product Manager Atco, Mr. Shaukat Ali Jawaid General Secretary PAF, along with members of the Experts Panel Major Gen. Ashur khan, Dr. Abu Bakar, Prof. Ejaz Ahmad Vohra and Dr. Syed Imran Ahamd .

The moderator in the session was Dr. Abu Bakar Sheikh while other panelists included Major Gen. Ashur Khan, Prof. Ejaz Ahmad Vohra, Dr.Syed Imran Ahmad, Dr. Amir Hameed, Prof. Khandkar from Bangladesh and others. This interactive discussion was attended by many other physicians as well who were present on this occasion. Dr. Abu Bakar Sheikh in his introductory remarks said that approach in high risk patients particularly of stroke will be different. However, it is essential to take care of the all important risk factors and modify the risks as far as possible. Those who have an MI risk of 10% are considered mild, those between 10-20% risks are considered moderate risk but more than 20% are grouped as high risk cases. We intervene to modify the risk with pharmacological and non-pharmacological interventions. Aspirin is extremely effective in secondary prevention but in primary prevention it is still being discussed in certain conditions and one has to be careful of the risk of GI bleeding.
Dr.Syed Imran Ahmad said that this risk of bleeding has to be calculated. Different scales are now available to calculate this risk. Mr.Shaukat Ali Jawaid pointed out that the risk of GI bleeds with Aspirin is much less as compared to various NSAIDs which are being routinely used. Referring to the Aspirin Awareness and Usage Study (AAUS) he said that this revealed that only 16% of patients with ACS took Aspirin at home, only 20% Family Physicians prescribed Aspirin to these patients but what was more criminal was the fact that on discharge from CCU only 50% of the patients were prescribed Aspirin along with other medications. Prof. Ejaz Ahmad Vohra said that one must rule out diabetes mellitus and if the patient is diabetic, then he or she must be put on Aspirin and Stations. Some patients may not tolerate combination of Aspirin and Clopidogrel; hence this must be kept in mind. It is advisable to take Aspirin therapy at night.
Dr. Amir Hameed said that at times hypertensive patients are prescribed Aspirin . In the elderly it is OK but in young patients, one has to be careful. Mr. Shaukat Ali Jawaid pointed out that Pakistan Aspirin Foundation always recommends that first the blood pressure must be brought under control and only then the patients should be prescribed low dose Aspirin therapy. Enteric coated LDA therapy is very safe and effective in long term use. Prof. Ejaz Ahmad Vohra said that in the elderly if they are taking Statin and Aspirin, one must control hypertension first because the risk of bleeding is also higher in this group. He also remarked that in Asia, almost 30% of strokes are hemorrhagic in nature as compared to just 1o-15% in the West. Aspirin is a very useful drug but it should not be misused. Recent studies have also shown its efficacy in colorectal cancer. Prof. Khandkar from Bangladesh opined that first high blood pressure has to be controlled before prescribing low dose aspirin therapy. Maj. Gen. Ashur Khan felt that a blood pressure of 140-150 was considered OK in the elderly in the past but now the recommendation is the same i.e. 130-135 SBP. Some family physicians, he further stated, prescribed Aspirin as treatment for hypertension which is not the correct approach, it has to be combined with an antihypertensive agent.
Dr. Abu Bakar Sheikh then presented different case scenarios of patients in different age groups and it was suggested that for prevention of CAD, TIA and stroke low dose aspirin therapy is effective but in the very old patients, it should be avoided particularly after the age of eighty years. Quality of life and span of life also came under discussion and Dr. Amir Hameed pointed out that different physicians have a different approach but many feel that quality of life is much more important than life span. Hence the physicians should ensure quality of life to the patients.
Earlier Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation highlighted the aims, objectives and accomplishments of the foundation so far. He pointed out that apart from holding seminars on Aspirin Update in different cities; such interactive sessions are also organized in collaboration with different professional societies like PCS, PHL, and PSP etc. Mr.Farhan Raza Product Manager Atco Laboratories which are sponsoring these CME programms of Pakistan Aspirin Foundation welcomed the participants and thanked the panel of experts for their valuable comments and suggestions to promote the use of low dose aspirin in its well established indications.


 

Pakistan Aspirin Foundation to revise its
guidelines on Medical Uses of Aspirin

Follow up study regarding Awareness and
Usage of Aspirin also being planned

HYDERABAD: A meeting of Pakistan Aspirin Foundation was held here on December 25th during the Pakistan Cardiac Societyís annual conference which discussed many important issues. Those who were present in the meeting included Prof. M. Akbar Chaudhry (President), former Presidents i.e. Prof. Abdus Samad, Major Gen. Ashur Khan, Dr. Maqbool H. Jafary besides Prof. M. Ishaq, Prof. S.H.Shafqat, Dr. Khawar Kazmi, Prof. Shahryar Sheikh, Prof. Mansoor Ahmad and Mr. Shaukat Ali Jawaid. Mr.Akhtar from ATCO Laboratories which are sponsoring all CME programmes of the Foundation was also present on special invitation.
The meeting reviewed the activities and progress of the Foundation so far. It was decided that the Consensus Report on the Medical Uses of Aspirin should be revised and updated. Prof. Abdus Samad Chairman of the Experts Panel was entrusted this responsibility to update this document. On a suggestion from Dr. Maqbool H.Jafary it was also decided to conduct a follow up study on Awareness and Usage of Aspirin to find out the impact of the CME and Awareness programmes being organized by the Foundation for the last many years. Dr. Maqbool H. Jafary along with Prof.M.Ishaq will develop the study protocol for this purpose.
Prof.Shahryar Sheikh referred to various studies wherein now the use of Aspirin in primary prevention is also being challenged and contested. However, Prof. Abdus Samad remarked that till today no study has refuted the safety and efficacy of Aspirin in reducing the morbidity and mortality in various cardiovascular disorders and this remains the mother antiplatelet agent which is quite economical and affordable besides being easily available every where. Mr. Akhtar briefed the participants about the measures they have taken to ensure quality of this preparation. The Quality Assurance Department, he said, is very strict and all efforts are made to ensure sustainable quality control in all batches besides the proper storage of the finished product. On Dr. Khawar Kazmiís suggestion it was stated that we have already added the world of Forum for Thrombosis and Atherosclerosis under the Foundation. However, since all over the world, the organizations active in this field are named as Aspirin Foundations, hence we also decided to name it as Pakistan Aspirin Foundation. Prof. Abdus Samar disclosed that now Aspirin has been included in the category of orphan drugs, since there is not much profit and non one is interested to promote its use.
The participants expressed their appreciation to Atco Laboratories for sponsoring the CME programmes to create awareness thereby promoting the use of Aspirin in its well established indications. It was also decided to hold such meetings in Jacobabad, Shikarpur, RahimYar Khan, Dera Ghazi Khan and Sukkur in the days to come. The participants who are all distinguished physicians and are always among the invited speakers at different conferences were also requested to utilize every available opportunity to talk about Aspirin thereby promoting its usage.


 

Aspirin Update seminar at Gojra
Prof. Akbar Chaudhry urges healthcare
professionals to promote the use of Aspirin
This economically priced mother anti-platelet agent reduces morbidity
and mortality in many disorders including cardiovascular diseases
Dr. Obaidur Rahman reminds the doctors to uphold professional ethics

From our correspondent

GOJRA (FAISALABAD): Pakistan Aspirin Foundation continues its Continuing Medical Education programme for the healthcare professionals updating them in the use of Aspirin in its well established indications. In this on-going academic programme, a seminar on Aspirin Update was also organized here on October 21st which was very well attended. Dr. Obaidur Rahman Consultant Physician and Cardiologist was the local organizer and the meeting was held in collaboration with the local Pakistan Medical Association. Prof. M. Akbar Chaudhry Principal Continental Medical College who is also President of Pakistan Aspirin Foundation was the guest speaker who in his presentation called upon the healthcare professionals in general and Family Physicians in particular to promote the use of Aspirin the economically priced mother anti-platelet agent in its well established indications. Despite proven safety and efficacy in a wide range or disorders, Aspirin still remains under-used all over the world and situation was no better Pakistan, he added.

Pakistan Aspirin Foundation in collaboration with PMA Gojra organized a seminar on ďAn Update on AspirinĒ at Gojra on October 21st 2010. Picture taken on the occasion shows from (L to R) Prof. M.Akbar Chaudhry President PAF presenting bouquet to Dr. Mian Mahmood ul Hassan  while on right Mr.Shaukat Ali Jawaid GS of PHL is presenting bouquet to Dr. Riaz A. Khan GS PMA Gojra and Dr. Obaidur Rehamn.

He also referred to the Aspirin Awareness and Usage Study (AAUS) conducted by Pakistan Aspirin Foundation which enrolled over fourteen hundred Acute Coronary Syndrome patients from seventeen Coronary Care Units across the country. This showed that only 20% of the Family Physicians prescribed Aspirin to the patients at the time of acute myocardial infarction while only 16% got Aspirin at home. This is a very dismal picture which shows that we need to create more awareness not only among the medical profession but public as well regarding the usefulness of this wonderful drug. One full tablet taken immediately after AMI, can prove life saving and numerous studies have documented 23% reduction in mortality in such a situation. In case Aspirin is combined with streptokinase, the risk reduction is over 40%. Aspirin is readily available every where and it is very economically priced, hence the physicians must educate their patients and general public that in case of chest pain, they must take one tablet of Aspirin and chew it or use soluble Aspirin.
All CCU patients on discharge must be put on Low Dose Aspirin therapy 75mg per day. Similarly all Type-2 diabetics, those patients who have had interventional cardiac procedures and stroke should be put on Low Dose Aspirin therapy unless there is some contraindication. Enteric coated Aspirin is safe and also effective even in long term use that is why it is and should be preferred. He also referred to the new and emerging indications for use of Aspirin like Pre-eclampsia, Dementia, Alzheimerís disease, Colo-rectal Cancer, Gastric and Esophageal cancer, insulin resistance and so on. Almost every day there is some new discovery of its uses and this wonderful drug which has been in clinical use for now over one hundred ten years continues to surprise us all. Once hypertension is controlled, all hypertensiveís also needs to be put on low dose aspirin therapy. However, in those patients where Aspirin is contra indicated, other antiplatelet agents should be used. Combination of Aspirin and Clopidogrel further enhances the risk reduction in cardiac patients. Now there is lot of data available supporting the use of Aspirin even in primary prevention of Coronary Artery Disease but the results of largest ever Primary Prevention Trial (ARRIVE) which will enroll over twelve thousand patients from five countries will be available in 2013 which it is hoped will conclusively prove the safety and efficacy of Aspirin even in primary prevention of CAD.

Group photograph taken during the seminar on Aspirin at Gojra shows from (L to R) Dr. Riaz A. Khan General Secretary PMA Gojra, Mr. Akhtar  General Manager Marketing from Atco Labs, Dr. Mian Mahmoodul Hassan and Prof. M. Akbar Chaudhry President of Pakistan Aspirin Foundation.

Responding to various questions from the audience, Prof Akbar Chaudhry said that use of Aspirin must be stopped at least five to seven days before elective surgery. Aspirin is not recommended in all pregnant patients but only in pregnancy induced hypertension. One of the participants advised the family physicians to use few drugs but they must know their price and side effects, interactions. Re-bleeding has also been noted in some patients after stenting and angioplasty, and these patients need to be carefully managed.
Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation highlighted the aims, objectives and achievements, accomplishments of the Foundation since its inception. It is a very democratic body and its membership is open to physicians and general public. He also quoted Scottish Physician Prof. Peter Elwood the pioneer research scientists who for the first time clinically proved and reported in 1974 that Aspirin can be a life saving drug in AMI. Peter Elwood says that we all must keep Aspirin with us all the time, at clinic and at homes as we ourselves, our friends of family members may need it any time and in case of an emergency i.e. Acute Myocardial Infarction it can save live. He thanked M/s Atco Laboratories for their generous sponsorship of these academic programmes and hastened to add that keeping up the professional ethics; they do not patronize or promote any particular brand of Aspirin. It is up to the medical profession to make their choice.
Earlier Dr. Obaidur Rahman in his welcome address advised the healthcare professionals to uphold professional ethics. Unethical practiced indulged in by some members of the medical profession was bringing bad name to the entire doctors community. Medicine is a noble profession and we all must practice ethical medicine. He thanked Pakistan Aspirin Foundation for selecting Gojra for one of their CME meetings.

Mr. Farhan Raza

This CME programme was conducted by Mr. Farhan Product Manager in Atco Laboratories which had sponsored this meeting. Atco Laboratories, it may be mentioned here is sponsoring all CME programmes of Pakistan Aspirin Foundation for the last many years. Atco has also produced a highly informative Booklet on Aspirin in Urdu which is being distributed among the healthcare professionals and public all over the country.


 

Aspirin Update Seminar at Sargodha
Patients with more than 10% absolute ten years risk of CAD
should be put on low dose Aspirin therapy - Prof. Akbar Chaudhry

Despite lot of data showing safety and efficacy of Aspirin in prevention of CAD and Stroke, this mother anti-platelet agent still remains under used

 

From our correspondent

SARGODHA: Pakistan Aspirin Foundation in collaboration with Pakistan Medical Association Sargodha organized a seminar on Aspirin Update here on October 20th 2010. It was chaired by Prof. M. Siddique a noted physician and it was very well attended by members of the medical profession. Prof. M.Akbar Chaudhry FRCP Principal Continental Medical College Lahore who is also President of Pakistan Aspirin Foundation in his presentation discussed in detail the well established indications of Aspirin therapy. He was of the view that despite lot of data showing its safety and efficacy in prevention of CAD and Stroke, this mother anti-platelet agent was still under used all over the world including Pakistan. This is one of the reasons that Pakistan Aspirin Foundation has started this CME programme for healthcare professionals to update them and promote the use of Aspirin to help the patients.

Pakistan Aspirin Foundation organized a seminar on Aspirin at Sargodha in collaboration with the local PMA.  Picture taken on the occasion shows on left Mr. Akhtar General Manager Marketing of Atco which had sponsored this CME programme presenting a flower bouquet to one of the distinguished paraticipants while President of Sargodha PMA Dr.Sikandar Hayat Warriach is also seen in the center. Also seen in the picture are Mr. Shaukat Ali Jawaid, Mr. Akhtar, Prof. Akbar Chaudhry, and Dr. Niazi.

Aspirin, he said was now one hundred ten years old drug. Speaking about its well established indications he mentioned Acute Myocardial Infarction, Acute coronary Syndrome, Secondary prevention of AMI, Primary prevention of CAD, Acute Ischemic Strokes, Transient Ischemic Attacks (TIAs), primary and secondary prevention of stroke, hypertension, diabetes mellitus besides prophylaxis against Deep Vein Thrombosis and Pulmonary Embolism. In addition it has numerous emerging indications which include colorectal cancer, esophageal and gastric cancer, prostate cancer, pre eclampsia, Alzheimerís disease, insulin resistance etc. This most economically priced and easily available anti-platelet agent which has life saving properties has proved to be a miracle drug which is also called as Poor Manís Statin.

Field force representatives of Atco laboratories photographed along with Prof. Siddique, Prof. Akbar Chaudhry and Dr. Mushtaq Cheema during the Aspirin seminar held at Sargodha on October 20th 2010

He advised the healthcare professionals that any patient who complains of chest pain should be asked to immediately chew 325mg tablet of Aspirin or use soluble Aspirin before taking him to any doctor or healthcare facility as it could prove life saving. We should keep Aspirin with us all the time, in emergency bag, at clinic and at home as we may need it any time. In case of Acute Myocardial Infarction if used within six hours, it reduces mortality by about 23% and if it is used along with streptokinase, the risk reduction could be 45%. It can be used in combination with clopidogrel which will further reduce the risk but one has to be careful of increased side effects. All CCU patients on discharge must be prescribed Low Dose Aspirin therapy 75mg daily unless there is some contra indication. Those who are allergic to Aspirin can be put on other ant platelet agents.
In case of stroke, Aspirin 150-300mg daily should be initiated as early as possible and then continued indefinitely. In high risk patients it can be combined with Dipyridamol or Ticlodipine or Clopidogrel. Studies have shown relative risk reduction of stroke and death with Aspirin by 31% as compared with placebo and there is minimal risk of bleeding. Relative risk reduction of secondary ischemic stroke, TIAs and death is 27% with Aspirin. There is evidence that continuous low dose Aspirin therapy reduces risk of colorectal cancer by 40-50%, esophageal cancer risk reduction is reported as 90% while gastric cancer reduction is reported 48% in male and 52% in female. There are reports that Aspirin can reduce prostate cancer risk by 50%.
He thanked Dr. Maqbool H. Jafary the former President of Pakistan Aspirin Foundation who had collected most of this data and called upon the healthcare professionals to ensure that all those who need to be on Low Dose Aspirin therapy are not deprived of the benefits of this miracle drug. Enteric coated Aspirin tablets are safe for long term use that is why it is preferred. Replying to questions from the audience Prof. Akbar Chaudhry said that Aspirin should be stopped at least seven to ten days before elective surgery and in case of emergency surgery, patients on Aspirin therapy may require plasma transfusion. In pregnancy it is only indicated in pre-eclampsia in women with poor obstetric history.
Prof. M. Siddique commended the presentation and remarked that at home Aspirin should be kept away from children.
Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation talked about the aims and objectives of the Foundation and also highlighted some of its achievements so far. He thanked Atco Laboratories for sponsoring CME activities of the Foundation for the last many years but hastened to add that keeping up the professional ethics, we do not promote and patronize any particular brand of Aspirin, he added. Earlier Dr.Sikandar Hayat Warraich President of Sargodha PMA welcomed Prof. Akbar Chaudhry, participants and also thanked Pakistan Aspirin Foundation for organizing this academic activity. He suggested that a public awareness session on Aspirin should also be organized which will be quite informative and useful.
The meeting was conducted by Mr. Farhan Raza Product Manager in Atco Laboratories which had sponsored this meeting.


 

Antiplatelet therapy has a role in prevention of
cardiovascular diseases - Dr. Maqbool H. Jafary
Regular use of Low Dose Aspirin reduces the risk of unstable angina by 46%, stable angina by 33%, peripheral arterial disease by 23% and in patients undergoing angioplasty by 53% - Prof. Akbar Chaudhry
Aspirin is considered as poor manís Statin - Prof. Feroze Memon

 

KARACHI: Prof. Feroze Memon Prof.of Cardiology at Isra University Hyderabad along with Prof. Naeem Aslam Prof. of Cardiology at Sheikh Zayed Medical College Rahim Yar Khan chaired the Breakfast session on Antiplatelet Therapy during the KIHD 3rd annual symposium. The session held at the KIHD campus on May 1st 2010 was very well attended. The panel of experts included Prof. Akbar Chaudhry President of Pakistan Aspirin Foundation and Dr. Maqbool H. Jafary. Also present were Prof. Wahid Sahibzada from Peshawar, Dr. Masood Ahmad from Ittefaq Hospital Lahore, Prof. S.H. Shafqat and Dr. A. Rashid Khan besides many family physicians.
In his introductory remarks Prof. Feroze Memon said Aspirin is considered as poor manís Statin. It is economically priced and is easily available. Hence its use need to be promoted in its well established indications.

KIHDís third annual symposium started with a breakfast session on Anti Platelet therapy with special reference to safety and efficacy of low dose Aspirin sponsored by Atco Labs. Group photograph taken on the occasion shows some eminent cardiologist of Pakistan from (L t o R) Prof. SH Shafaqt, Dr. Masood, Prof. Naeem Aslam, Mr. Farhan Raza (Product Manager Atco), Prof. Feroze Memon, Prof. Ishaq, Prof. Akbar Chaudry, Mr. Shaukat Ali Jawaid (Chief Editor PULSE), Prof. Hafiz Chaudry, Prof. Wahid Sahibzada who participated in the discussion. Mr. Zia and Dr. Faisal from Atco Labs are also seen on extreme left and extreme right.

Prof. Akbar Chaudhry Principal Continental Medical College in his brief presentation highlighted the safety and efficacy of antiplatelet therapy in reducing morbidity and mortality in cardiovascular diseases. He was of the view that CAD has now become an epidemic in Pakistan. Use of Aspirin therapy he said is recommended for all apparently healthy individuals at high risk of CVD. AHA recommends it for primary prevention of first mi which is reduced by one third and one sixth reduction in vascular events. Similarly in secondary prevention myocardial infarction risk is reduced by one third, stroke by a quarter and CVD death by one sixth. Enteric coated aspirin he said is preferred as it is safe and there is no risk of gastric irritation. Low dose aspirin therapy is extremely safe and effective but those who are resistant or allergic to Aspirin, should be put on other antiplatelet agents.
Dr. Maqbool H. Jafary in his remarks said that emphasis should always be on preventive aspects. Anti platelets have a role in prevention of cardiovascular diseases? Participating in the discussion Prof. M. Ishaq said that Aspirin remains under utilized. It is economical priced and Pakistan Aspirin Foundaiton also needs to revise its guidelines which were earlier revised couple of years ago. AAUS study conducted by Pakistan Aspirin Foundation had revealed very low use of Aspirin by Family Physicians as well as in CCU when the patients were being discharged but due to CME activities by the PAF, now use of Aspirin has considerably improved among the family physicians as well. Prof.Feroze Memon felt that since it is the junior doctors who prepare the discharge slips in the CCU, they should be educated not to forget aspirin in the prescription. There are very few contra indications for the use of Aspirin and the important one are active peptic ulcer disease but it must be ensured that diagnosis of PU are correct and one should not confuse it with Gas, and heartburn etc which is quite common.
Persantin it was said is not superior to aspirin therapy. Persantin is used quite frequently in stroke patients as well as in TIAs. In fact it is the combination of Aspirin and Persantin which is considered more effective in these Stroke and TIA patients. Prof. S.H. Shafqat opined that as the awareness about the use of Aspirin goes up, hopefully more and more patients will benefit. It remains under use and family physicians in particular must promote its use, he remarked. Dr. Maqbool H.Jafary opined that we need to conduct another study to find out the benefits of our CME programmes which have been going on now for many years wherein a large number of Family Physicians have been participating. Prof. Naeem Aslam remarked that all Type-2 diabetics must be put on low dose Aspirin therapy on regular basis and the recommended dose is 150mg of enteric coated tablets. Dr. Masood consultant cardiologist from Ittefaq Hospital Lahore felt that except patients with gastric symptoms, Aspirin can be safely prescribed to CAD, ACS patients. Dr. A Rashid Khan from Abbasi Shaheed Hospital said that regular use of low dose Aspirin reduces morbidity and mortality in cardiovascular diseases significantly. It added advantage is that it is economically priced and its availability is not problem even in small towns and cities.
Responding to another question Prof. Akbar Chaudhry said that in case of major surgery, Aspirin therapy should be stopped at least ten days before surgery but in case of minor surgery, even five days stoppage of aspirin therapy is good enough. This meeting was sponsored by M/s Atco laboratories as a part of their CME programme to keep the healthcare professionals update on the use of Aspirin therapy. Atco Laboratories has also played a vital role in promoting the use of Aspirin in Pakistan sponsoring all the academic activities of Pakistan Aspirin Foundation for the last many years.


 

Aspirin Update Seminar at Okara
In primary prevention Aspirin reduces the risk of first MI
by 33%, risk of first stroke by 25% and the risk of
CVD death by about 17% - Prof. Akbar Chaudhry

Usage of Low Dose Aspirin has increased but
still we need to do a lot more
Family Physicians and GPs can play a vital role in promoting
the use of LDA which can also save many precious lives in AMI

 

From our correspondent

OKARA: Pakistan Aspirin Foundation in its Continuing Medical Education programme to promote the use of Aspirin in its well established indications organized a seminar on Aspirin Update in collaboration with Pakistan Medical Association Okara on April 8th 2010. The meeting held at the local PMA house was very well attended by members of the PMA. Prof. M. Akbar Chaudhry a noted physician and President of Pakistan Aspirin Foundation who is currently Principal of Continental Medical College Lahore was the main guest speaker.

Prof. M. Akbar Chaudhry and Mr. Shaukat Ali Jawaid President and General Secretary respectively of Pakistan Aspirin Foundation photographed along with office bearers of PMA Okara and some other guests during the seminar on Aspirin Update held at Okara on April 8th 2010

In his presentation Prof. Akbar Chaudhry highlighted the safety and efficacy of Aspirin therapy in coronary artery disease particularly Acute Coronary Syndromes and said that one tablet of soluble Aspirin or four tablet of enteric coated Aspirin chewed immediately after chest pain can prove to be life saving. Most often the heart attacks occur late at night or early in the morning hours when it is not possible to find a doctor or reaching the healthcare facility may also take some time. Hence, if Aspirin is readily available, the patient should be advised to immediately take Aspirin tablet and then efforts should be made to shift the patient to a hospital. It was also pointed out that recent meta analysis in Cochran Review has revealed that regular use of low dose Aspirin should be preferred at night which can take care of early morning episode in case of blood pressure peaks.

Pakistan Aspirin Foundation in collaboration with PMA Okara organized a seminar on Aspirin Update at the local PMA House on April 8th. Photograph taken on the occasion shows Prof. M.Akbar Chaudhry President of PAF along with some members of PMA and executives and field force representatives of Atco Laboratories which had sponsored this meeting.

American Heart Association has recommended regular use of low dose aspirin for all apparently healthy individuals who are at risk of cardiovascular diseases. In random trials and Meta analysis, it has been shown that Aspirin significantly reduces the risk of cardiovascular diseases. As regards primary prevention, it reduces first MI by about one third and all important vascular events by one sixth. In secondary prevention, MI is reduced by one third and stroke by about a quarter and cardiovascular death by one sixth. Speaking about the guidelines for primary prevention of CVD Prof. Akbar Chaudhry said that one should begin risk factor assessment in adults at the age of twenty years. All adults over the age of forty years should know their absolute risk of developing CVD. Risk intervention strategies include smoking cessation, physical activity, diet therapy, weight control, blood pressure control, lipid control, diabetes control and Aspirin therapy.

Prof. Akbar Chaudhry President Pakistan Aspirin Foundation and Principal Continental Medical College presenting flower bouquet to Dr. Abdul Aleem Asif and Dr. Zaeemuddin Abid consultant physicians in Okara at the Aspirin Update seminar held in Okara on April 8th 2010.

Speaking about the benefits of Aspirin, Prof. Akbar Chaudhry said that in primary prevention it reduces the risk of first MI by 33%, reduces the risk of first stroke by 25% and the risk of CVD death by about 17%. In secondary prevention, the chances of serious vascular events are reduced by 46% in unstable angina, 33% in stable angina, 23% in peripheral arterial disease and 53% in patients undergoing angioplasty. Despite all these findings, it is a pity that Aspirin remains under used. Referring to the Aspirin Awareness and Usage Study (AAUS) conducted by Pakistan Aspirin Foundation couple of years ago at seventeen CCUs all over Pakistan which enrolled over fourteen hundred ACS patients, Prof. Akbar Chaudhry said that only 16% of patients got aspirin at home when they suffered from chest pain. Again only 20.8% of these patients were prescribed Aspirin by their family physicians and what is more tragic is the fact that only 50% of these patients were prescribed Aspirin on discharge. It is because most often the discharge slips are prepared by junior house offices who need to be educated as most of them do not realize the importance of Aspirin therapy. However, Prof. Akbar Chaudhry further stated that this study was conducted many years ago. Since then Pakistan Aspirin Foundation has been conducting its CME activities all over the country and this has increased the usage of Aspirin therapy to a great extent though we still need to do a lot to promote the regular use of low dose Aspirin in its established indications.
Prof. Akbar Chaudhryís views were further confirmed when taking part in the discussion Dr. Zaeemuddin Abid consultant physician pointed out that he has started using Aspirin in his patients. Whenever the patient with ACS comes, he immediately asks him to take two tablets of Aspirin. First their blood pressure is controlled and then they are put on regular use of Low Dose Aspirin therapy. Once he saw a patient who died the next morning due to acute myocardial infarction. Since then, as a practice he makes sure that all these patients are given aspirin immediately when they consult him and it also convinces the patients of the importance of Aspirin therapy.

Members of Sales team of Atco Laboratories photographed along with Mr. Akhtar Tahir Business Unit Head and Mr. Farhan Raza Product Manager Atco Laboratories during a seminar on Aspirin Update held at Okara recently.

Dr. Abdul Aleem another consultant physician of Okara pointed out that Aspirin is extremely safe and effective in ACS. In his clinical practice he has found Aspirin highly beneficial in acute coronary syndrome. He advised his patients to immediately take Aspirin tablet in case of chest pain irrespective of the fact whether it is cardiac in nature or not but those who do not tolerate Aspirin they are advised not to take it. Similarly in acute gastric bleeding, patients are advised not to take Aspirin. He advised the family physicians to use enteric coated Aspirin which is much safer. Dr. Aleem further stated that in secondary prevention of CAD, Aspirin should be used without any hesitation unless it is contra indicated. However, he re-emphasized that one must first control blood pressure before putting patient on low dose aspirin therapy. In elderly patients with gout, urine analysis and keratinine should be checked regularly. Aspirin, Dr. Aleem said is very economically priced wonder drug and affordability is not a problem. It should be used more and more. Family Physicians should encourage its usage. All doctors over the age of fifty years, he said, must use low dose aspirin regularly.

Mr. Shaukat Ali Jawaid General Secretary Pakistan Aspirin Foundation highlighted the objectives and accomplishments of the Foundation so far. Referring to the use of Aspirin therapy in primary prevention of CAD, he stated that though lot of evidence is available but the largest trial which will enroll over twelve thousand patients in five countries including USA, UK, Germany and China has commenced in 2009 and it will last for four years. The results of this ARRIVE study will be available in 2013 which will further confirm the efficacy of regular use of low dose Aspirin therapy in primary prevention of CAD. He also referred to the publication of Book on Aspirin- the wonder life saving drug, an Urdu Booklet on Aspirin, revision of consensus report on use of Aspirin in various diseases which gives details about the dosage, indications and contra indications etc. This report is also accessible on the website of Pakistan Aspirin Foundation (www.pakaspirin.org) and it is being freely distributed throughout the country. Both Prof. Akbar Chaudhry and Mr. Shaukat Ali Jawaid made it clear that though they are thankful to M/s Atco Laboratories and its team headed by Mr. Akhtar and Mr. Farhan Raza for helping Pakistan Aspirin Foundation in its academic activities but upholding professional ethics, they do not support any particular brand of Aspirin. It is up to the physicians to prescribe the drug of their choice based on their clinical experience and trust.
Later Dr. Liaquat Ali took up the issue of violence against doctors and asked the doctors community to have unity among their ranks. He also talked to the SHO and other officials of the district administration urging them to arrest the culprits who misbehaved with doctors on duty at the local DHQ Hospitals a few days ago otherwise they will march to their offices to stage a sit in and record their protest.
The programme was conducted by Dr. Nasir Mahmood General Secretary of the local PMA while Dr. Ishtiaq Ali President of PMA also briefly spoke on the occasion. Later flower bouquet was presented to the guest speakers and others. The meeting as usual was sponsored by Atco Laboratories for which Mr. Farhan Raza and his team from Atco laboratories had been quite busy. Mr. Akhtar Business Unit Head in Atco laboratories was also present on this occasion.
The PMA Okara needs to be commended to have established its own purpose built PMA House which is being used for holding all such academic activities. The PMA Okara it is learnt is quite active and its successive leadership has been quite busy in not only holding CME programmes from time to time but also safeguarding the interests of the doctorís community. During the recent violence against the doctors, the PMA has played a vital role to ensure that their viewpoint is heard by the administration and necessary steps are taken so that doctors can work with devotion without any fears about their security.


 

Aspirin Update seminar at Kasur
Regular use of low dose Aspirin reduces morbidity
and mortality in CAD - Prof. Akbar Chaudhry
All Type-2 diabetics should be put on Aspirin therapy
if there is no contra indication - Prof. Mahmood Ali Malik

 

KASUR: Pakistan Aspirin Foundation in collaboration with the PMA Kasur organized a seminar on An Update on Aspirin here on April 7th 2010. Prof. Mahmood Ali Malik a noted physician and former Principal of King Edward Medical College and Prof. M. Akbar Chaudhry President of Pakistan Aspirin Foundation currently Principal of Continental Medical College Lahore were the two guest speakers. The meeting was very well attended by members of the PMA which included GPs and Family Physicians as well.

Pakistan Aspirin Foundation in collaboration with PMA Kasur organized a seminar Update on Aspirin at Kasur on April 7th. Picture sows Dr. Safdar one of the senior most physicians presenting flower bouquet to Prof.M. Akbar Chaudhry President of the Foundation.

In his presentation Prof. Akbar Chaudhry said that Aspirin which has now completed over one hundred ten years of its use in clinical medicine was a wonder drug of the century. Despite numerous studies which have proved that continued use of low dose Aspirin reduces the morbidity and mortality to a great extent, it remains underused. Its established indications include Acute Myocardial Infarction, Acute Coronary Syndrome, secondary prevention of MI, primary prevention of CAD, TIAs and Stroke, prophylaxis for thromboembolism, DVT, Hypertension and Diabetes. In addition there are many emerging new indications like cancer, prostate cancer, Alzheimerís disease, Pre-eclampsia, renal diseases, insulin resistance, etc., which continues to amaze the research scientists.

Prof. Mahmood Ali Malik, Prof. Akbar Chaudhry, Dr. Ghulam Shabbir Yazdani, Dr. Inayat, Mr. Akhtar Business Unit Head of Atco and others photographed after the seminar on Aspirin held at Kasur recently.

He also gave a brief historical background to the discovery of Aspirin and the story starts from 1948 but it was the pioneering study of Scottish Physician Dr.Peter Elwood who first showed in 1974 that Aspirin prevents heart attacks. Since then its anti-platelet activities have been highlighted in various disorders. In case of acute myocardial infarction, one full tablet of Aspirin or use soluble Aspirin immediately which will reduce the chances of any fatal event by almost 25%. According to reports over forty thousand tones and one hundred billion tablets of Aspirin are used every year all over the world. Its popular uses include cardiovascular diseases, arthritis, headaches, etc. As regards its use in primary prevention of cardiovascular diseases, studies have shown that it reduces non-fatal MI by 32%, non-fatal stroke by 18% and total cardiovascular mortality is reduced by 13% besides it also reduces important vascular events by 13%. It reduces strokes in women much more than men.
Continuing Prof. Akbar Chaudhry said that if the absolute ten years risk is less then six percent, there is no need for aspirin but if it is between 7-14%, it should be left to the patientís preference. However, if the absolute ten years risk is more than 15%, these patients must be put on Aspirin therapy. In secondary prevention of cardiovascular diseases, Aspirin reduces non-fatal MI by 32%, non-fatal stroke by 27% and total CV mortality by 15% and important vascular events by 25%.

Pakistan Aspirin Foundation in collaboration with PMA Kasur organized a seminar on Aspirin Update at Kasur on April 7th which was very well attended. Picture shows Prof. Akbar Chaudhry, Prof. Mahmood Ali Malik, Mr. Shaukat Ali Jawaid, Dr. Ghulam Shabbir Yazdani, Dr. Aslam Randhawa and Dr. Inayatullah speaking at the occasion.

As regards use of Aspirin in stroke, Meta analysis of six studies which enrolled 51, 342 women and 44,112 men the reduction in stroke in women was 17% as compared to men which was 14%. Evidence is also accumulating regarding the use of low dose aspirin in primary prevention of stroke. In case of acute ischaemic stroke, the patient should be given 150-300mg of Aspirin within forty eight hours as it is the drug of choice. Aspirin reduces the risk of early death as well as recurrence of stroke. SALT study regarding secondary ischaemic stroke has demonstrated that relative risk reduction of stroke and death with Aspirin vs. placebo is 31% with minimal risk of bleeding. Again relative risk reduction of TIA and death is 27% with Aspirin therapy. Regular use of low dose Aspirin also helps in prevention of secondary stroke. Various studies have confirmed that Aspirin remains underused in stroke, TIAs, CAD. Hence these patients should be encouraged to use Aspirin for secondary prevention especially in the high risk patients.
Prof. Akbar Chaudhry also refereed to AAUS study conducted by Pakistan Aspirin Foundation which involved over fourteen hundred ACS patients in 17 CCUs all over Pakistan. It showed that only 16% patients got Aspirin at home, only 20% patients were advised use of Aspirin by GPs while in ER 60% patients got Aspirin and in Ward about 71% patients got Aspirin. What was more surprising was the fact that at discharge only 50% of these patients were prescribed Aspirin. Prof. Akbar Chaudhry remarked that since most often the discharge slip is prepared by junior doctors, they do not give too much importance to Aspirin. However, ever since we started this awareness campaign, the situation has improved and now the use of Aspirin in its well established indications is increasing. However, there is still lot to be done as regards education of the GPs, Family Physicians, other healthcare professionals as well as the patients. He concluded his presentation by stating that every doctor must keep Aspirin with him, at the clinic as they may need it any time and it might prove life saving. They should also educate the patients that in case of chest pain irrespective of the fact whether it is cardiac or non cardiac, they must immediately chew a full tablet of Aspirin of 325mg or use soluble Aspirin. Combination therapy of Aspirin plus clopidogril further reduces the relative risk by 20%. In patients who are sensitive to Aspirin therapy, other anti platelet agents should be used. Enteric coated Aspirin is preferred as it eliminates the chances of any gastric irritation. Prof. Akbar Chaudhry acknowledged Dr. Maqbool H. Jafary the former President of PAF who he said has made a major contribution to this presentation.

Dr. Aslam Randhawa EDO Health Kasur and Dr. Iqbal Mayo President PMA Kasur presenting bouquet to Prof. Mahmood Ali Malik and Mr.Shaukt Ali Jawaid at the Aspirin seminar held here on April 7th 2010

Prof. Mahmood Ali Malik in his brief presentation advised the participants to control blood sugar and blood pressure of their patients. In diabetics a BP level of 120/80 is desirable but 130/85 is also acceptable. Make sure that the HbA1c is less than six which is preferred. Fasting blood sugar should be less than one hundred which must be aimed at. All Type-2 diabetics in high risk group must be put on regular low dose Aspirin therapy. However, young patients, with no history of cardiovascular disease, no TIA, no family history, non-smokers will not require Aspirin therapy. In known ulcer patients, Aspirin is avoided because of risk of bleeding. However, in case of emergency if need be, one tablet of Aspirin could be use in AMI just once as it might prove life saving.
Dr. Aslam Randhawa EDO Health speaking at the occasion said that Aspirin is very economically priced drug which is easily available and affordable. He thanked the speakers for their valuable advice and felt that many a timeís doctors in rural areas with not many facilities can save many precious lives by just administering Aspirin therapy to AMI patients.
Dr. Iqbal Mayo President of local PMA and Dr. Inayatullah Sheikh GS of PMA also briefly addressed the meeting and thanked the speakers and Atco Laboratories for sponsoring this academic activity. Dr. Ghulam Shabbir Yazdani consultant cardiologist at DHQ Hospital Kasur welcomed the guest speakers.
Earlier Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation highlighted the history and accomplishments of the Foundation. He as well as Prof.Akbar Chaudhry both emphasized that the Foundation does not promote any particular brand of Aspirin and it is up to the physicians to decide. Keeping up the professional ethics we just promote the use of Aspirin. However, we are grateful to M/s Atco Laboratories who have been sponsoring our CME programmes all over the country for the last many years. They specially thanked Mr. Akhtar Business Unit Head and Mr. Farhan Raza Product Manager from Atco Laboratories for organizing these meetings in far flung areas all over Pakistan on regular basis to update the healthcare professionals on safety, efficacy and use of Aspirin therapy. Copies of Consensus Statement on Guidelines for the use of Aspirin as well as an Urdu Booklet on Aspirin was also distributed among the participants.
Prof. Mahmood Ali Malik, Prof. Akbar Chaudhry and Mr. Shaukat Ali Jawaid also visited the DHQ Hospital Kasur where they were welcomed by Dr. Ghulam Shabbir Yazdani. They also met the MS of the hospital and visited various sections of the hospital. During the visit to the CCU and cardiology ward, Dr. Yazdani informed that during the last three months they had received about fifty patients of AMI and most of them were quite young. Thrombolysis therapy is available free. The 120-Bed DHQ Hospital has 32-bed cardiology ward. Senior staff at the hospital includes physician, surgeon, cardiologist, obstetrician and gynaecologist besides pediatrician. Lot of development activity is going on to improve and upgrade the facilities available at the hospital. A few more residences for senior doctors are also being constructed.


 

More efforts are needed to create awareness
about the use of Aspirin - Nisar Khuro

Over use of antibiotics and over dosing of drugs must be
checked as it results in serious adverse effects

 

From our correspondent

LARKANA: Inaugurating the 5th National Conference of Pakistan Aspirin Foundation held here at the Chandka Medical College, Mr. Nisar Khuro Speaker of the Sindh Assembly has emphasized the need to create awareness among public as well as the healthcare professionals about the use of Aspirin which is quite safe and effective besides being economically priced drug. He also advised the healthcare professionals to check the over use of antibiotics and avoid overdosing of drugs as they all lead to serious adverse effects thereby increasing morbidity.

Mr.Ayaz Soomro Sindh Minister for Law presenting a shield to Prof. Mahmood Ali Malik former Principal KEMC and founder President of Pakistan Aspirin Foundation at the public awareness session on Aspirin organized by Pakistan Aspirin Foundation at SMBBMU/CMC Larkana on October 31st. Prof. Saeed Ahmad Sangi and Prof. Akbar Chaudhry are also seen in the picture.

Quality of the drugs being made available was another issue which needs to be looked into. He further stated that we all need to overcome our weaknesses and be loyal to the Nation. By overusing the drugs particularly the antibiotics, we will not be serving the ailing humanity. He suggested promoting rational use of drugs and antimicrobial agents and keeping the healthcare professionals informed on such issues. He also referred to a recent resolution passed by the Sindh Assembly wherein it was suggested that all couples before getting married must be examined and tested for Thalassaemia major, Hepatitis B & C and AIDs. The doctors should also prescribe cost effective medications which are affordable by the people. Over use of antibiotics often leads to kidney failure and other serious diseases which all can be checked and prevented by ensuring ethical practice.
Health and Education Mr. Nisar Khuro said are some of the basic issues and the government was trying to give them due importance and priority. He hoped that with democratic era the country will eventually find peace, overcome terrorism, and ensure economic development. Once the under construction roads are completed, we will have more flights and bigger planes coming to Mohenjo Daro airport and Larkana will get its recognition which it deserves. Nothing is impossible and we all can make everything possible by working together, he remarked.

Mr. Nisar Khuro Speaker Sindh Assembly was the chief guest at the national conference of Pakistan Aspirin Foundation held at SMBBMU/Chandka Medical College Larkana on October 31st 2009. Picture shows Mr. Nisar Khuro, Prof. Sikandar Sheikh VC SMBBMU, Prof.Mahmood Ali Malik, Dr. Maqbool H. Jafary, Prof.Javed Akram, Prof. Zaman Sheikh, Prof. Saeed Ahmad Sangi and Dr. Abdul Majeed speaking in the inaugural session.

Prof. Sikandar Sheikh Vice Chancellor of Shaheed Mohtarma Benazir Bhutto Medical University in his address at the occasion said that SMBBMUJ got its charger on October 18th 2008 and it formally started functioning on July 9th 2009. Its constituent institutions include Chandka Medical College, Sardar Ghulam Mohammad Maher Medical College, Chandka Dental College which was being established, and Chambat Institute of Medical Sciences. We have short term and long term goals for the development of this university. We are shortly sending fifteen to twenty young doctors for higher training leading to PhD in different basic sciences and by the time they return, we will have fully developed basic sciences departments and laboratories. Three to four new buildings are being constructed while a 500-bed state of the art teaching hospital will be part of the University which will provide the most modern teaching, training and diagnostic facilities. Refresher courses for the faculty members are also being organized under faculty development programme. Departments of plastic surgery, thoracic surgery and hepatology will soon be established. He thanked Pakistan Aspirin Foundation for selecting SMBBMU/CMC as a venue for their national conference. Such academic activities also help improve CPD of the participants thereby helping improve the patient care, he added.
Dr. Maqbool H. Jafary President of Pakistan Aspirin Foundation in his presidential address highlighted the safety and efficacy of Aspirin which is the most economically priced drug. This life saving miracle drug continues to surprise us all as its new and emerging indications keep on increasing every day. Lot of research is going on these days. In particular it is its antiplatelet effects which has helped save many patients suffering from acute myocardial infarction, Acute Coronary Syndrome and helped reduce morbidity from cardiovascular and cerebrovascular diseases.

Mr. Ayaz Soomro Sindh Minister for Law was the chief guest at the public awareness session organized by Pakistan Aspirin Foundation during its national conference at SMBBMU/Chandka Medical College Larkana on October 31st 2009. Picture shows him presenting conference shields to (from L to R) Prof. Sikandar Sheikh, Prof. Akbar Chaudhry, Dr.Maqbool H.Jafary, Prof. Talat Naheed and Prof. Khalida Soomro.

Dr. Saeed Sangi Prof.of Cardiology at Chandka Medical College convener of the conference welcomed the guests and participants to the conference. He also thanked the chief guest for gracing the occasion and Vice Chancellor, Principal and faculty members of SMBBMU, CMC for their cooperation. He thanked the delegates and participants particularly from Karachi and Lahore who made it possible to attend and make presentations in the conference.
One of the scientific sessions during the conference was chaired by Prof. Wazeer Sheikh former Principal of CMC and Councilor of CPSP while another session was chaired by Prof. Abrar Ahmad Shaikh Dean Faculty of Medicine at SMBBMU. Prof. M. Akbar Chaudhry chaired the third scientific session. An important highlight of the conference was participation of fifteen former and current Principals of various medical colleges. A number of faculty members from CMC and guests from Lahore and Karachi were members of the Experts Panel in different sessions.
Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation introduced the guest speakers besides highlighting the aims and objectives of the Foundation and its accomplishments so far. Later conference mementoes in the form of shields were presented to the chief guest, VC SMBBMU, Principal CMC, Mr. Munawar Abbasi the local MPA and members of the organizing committee. The traditional Sindhi Ajrak and Cap were presented to all the guest speakers, Patron, Convener and membersí of the organizing committee. The meeting started late and time management could not be improved despite best efforts. Hence no time was left for discussion after the presentations which is so essential. However, the organizers did provide time for discussion on all the presentations at the end of the third scientific session.
Dr. Saeed Sangi hosted a dinner at his residence on Friday October 30th which was largely attended by guests from Karachi and Lahore besides faculty members and Vice chancellor of SMBBMU, CMC and elite of the city. Apart from Atco Laboratories who not only arranged travel of the speakers and their stay besides hosting lunch on October 31st during the conference and making excellent transport arrangements, M/s PharmEvo arranged the conference backdrop and shields. M/s Himont organized the registration desk while a few selected companies participated in the exhibition. Their contributions were recognized by the organizers at the public awareness session held before dinner and they were presented conference mementoes.

Scientific Sessions

Prof. Wazeer Sheikh former Principal Chandka Medical College along with panel of experts chaired the first scientific session. Mr. Shaukat Mutakee consultant pharmacist was the first speaker who talked about mode of action of Aspirin and other antiplatlet agents besides mentioning the side effects profile. He also pointed out that these days 81mg tablet instead of 75mg tablet is being used which is considered much better. Aspirinís duration of action, he said, is four to six hours and its elimination half life is 4.7 to 9 hours. It does have interaction with other drugs and certain foods and so far the aspirin resistance has been reported in 5.5% of cases.

Mr. Farhan Raza Product Manager Atco Laboratories, Mr.Shaukat Ali Jawaid, Prof. Akbar Chaudhry, Dr. Maqbool H. Jafary, Prof. Saeed Ahmad Sangi, Prof. Mahmood Ali Malik, Prof. Khalida Soomro and others photographed during the national conference of Pakistan Aspirin Foundation at Chandka Medical College Larkana on October 31st 2009.

Prof. Javed Akram Principal Allama Iqbal Medical College highlighted the cost effectiveness of Aspirin therapy. Aspirin, Prof. Javed Akram opined, is a time tested drug. Even otherwise old is always considered Gold. Effectiveness of a drug is measured in various forms i.e. can it cure the disease, can it reduce the majority of the symptoms, safety of the drug also plays a vital role in efficacy and effectiveness. He also referred to various drugs like coxibs and other NSAIDs which had to be withdrawn later on due to their serious side effects. Similarly Hormone Replacement Therapy had to be withdrawn but Aspirin remains in the market and is in clinical use for over hundred years and its indications are increasing with the every passing day. Aspirin is far more effective and better tolerable than clopidogrel which can be effectively used in combination with Aspirin in various conditions. Various studies have shown that Aspirin is the most effective drug in Acute Coronary Syndromes and Acute Myocardial Infarction in particular; stroke and TIAs, secondary prevention of hypertension and stroke but it must be used as per its established protocol. He advised the physicians not to be afraid of simple things. Had Aspirin been a more expensive drug, more healthcare professionals would have been using this, he remarked.
Dr. Maqbool H. Jafary President of Pakistan Aspirin Foundation highlighted the efficacy of combination of Aspirin with Clopidogrel which leads to 20% further risk reduction in AMI. However, this combination should be avoided in primary prevention of cardiovascular events. But this combination can be used in ACS without stents, with bare metal stents, drug eluting stents but not in stroke. Dr. Jawaid Akbar Sial from Chandka Medical College spoke about non-invasive role of GPIIb/IIIa.
Prof. Abrar Sheikh Dean Faculty of Medicine at SMBBMU along with panel of experts chaired the next session. Prof. Zaman Sheikh Prof. of Medicine at DUHS and Executive Director of National Institute of Diabetes and Endocrinology in DUHS spoke about the use of Aspirin in diabetes. He opined that all Type-2 diabetics who are at risk of developing cardiovascular diseases must be put on low dose aspirin therapy. Enteric coated tablet of 75mg is as effective as high dose. Similarly low dose Aspirin therapy should also be prescribed to high risk individuals over the age of forty years, he remarked.
Prof. Mahmood Ali Malik an eminent physician and former Principal of King Edward Medical College in his presentation again emphasized the usefulness of low dose aspirin therapy in all Type-2 diabetics since they are at high risk of developing cardiovascular diseases as well. Studies, he said, have shown that ten years before development of diabetes, people are prone to develop cardiovascular diseases. Abdominal obesity, hypertension, diabetes mellitus, dyslipidemais, chronic cardiovascular diseases are all considered important risk factors. He then talked about the clinical features of Type-2 diabetes. The patients should be advised to control their hypertension, blood glucose, and dyslipidemias. He suggested that all patients with previous myocardial infarction, TIAs, vascular surgery, angioplasty must be put on low dose Aspirin therapy. Majority of the Type-2 diabetics, he said, are high risk patients.
Prof. Ejaz Ahmad Vohra another noted physician and Dean postgraduate studies at Ziauddin Medical University in his presentation pointed out that TIAs should be treated as an established Angina. Most of the diabetics, he further stated, are killed because of cardiovascular diseases. Unless there are some contra indications, all stroke patients and those with TIAs should be prescribed low dose aspirin therapy for secondary prevention.
Prof. Saeed Ahmad Sangi Prof.of Cardiology at Chandka Medical College presented the futuristic vision of medicine. He felt that soon the surgeons are expected to be out of job as robots will take up most of the surgery. Artificial hearts will become available. Cardiovascular medicine by 2034 will undergo drastic changes and after some time anti obesity drugs will be available. Biotechnology is making tremendous progress. It is expected that the incidence of myocardial infarction will go down in the developing countries. Stem cells will become available as standard procedures. There will be drastic reduction in cardiac surgery as robotic surgery will be a reality. Artificial heart replacement will become possible. Prof. Khalida Soomro Professor of Cardiology at Dow University of Health Sciences was the next speaker in this session who also talked about newer antiplatelet agents like GPIIb/IIIa.
Dr. Maqbool H. Jafary in his second presentation talked about the new and emerging indications of Aspirin Therapy which include colorectal cancer, gastric and esophageal cancer, Alzheimerís disease, pregnancy induced hypertension, renal disorders, pulmonary embolism, DVT etc. During the discussion which followed rational use of antiplatelet therapy in acute coronary syndrome was highlighted.


Prof. Akbar Chaudhry takes over as the
new President of Pakistan Aspirin Foundation

Prof. Javed Akram to organize the next National Conference at Lahore in 2011

 

LARKANA: After consensus among the founder members, Prof. M. Akbar Chaudhry former Principal of Fatima Jinnah Medical College and currently Principal of Continental Medical College Lahore was selected as the new President of Pakistan Aspirin Foundation. He replaced Dr. Maqbool H. Jafary whose term expired this month. A decision to this effect was taken at the General Body Meeting/consensus consultations held before and during the recently held national conference of Pakistan Aspirin Foundation at Larkana on October 31st 2009.

Prof. M. Akbar Chaudhry Principal Continental Medical College and newly elected President of Pakistan Aspirin Foundation presenting shields to Prof. Ejaz Ahmad Vohra, Prof. Khalida Soomro and Prof. Javed Akram during the national conference of Pakistan Aspirin Foundation held at SMBBMU/CMC Larkana on October 31st 2009.

Prof. Akbar Chaudhry, it may be mentioned here is the life member of Pakistan Aspirin Foundation and has successfully organized one of the National Conferences at FJMC. He has also been working as Central Coordinator for Pakistan Aspirin Foundation for Punjab for the last two years. Selection of the President is made keeping in view the fact that the person selected must show his commitment, must have time to coordinate and organize its Continuing Medical Education programmes which involves lot of travelling to small cities and towns all over the country. As per schedule and past traditions of rotating Presidentship of the Foundation in different provinces, this time it was the turn for some one from Punjab. Prof. Mumtaz Hassan an eminent physician and former Principal of King Edward Medical College was the first choice. However, he expressed his inability due to some personal engagements but assured his support for the CME activities. He further stated that he will fully support Prof. Akbar Chaudhry and will be too glad to be one of the speakers at the CME programmes.
Prof. Javed Akram Principal of Allama Iqbal Medical College was selected as organizer for the next national conference which will be held at Lahore during 2011. He is also a founder member of Pakistan Aspirin Foundation. Keeping in view his organizational capabilities the members were unanimous that we will have a very successful meeting with good informative and interesting scientific programme in 2011.

Mr. Ayaz Soomro Sindh Minister for Law presenting shields to Mr. Munawar Abbasi MPA, Prof. Saeed Ahmad Sangi, Prof. Asadullah Maher Principal CMC and Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation at the public awareness session on Aspirin at CMC Larkana on October 31st 2009.

Organizing this national conference at Larkana had been a very difficult task due to the prevailing law and order situation in the country besides inaccessibility. There are a few flights to Mohenjodaro Airport from different cities in Pakistan and that too not daily. Hence, some of the delegates from Lahore had to travel to Sukkur to reach Larkana and managed to get their return flights from Sukkur to Karachi and then Lahore which was quite inconvenient. However, it was their dedication, devotion and commitment that they made it possible despite difficult travel schedule.
Among the invited guest speakers and participants who travelled from Karachi and Lahore to participate in the conference were Prof. Mahmood Ali Malik former Principal of KEMC and founder President of Pakistan Aspirin Foundation, Prof. M. Akbar Chaudhry Principal Continental Medical College, Prof. Javed Akram Principal Allama Iqbal Medical College, Prof. Talat Naheed Prof.of Medicine at FJMC. From Karachi the speakers included Dr. Maqbool H. Jafary, President of Pakistan Aspirin Foundation, Prof. Ejaz Ahmad Vohra Dean Postgraduate Studies and Head of Dept. of Medicine at Ziauddin Medical University, Prof. Zaman Sheikh Prof.of Medicine at DUHS and Executive director of National Institute of Diabetes and Endocrinology at Ojha Campus, Prof. Khalida Soomro from DUHS Karachi, Mr. Shaukat Muttaki consultant pharmacist. The meeting was also attended by some cardiologists from interior of Sindh besides the faculty members of Sardar Ghulam Mohammad Maher Medical College at Sukkur and Chandka Medical College, SMBBMU Larkana and students of Chandka Medical College.
During the General Body meeting Prof. Mahmood Ali Malik, Prof. Akbar Chaudhry and Dr. Maqbool H. Jafary recorded their appreciation for Prof. Saeed Sangi for organizing this meeting at such a short notice. They also put on record the efforts made by General Secretary of Pakistan Aspirin Foundation Mr. Shaukat Ali Jawaid to make it possible that the meetings are held as schedule. They also expressed their gratitude to Atco Laboratories in general and its focal person looking after Aspirin related activities Mr. Farhan Raza Product Manager in Atco in particular and the entire ATCO team for their hard work which helped to make the conference a success.
Dr. Maqbool H. Jafary thanked the members for their support during his tenure as President and said that he tried his best to contribute as much as possible. Apart from addressing various CME meetings at Isra University in Hyderabad, KIHD in Karachi, small towns and cities like Khanewal, Vehari, Sialkot, Sahiwal etc., a booklet on Aspirin in Urdu was also published to create awareness and promote the use of Aspirin. It is quite useful not only for the public but also for the Family Physicians. Now efforts are being made to translate this booklet in other regional languages. Prof. Akbar Chaudhry speaking at the occasion sought help and assistance from all the members so that we can carry forward the message and thus promote the aims and objectives of Pakistan Aspirin Foundation.


Public awareness session on Aspirin
There is no dearth of good doctors
in Larkana - Ayaz Soomro

Experts highlight safety and efficacy of Aspirin in various diseases

 

LARKANA: There is no dearth of good doctors in Larkana and many of them continue to serve the ailing humanity with devotion and dedication. This was stated by Mr. Ayaz Soomro Provincial Minister for Law, Government of Sindh. He was speaking at the public awareness session during the national conference of Pakistan Aspirin Foundation held here on October 31st 2009.
The meeting was largely attended by faculty members of SMBBMU, CMC, medical students, and representatives of public and legal profession. Also present on the occasion were Vice Chancellor of SMBBMU Prof.Sikandar Sheikh, Mr. Abbasi MPA and Prof. Asadullah Maher, Principal of Chandka Medical College.

Prof. Abrar Ahmad Sheikh Dean Faculty of Medicine at SMBBMU Larkana chaired the first scientific session during the national conference of Pakistan Aspirin Foundation held at CMC on October 31st 2009. Picture shows him presenting conference mementoes to the guest speakers from (L to R) Prof. Ejaz Ahmad Vohra, Prof. Zaman Sheikh, Prof. M. Akbar Chaudhry and Prof. Mahmood Ali Malik.

Mr. Ayaz Soomro thanked Pakistan Aspirin Foundation for selecting Larkana as a venue for their national conference and hoped that such academic activities will be extremely beneficial not only for the healthcare professionals but public as well. Larkana as a city, he said, has been neglected for too long and so was the case with Chandka Medical College. Our government has now given it the status of a medical university named after late Mohtarma Benazir Bhutto and in the days to come it will be an important medical institution in this part of the country. Larkana has received four martyrs of the Bhutto Family who are all buried in Naudero at Garhi Khuda Bakhsh. Late Mr. Z.A. Bhutto the Prime Minister of Pakistan laid the foundation of Pakistanís atomic programme and now we have become an atomic power quite capable of defending ourselves against all sort of aggressions, he added.
Earlier eminent speakers which included Prof. Mahmood Ali Malik, Prof. Akbar Chaudhry, and Dr. Maqbool H. Jafary highlighted the safety and efficacy of Aspirin therapy in its well established indications. This is an extremely cost effective drug which significantly reduces morbidity and mortality when used under instructions by the doctors. Prof.Mahmood Ali Malik opined that all Type-2 diabetics must be put on low dose aspirin therapy for indefinite period. Prof. Akbar Chaudhry stated that Aspirin is extremely useful in a large number of cardiovascular diseases, cerebrovascular diseases including Stroke and TIAs. Dr. Maqbool H. Jafary outgoing President of Pakistan Aspirin Foundation said that people should carry Aspirin tablets with them as they or any one else might use it. As soon as on feels chest pain, one full tablet of Aspirin 325mg should be chewed immediately or soluble aspirin should be taken immediately. It will reduce the chances of any mortality from heart attack by 25%. However, if it is added with streptokinase, the mortality reduction is almost over 40%.
Earlier Dr. Saeed Ahmad Sangi Prof. of Cardiology and convener of the conference talking about future of medicine in general and cardiology in particular referred to the startling changes which might take place in the days to come. Addressing the participants in Sindhi, he also highlighted the efficacy of Aspirin in various diseases. This in fact was translation of the Urdu Booklet on Aspirin authored by Dr. Maqbool H. Jafary and Mr.Shaukat Ali Jawaid. The participants felt that the book should also be translated in Sindhi and other regional languages.
Replying to questions from the participants it was stated that low dose aspirin is indicated in all patients after interventional procedures like angioplasty and stenting. In case some patients are allergic to aspirin, there are other anti platelet agents which are of course expensive but quite effective. Combination of Aspirin and Clopidogrel is also being increasingly used in various diseases.


 

Seminars on Aspirin Update at Tando Adam Khan and Hala
Aspirin therapy is now also being increasingly
used for primary prevention of CAD
All high risk patients with absolute ten years risk of
more than 15% must be prescribed Aspirin along
with other drugs - Dr. Maqbool H. Jafary

From our correspondent

TANDO ADAM KHAN AND HALA: While safety and efficacy of Aspirin therapy in secondary prevention of coronary artery disease is well established, it is now also being increasingly used in primary prevention of cardiovascular diseases. This was stated by Dr. Maqbool H. Jafary a noted physician and President of Pakistan Aspirin Foundation. He was addressing seminars organized by Pakistan Aspirin Foundation in collaboration with local PMA at Tando Adam Khan and Hala on October 9th 2008. Both these meetings were sponsored by Atco Laboratories as a service to provide Continuing Medical Education for the healthcare professionals.

A group photograph of some of the participants to the seminar on Aspirin Update and local
PMA office bearers photographed along with the speakers at Taulka Hospital Tando Adam Khan

In his comprehensive presentation on Aspirin Update titled as Aspirin- the Wonder Drug, Dr. Maqbool H. Jafary first traced the historical back ground and discussed at length that how  Dr.Flex Hoffman discovered this agent. At present 37.6% of Aspirin is being used in cardiovascular diseases and more than hundred billion tablets are consumed annually. It was Dr. Peter Elwood a Scottish Physician who did pioneering work as regards use of aspirin in cardiovascular diseases and showed in 1974 that it prevents myocardial infarction. Now Aspirin is being used for not only secondary prevention but also primary prevention of cardiovascular diseases.  There are numerous studies to prove that all high risk patients with absolute ten years risk of more than 15% must be prescribed Aspirin therapy along with other drugs. If the ten years absolute risk is less than 6%, no aspirin is required but if this risk is between 7-14% it should he left at patient choice. Obese patients, those with family history of cardiovascular disease, those suffering from high blood pressure, diabetics all come into high risk group.

Pakistan Aspirin Foundation in collaboration with PMA Tando Adam Khan organized a seminar on Aspirin Update on October 9th 2008. Picture shows Dr. Maqbool H. Jafary President of PAF, Dr. Gada Husssain Bhellr, Mr. Shaukat Ali Jawaid, Dr. Abdul Hameed Ghauri and Dr. Bashir Khaskheli speaking at the occasion.

As regards secondary prevention of cardiovascular diseases, numerous studies has shown that it reduces non-fatal MI by 32%; non-fatal strokes by 27%, total cardiovascular mortality by 15% and  vascular events by 15%.  In case of acute myocardial infarction the patient must be advised to take a full tablet of aspirin immediately chew it or use soluble aspirin followed by 75mg of enteric coated Aspirin indefinitely unless there are contra indications. Aspirin therapy alone reduces 25% mortality in AMI if taken immediately but if it is combined with streptokinase within six hours, the mortality reduction is increased to 42%. Most often there is no increased risk of bleeding. In Acute Coronary Syndromes risk of another MI and death is reduced by 50% as shown in ISIS-II study.

Talking about the use of Aspirin therapy in stroke, Dr. Jafary pointed out that 150-300mg of Aspirin is the drug of choice within forty eight hours. He made it clear that even if it is hemorrhagic stroke, one tablet of 300mg used immediately in case of myocardial infarction  is not going to do much harm but it can prove to be life saving. Once the patient is stable, then investigations can be undertaken to determine whether it is ischaemic or hemorrhagic stroke. Aspirin has proven benefits in secondary prevention of secondary strokes. In high risk individuals, Aspirin is combined with clopidogrel which ensures 20% relative risk reduction of second MI or stroke. In patients who have had intervention procedures like angioplasty or stenting, combination of Aspirin and Clopidogrel is used unless there is some contra indication. Regarding its use in hypertension, it is important that first blood pressure should be controlled and then the patient should be put on Aspirin therapy. All Type-2 diabetics should also be put on regular aspirin therapy, he added.

Some office bearers of PMA Hala and participants to Aspirin seminar photographed after the meeting on October 9th 2008.

He then briefly discussed the emerging indications for use of Aspirin therapy like colorectal cancer, esophageal and gastric cancer, pulmonary embolism, DVT, renal diseases etc. He also briefly referred to the ARRIVE study which will enroll over twelve thousand patients at four hundred centers in five countries which will complete in 2013. It will provide sufficient evidence regarding use of Aspirin therapy in primary prevention of coronary artery diseases, he added.

Responding to various questions Dr. Jafary stated that Experts Panel of Pakistan Aspirin Foundation in its Consensus Statement on Medical Uses of Aspirin has clearly stated the dosage, indications and contra indications for use of Aspirin. Copies of this consensus statement will be distributed among the participants later and they are also available on the website of Pakistan Aspirin Foundation.(www.pakaspirin.org)

On left Dr. Maqbool H. Jafary President Pakistan Aspirin Foundation presenting Life Membership shield to Dr. Abdul Hameed Ghauri while other pictures show guests being presented traditional Sindhi Ajrak and flowers during the seminar on Aspirin Update held at Tando Adam Khan recently.

Dr. Abdul Hameed Ghauri in charge of Coronary Care Unit at the local hospital in his presentation pointed out that there is need to educate the healthcare professionals on the safety and efficacy of Aspirin in cardiovascular diseases. It has proved to be a life saving drug. We as cardiologists are aware of its benefits though it is still being under used. A vast majority of deaths in the developing countries, he said, are due to cardiovascular diseases and  hypertension requires life long therapy. The doctors need to be updated on preventive properties of anti platelet and anti cholesterol drugs. We can prevent a large number of these deaths by taking simple measures, life style modification, use of healthy diet and appropriate drugs. GPs, he said, play an important role in health delivery system hence they need to be kept update through such CME programmes.

Dr. Maqbool H. Jafary emphasized upon the family physicians that they must ensure more and more use of Aspirin in its well established indications. The Aspirin Awareness and Usage Study (AAUS) conducted by Pakistan Aspirin Foundation which enrolled over fourteen hundred ACS patients in seventeen coronary care units across the country showed that only 16% patients used Aspirin therapy at home and only 20% of the GPs prescribed Aspirin while only 52% of the patients discharged from the CCUs were prescribed aspirin along with other drugs. This is a very dismal picture and we need to improve it for the safety of the patients, he added.

The meeting at Tando Adam Khan was also attended by healthcare professionals from Shahdadpur and other adjoining areas and they showed keen interest and wished that a similar programme should be organized at Shahdadpur as well.

Earlier Mr. Shaukat Ali Jawaid General Secretary of Pakistan Aspirin Foundation highlighted the activities and accomplishments of the Pakistan Aspirin Foundation. He made is clear that they do not promote any particular brand of Aspirin keeping up professional ethics. He however thanked Atco Laboratories and their cardiovascular team headed by Mr. Akhtar and Product Manager Mr. Farhan Raza for making arrangements to sponsor CME programmes of the Pakistan Aspirin Foundation for the last many years. Dr.Bashir Khaskheli General Secretary PMA welcomed the speakers and the participants of the seminar.  Dr. Gadda Hussian Bheller In charge of Taulka Hospital Tando Adam Khan, President of local PMA and Medical Supdt. of Shahdadpur Taulka Hospital presented traditional Sindhi Ajrak among the guest speakers. The meeting was conducted by Mr. Farhan Raza Product Manager from Atco Laboratories while Mr. Akhtar Business Unit Head of Cardiology in Atco was also present on the occasion.

At Hala, the meeting was chaired by Dr. Abdul Rashid Memon President elect of Hala PMA while the programme was conducted by Dr. Ateeque. Guest speakers and the participants were welcomed by Dr. Abdul Sattar Meer General Secretary of Hala PMA.

Presentation by Dr. Maqbool H. Jafary was followed by lively discussion.  Replying to a question regarding role of Aspirin in smokers, Dr.Jafary said that smoking is an important risk factor in coronary artery disease and hypertension; hence Aspirin has a role in these people. Responding to another question he said that as a rule, all such drugs must be avoided during pregnancy, Aspirin is no exception. If there is a need, some other pain killer like paracetamol can be used. Some experts say that in case of IHD, one can continue Aspirin therapy during pregnancy but if one can avoid it, it is much better. Regarding effects of Aspirin on liver, Dr. Jafary said it has no effect and it does not disturb liver enzymes. In case of fatty liver, one must look at the back ground like obesity. These are some of the manifestations in pre diabetic stage and these patients will eventually develop diabetes. As a primary prevention one can use Aspirin particularly if other risk factors are also present.


 
 
 
 
 

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