Drug Criteria & Outcomes-A different take on using aspirin

David S. Roffman, PharmD, BCPS, associate professor at University of Maryland's School of Pharmacy in Baltimore and a therapeutic consultant for the cardiac care unit in the university's medical system, has a slightly different take on the data discussed by Aileen Luzier, PharmD, in this month's cover article.

"My bias is that the degree of the significance of this interaction is not fully understood," Roffman says. "Dr. Luzier states that upfront in talking about the one study that may provide some more evidence one way or the other. I'm not sure that particular trial will provide all the answers because it's not a head-to-head study of small dose vs. large dose in the face of ACEIs [angiotensin converting enzyme inhibitors].

"But I think the conclusion I would make at this point in terms of clinical utility of these two drugs together is that the weight of the evidence of the effectiveness of aspirin and the effectiveness of ACEIs in people with coronary disease and CHF is so clear that even if there is a potential reduction in the benefit, we are obliged to still use the two drugs together.

'Should we or should we not?'

"There are not enough data that say the reduction of the effect of ACEIs by aspirin is significant enough an outcome that we shouldn't do this. The question is, Should we or should we not? If there is a dose-related argument here — which I admit may be part of the reason the data are a little confusing given what we know about the beneficial effects of aspirin and the beneficial effects of ACEIs in people with heart failure of ischemic etiology — there is little choice but to use both drugs."

[Roffman can be reached at the school of pharmacy, University of Maryland, Baltimore. Tele phone: (410) 706-3215. E-mail: droffman@rx. umaryland.edu.]