29th September 2025, A/Prof Chee L Khoo
I must admit that I have been doing this for many years on an ad hoc basis. I have been screening for helicobacter pylori (HP) infection in patients who need to be on aspirin (primary or secondary prevention of coronary artery disease). This isn’t what is recommended in any cardiovascular (CV) disease guidelines until recently but the evidence is not robust.…
6th September 2025, A/Prof Chee L Khoo
We all have patients at risk of thromboembolism (mainly from atrial fibrillation risks) and atherosclerotic cardiovascular disease (primarily, coronary artery disease). They may require both anti-coagulant as well as anti-platelet therapy. Sometimes, we don’t have a choice as they have high risks for both. Theoretically, they at high bleeding risks. Yet, our cardiology colleagues have to make that difficult decision to continue both.…
24th February 2024, A/Prof Chee L Khoo
In May 2022, the US Preventative Services Task Force (USPSTF) recommended that we avoid routine aspirin for primary prevention of CVD for anyone at all (1). In particular, for those between 40–59-year-old with a 10-year CVD risk 10%, the decision to initiate aspirin for the primary prevention should be an individual one as the evidence of the net benefit of aspirin use in this group is small.…
29th April 2023, Dr Chee L Khoo
We have a increasing number of patients who has undergone a percutaneous coronary intervention (PCI). This could be in the acute setting of an acute coronary syndrome (ACS) or electively during an exploratory angiogram. Stents used to be bare metal. Then came the first-generation drug eluting stents. The latest generation drug eluting stents are better at reducing subsequent thrombosis of the stented and unstented coronary segments.…
4th January 2023, Dr Chee L Khoo
The most recent US Prevention Services Task Force (USPSTF) recommendations pour cold water onto its use in primary prevention of CVD in April 2022 (1). We explored the details and rationale behind that turnaround recently. The recommendation for use of aspirin for prevention of colorectal cancer is lumped in together with the recommendation for CVD prevention.…
9th September 2022, Dr Chee L Khoo
While aspirin does provide a modest benefit in reducing nonfatal MI and nonfatal stroke events, low dose aspirin has little or no effect on cardiovascular disease mortality or all-cause mortality in patients who have not had cardiovascular disease (1). In 2016, the US Preventive Services Task Force (USPSTF) concluded that the beneficial effect of aspirin for the primary prevention of CVD was modest and occurred at doses of 100 mg or less per day (2).…
13th February 2021, Dr Chee L Khoo
Aspirin as a chemoprotective agent against colorectal cancer (CRC) has gone through quite exhaustive reviews over the last 20 years. After initially recommended against using aspirin for CRC prevention in 2007, the US Preventative Services Task Force (USPSTF) in 2015 recommended initiating low-dose aspirin use for the primary prevention of CVD and CRC in “adults aged 50 to 59 years who have a >10% 10-year CVD risk, are not at increased risk for bleeding, have a life expectancy of at least 10 years and are willing to take low-dose aspirin daily for at least 10 years” (1).…
13th December 2020, Dr Chee L Khoo
If you have been following GPVoice over the years, you would have realised that I am easily confused. I am confused again. Why are some patients who has had a TIA or minor stroke on aspirin and some on dual antiplatelet therapy (DAPT)? With supplies of some of these agents interrupted during the pandemic, can we swab one anti-platelet agent for another?…
The US Preventive Services Task Force (USPSTF) recommends low-dose aspirin use for the prevention of cardiovascular disease among average-risk individuals aged 50 to 59 years with a 10% or greater 10-year risk of cardiovascular disease (1). Long-term regular aspirin use is also associated with reduced risk of obesity- and inflammation-associated cancers, particularly colorectal cancer (CRC) (2,3). Numerous follow up trials have consistently demonstrated significant reductions in risk in GI cancers – the NIH-AARP (4), the Nurses Health Study (5) and the Health Professionals Follow-up study (6,7).…
15th September, 2018, Dr Chee L Khoo
There is definitely a role for aspirin in preventing cardiovascular (CV) events in patients who already had a CV event (secondary prevention). There is always a risk of gastrointestinal and intracranial bleeding. Because the risk of another event after the first is often significantly higher, when one works out the risk benefit ratio, the benefits of aspirin use usually wins.…
15th August 2018, Dr Chee L Khoo
Following an acute coronary event we know that two anti-platelets are better than aspirin alone in preventing further coronary events. What about a cerebro-vascular events? Following a mild CVA or a TIA, we would normally commenced aspirin to prevent another stroke especially in the first 90 days. Would adding another agent to aspirin be better in preventing further strokes?…