Inappropriate Use of Aspirin in Real-Life Cardiology Practice: Results from the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) Study

Oğuzhan Çelik

doi:10.5152/balkanmedj.2021.21143

Oğuzhan Çelik¹, Cem Çil¹, Özcan Başaran¹, Erkan Demirci², Veysel Ozan Tanık³, Emine Altuntaş⁴, Kadriye Memiç Sancar⁵, Özcan Örsçelik⁶, Mücahit Yetim⁷, Lütfü Bekar⁷, Osman Karaarslan⁷, Bülent Özlek¹, Eda Özlek¹, Aysel Gökçek¹, Tolga Doğan⁸, Mubariz Murat Resulzade⁹, Çağlar Kaya¹⁰, Emrah Küçük¹¹, Tuncay Kırış¹², Abdullah Orhan Demirtaş¹³, Murat Civan¹⁴, Ramazan Asoğlu¹⁵, Volkan Doğan¹, Murat Biteker¹

¹Department of Cardiology, Muğla Sıtkı Koçman University School of Medicine, Muğla, Turkey
²Clinic of Cardiology, Kayseri City Hospital, Kayseri, Turkey
³Department of Cardiology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
⁴Department of Cardiology, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Turkey
⁵Department of Cardiology, Mehmet Akif Ersoy Training and Research Hospital, İstanbul, Turkey
⁶Department of Cardiology, Mersin University School of Medicine, Mersin, Turkey
⁷Department of Cardiology, Hitit University Çorum Erol Olçok Training and Research Hospital, Çorum, Turkey
⁸Department of Cardiology, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
⁹Clinic of Cardiology, Private Hospitalpark Darıca Hospital, Kocaeli, Turkey
¹⁰Department of Cardiology, Trakya University School of Medicine, Edirne, Turkey
¹¹Clinic of Cardiology, Kızıltepe State Hospital, Mardin, Turkey
¹²Department of Cardiology, İzmir Katip Çelebi University, Atatürk Training and Research Hospital, İzmir, Turkey
¹³Clinic of Cardiology, Adana City Hospital, Adana, Turkey
¹⁴Department of Cardiology, Bahçelievler Vital Private Hospital, İstanbul, Turkey
¹⁵Department of Cardiology, Adıyaman University School of Medicine, Adıyaman, Turkey

DOI : 10.5152/balkanmedj.2021.21143

Pages : 183-189

Background: Indications and appropriateness of aspirin use have not been well investigated in Turkey.
Aims: To investigate the prescription patterns and appropriateness of aspirin in a real-world clinical setting.
Study Design: Cross-sectional study.
Methods: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) is a cross-sectional and multicenter study that included 5007 consecutive patients aged 18 or over who presented to 30 different cardiology outpatient clinics from 14 cities throughout Turkey. Only patients using aspirin (80-325 mg) were included. The study population was divided into 2 groups regarding the use of aspirin: primary prevention (PP) group and secondary prevention (SP) group. The indication of aspirin use was evaluated following the 2016 European Society of Cardiology (ESC) and the 2016 United States Preventative Services Task Force (USPTF) guidelines in the PP group.
Results: A total of 5007 patients (mean age 62.15 ± 11.05, 39% female) were enrolled. The PP group included 1132 (22.6%) patients, and the SP group included 3875 (77.4%) patients. Of the 1132 patients, inappropriate use of aspirin was determined in 100% of the patients according to the ESC guidelines, and 71% of the patients according to the USPTF guidelines. Multivariate logistic regression analysis showed age OR: 0.98 CI (0.97-0.99) P = .037, smoking OR: 0.60 CI (0.44-0.82) P = .001, heart failure OR: 2.11 CI (1.14-3.92) P = .017, hypertension OR: 0.51 CI (0.36-0.74) P < .001, diabetes mellitus OR: 0.34 CI (0.25-0.47) P < .001, oral anticoagulant use OR: 3.01 CI (1.10-8.25) P = .032, and female sex OR: 2.73 CI (1.96-3.80) P < .001 were independent predictors of inappropriate aspirin use in PP patients.
Conclusion: Although there are considerable differences between the USPTF and the ESC guidelines with respect to recommendations for aspirin use in PP, inappropriate use of aspirin in Turkey is frequent in real-world practice for both guidelines. Besides, heart failure, oral anticoagulant use, and the female sex of the patients were independent predictors of inappropriate use of aspirin.

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