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New Findings on Aspirin and Heart Attacksby Dianne Witter A long-standing conundrum for emergency room physicians, oncologists, and other clinicians may now be solved. The question: whether to administer potentially life-saving aspirin to cancer patients with thrombocytopenia who are having heart attacks—or to withhold aspirin out of concern that it may further lower platelet counts and cause lethal bleeding. No guidelines currently exist for treatment of heart attacks in patients with cancer, so there is a great variation in the way such patients are treated. Physicians have been especially perplexed about what to do for cancer patients who develop blood clots, which can be caused by the cancer itself or by the chemotherapy. New findings by researchers at The University of Texas M. D. Anderson Cancer Center shed much more light on the issue and may soon simplify such decisions for doctors. With her colleagues, Dr. Mona G. Sarkiss, an assistant professor in the Department of Anesthesiology and Pain Medicine, published an article on this topic in the February 1, 2007, issue of Cancer. Their study suggested that aspirin should be given to cancer patients having heart attacks, and that—in fact—without it, many of them will die. The findings of the retrospective study defy conventional logic but make a compelling case for the benefits of aspirin in such situations. Researchers found that fully 9 of 10 cancer patients with thrombocytopenia who were experiencing a heart attack and who did not receive aspirin died, while only one cancer patient out of a group of 17 who did receive aspirin died. “From this analysis, we have found that the single most important predictor of survival in these patients is whether or not they received aspirin,” said the study’s senior investigator, Jean-Bernard Durand, M.D., an assistant professor in the Department of Cardiology at M. D. Anderson. “Why that is, we’re not sure. There appears to be a ‘platelet paradox’ suggesting that cancer may affect the mechanism of the way blood clots.” According to Dr. Durand, more research is needed to better understand this contradiction, but in the meantime, the decision on the use of aspirin should be made by both the cardiologist and oncologist on the treatment team. At higher risk According to the World Health Organization, of the approximately 10 million cancer patients worldwide, about 1.5 million may develop blood clots during their treatment. As such, they are at a much higher risk of dying from heart disease. “Now that we have this study, it would be a travesty if someone who survived treatment for cancer died of a heart attack soon after because they didn’t receive treatment with aspirin,” Dr. Durand said. After making the empirical observation that M. D. Anderson patients who were being treated for heart attacks often seemed to have very good clinical outcomes when given aspirin and/or beta blockers, Dr. Durand and a multiinstitutional team of researchers conducted a retrospective analysis of cancer patients treated for heart attacks at M. D. Anderson over a one-year period. The 70 patients were divided into two groups based on their platelet counts, and data were collected on the use of aspirin, bleeding complications, and survival. The team found that heart attack patients with low platelet counts who did not receive aspirin had a seven-day survival rate of only 6%, while those who received aspirin had a 90% survival rate. In addition, the patients who used aspirin had no severe bleeding complications, but patients with low platelet counts who developed a blood clot and were not given aspirin died. The beneficial effect of aspirin also was seen in cancer patients with normal platelet counts. Seven-day survival was 88% in aspirin-treated patients and 45% in patients who did not receive aspirin, the researchers found. Dr. Durand observed that these death rates are still abnormally high compared with those of patients without cancer. “For someone with acute coronary syndrome anywhere in the United States, an expected seven-day mortality is less than one percent,” he said. The findings in patients in either group who were treated with beta blockers paralleled those of the aspirin-only treatment groups. The protective effect was not as strong as was seen with aspirin but was still life-saving. The researchers noted that their report may be the first to describe the risk-benefit profile of aspirin therapy in patients with thrombocytopenia.For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789. Other articles in OncoLog, February 2007 issue:
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