Are We There Yet? Another Milepost in the Journey to Identify Appropriate Candidates for Aspirin Primary Prevention
Authors: Evelyn P. Whitlock, Eric S. Johnson
Journal: Annals of Internal Medicine (2019)

Editorials19 March 2019Are We There Yet? Another Milepost in the Journey to Identify Appropriate Candidates for Aspirin Primary PreventionEvelyn P. Whitlock, MD, MPH and Eric S. Johnson, PhDEvelyn P. Whitlock, MD, MPHPatient-Centered Outcomes Research Institute, Washington, DC (E.P.W.)Search for more papers by this author and Eric S. Johnson, PhDCenter for Health Research, Kaiser Permanente Northwest, Portland, Oregon (E.S.J.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0416 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The sex-specific models published in Selak and colleagues' article (1) to predict risk for major bleeding events in adults without cardiovascular disease (CVD) who are not receiving antiplatelet therapy offer a major step toward more evidence-based, individualized decision making about aspirin use to prevent CVD (and perhaps colorectal cancer). This research has several strengths. First and foremost, it directly responds to a key evidence gap identified by a major guideline developer, the U.S. Preventive Services Task Force (2). The predictive models' development followed recommendations for valid prognostic research (3) and built on a substantially expanded evidence base for understanding expected ...References1. Selak V, Jackson R, Poppe K, Wu B, Harwood M, Grey C, et al. Predicting bleeding risk to guide aspirin use for the primary prevention of cardiovascular disease. A cohort study. Ann Intern Med. 2019;170:357-68. doi:10.7326/M18-2808 LinkGoogle Scholar2. Bibbins-Domingo K; U.S. Preventive Services Task Force. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164:836-45. [PMID: 27064677]. doi:10.7326/M16-0577 LinkGoogle Scholar3. Steyerberg EW, Moons KG, van der Windt DA, Hayden JA, Perel P, Schroter S, et al; PROGRESS Group. Prognosis research strategy (PROGRESS) 3: prognostic model research. PLoS Med. 2013;10:e1001381. [PMID: 23393430] doi:10.1371/journal.pmed.1001381 CrossrefMedlineGoogle Scholar4. Selak V, Kerr A, Poppe K, Wu B, Harwood M, Grey C, et al. Annual risk of major bleeding among persons without cardiovascular disease not receiving antiplatelet therapy. JAMA. 2018;319:2507-20. [PMID: 29946729] doi:10.1001/jama.2018.8194 CrossrefMedlineGoogle Scholar5. Zheng SL, Roddick AJ. Association of aspirin use for primary prevention with cardiovascular events and bleeding events: a systematic review and meta-analysis. JAMA. 2019;321:277-87. [PMID: 30667501] doi:10.1001/jama.2018.20578 CrossrefMedlineGoogle Scholar6. Whitlock EP, Burda BU, Williams SB, Guirguis-Blake JM, Evans CV. Bleeding risks with aspirin use for primary prevention in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:826-35. [PMID: 27064261]. doi:10.7326/M15-2112 LinkGoogle Scholar7. Moons KGM, Wolff RF, Riley RD, Whiting PF, Westwood M, Collins GS, et al. PROBAST: a tool to assess risk of bias and applicability of prediction model studies: explanation and elaboration. Ann Intern Med. 2019;170:W1-33. [PMID: 30596876]. doi:10.7326/M18-1377 LinkGoogle Scholar8. Hippisley-Cox J, Coupland C. Predicting risk of upper gastrointestinal bleed and intracranial bleed with anticoagulants: cohort study to derive and validate the QBleed scores. BMJ. 2014;349:g4606. [PMID: 25069704] doi:10.1136/bmj.g4606 CrossrefMedlineGoogle Scholar9. Moons KG, Altman DG, Reitsma JB, Ioannidis JP, Macaskill P, Steyerberg EW, et al. Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD): explanation and elaboration. Ann Intern Med. 2015;162:W1-73. [PMID: 25560730]. doi:10.7326/M14-0698 LinkGoogle Scholar10. Dehmer SP, Maciosek MV, Flottemesch TJ, LaFrance AB, Whitlock EP. Aspirin for the primary prevention of cardiovascular disease and colorectal cancer: a decision analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2016;164:777-86. [PMID: 27064573]. doi:10.7326/M15-2129 LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Patient-Centered Outcomes Research Institute, Washington, DC (E.P.W.)Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (E.S.J.)Disclaimer: The opinions expressed here are those of the authors and do not necessarily represent the views, opinions, or policies of the Patient-Centered Outcomes Research Institute or its Board of Governors.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0416.Corresponding Author: Evelyn P. Whitlock, MD, MPH, Patient-Centered Outcomes Research Institute, 1828 L Street, NW, Suite 900, Washington, DC 20036; e-mail, [email protected]org.Current Author Addresses: Dr. Whitlock: Patient-Centered Outcomes Research Institute, 1828 L Street, NW, Suite 900, Washington, DC 20036.Dr. Johnson: The Center for Health Research, Kaiser Permanente Northwest, 3800 North Interstate Avenue, Portland, OR 97227.This article was published at Annals.org on 26 February 2019. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPredicting Bleeding Risk to Guide Aspirin Use for the Primary Prevention of Cardiovascular Disease Vanessa Selak , Rod Jackson , Katrina Poppe , Billy Wu , Matire Harwood , Corina Grey , Romana Pylypchuk , Suneela Mehta , Andrew Kerr , and Sue Wells Metrics Cited byPrognostic bleeding risk models predict aspirin-related risk 19 March 2019Volume 170, Issue 6Page: 411-413KeywordsCardiovascular diseasesColorectal cancerDecision analysisDecision makingDisclosureHemorrhageInformation storage and retrievalMedical risk factorsPopulation statistics ePublished: 26 February 2019 Issue Published: 19 March 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...