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Aspirin saved lives of patients with cancer who had myocardial infarction
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Aspirin can save the lives of patients with cancer who have myocardial infarction despite the possibility of fatal bleeding, according to a press release.
Researchers at The University of Texas MD Anderson Cancer Center have proven wrong a common medical belief that patients with cancer who have MI could experience lethal bleeding if treated with aspirin. However, without the life-saving aspirin treatment, most of these patients will die.
Aspirin can thin blood and because patients with cancer experience low platelet counts and abnormal clotting, physicians believed aspirin was contraindicated for patients with cancer.
“The notion that MI in patients with low platelets should be treated with clot-dissolving aspirin defies logic, unless you suspect that the cancer is interfering with platelet function,” Jean-Bernard Durand, MD, assistant professor in the department of cardiology at MD Anderson, and a researcher on the study, said in a press release.
Survival rates
Durand and colleagues conducted a retrospective analysis of patients with cancer who were treated for MI at MD Anderson in 2001. They divided 70 patients into two groups and collected Data on aspirin use, bleeding complications and survival.
The researchers found that nine out of 10 patients with cancer who had thrombocytopenia and were experiencing an MI died if they did not receive aspirin, compared with one patient in a group of 17 similar patients.
Patients with low platelets that had MI and did not receive aspirin had a seven-day survival rate of 6%, compared with a 90% survival rate in those who received aspirin. In addition, patients with low platelet counts who formed a blood clot and did not receive aspirin died. There were no severe bleeding complications associated with patients who used aspirin.
“The explanation may be that aspirin interrupts only one of many platelet signaling pathways and is not, in fact, an impressive inhibitor of platelet function,” said Joel Moake, MD, Platelet Disorders and Physiology section editor for Hem/Onc Today. “Aspirin acetylates platelet COX-1 and inhibits platelet thromboxane A2 formation from arachidonic acid. Aspirin does not, however, impair critical events in hemostasis.”
Aspirin benefits were also identified in patients with normal platelet counts. Seven-day survival was 88% in patients treated with aspirin, compared with 45% of patients not treated.
“We believe tumors may be releasing chemicals that allow the cancer to form new blood supplies, which makes blood more susceptible to forming clots,” Durand said. “There appears to be a platelet paradox suggesting that cancer may affect the mechanism of the way blood clots, and from this analysis, we have found that the single most important predictor of survival in these patients is whether or not they received aspirin.”
According to the World Health Organization, of the 10 million patients with cancer worldwide, 1.5 million may develop blood clots during their treatment, and are at much higher risk of dying from heart disease if not treated properly. According to Durand, no guidelines exist for treating MI in patients with cancer. This is also true for treating blood clots, which affect about 15% of patients with cancer.
“Now that we have this study, it would be a travesty if you survive treatment for cancer only to die of an MI soon thereafter,” Durand said in the press release.
Moake cautioned, however, that accepting these results now is too soon. – by Emily Shafer