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1. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer

Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer 1 Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer Interim Guidance from the Kaiser Permanente National Integrated Cardiovascular Health (ICVH) Work Group October 5, 2018 Three randomized clinical trials (ARRIVE 1 , ASCEND 2 , and ASPREE 3 ) recently published results on aspirin use in patients without known Atherosclerotic Cardiovascular Disease (ASCVD). The studies looked at benefits including (...) cardiovascular event prevention, and risks including serious bleeding events. Overall the studies suggest that aspirin lacks net benefit (total benefits minus total harms) beyond age 70, and there is low net benefit in younger adults. USPSTF 2016 aspirin recommendations point to highest net benefit for aspirin in adults age 50-59 (lower bleeding risk than older patients) with 10-year ASCVD risk* >10%. The National Kaiser Permanente Aspirin recommendations will be formally updated following a comprehensive

2019 Kaiser Permanente National Guideline Program

2. Kaiser Permanente National Aspirin Clinician Guide

Kaiser Permanente National Aspirin Clinician Guide This Clinician Guide expires within two years of the posted month. 1 See National Clinical Library for current version (https://cl.kp.org). Aspirin Clinician Guide October 2018 Introduction These recommendations were developed to assist primary care physicians and other clinicians in aspirin use. The KP National Integrated Cardiovascular Health Guideline team adopted the 2016 aspirin recommendations developed by the United States Preventive (...) Services Task Force (USPSTF) on “Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication” for patients without Atherosclerotic Cardiovascular Disease (ASCVD). It is not intended or designed as a substitute for the reasonable exercise of independent clinical judgment by practitioners. Aspirin Therapy at 81 mg Orally Daily for Adults without ASCVD Risk Assessment ? 10-year ASCVD Risk is risk of fatal or nonfatal myocardial infarctions or strokes in adults. A region may

2018 Kaiser Permanente National Guideline Program

3. Low-Dose Aspirin Use During Pregnancy

Low-Dose Aspirin Use During Pregnancy ACOGCOMMITTEEOPINION Number 743 Committee on Obstetric Practice Society for Maternal–Fetal Medicine This Committee Opinion was developed by the Committee on Obstetric Practice in collaboration with committee member T. Flint Porter, MD, and the Society for Maternal–Fetal Medicine in collaboration with members Cynthia Gyamfi-Bannerman, MD, MS, and Tracy Manuck, MD. Low-Dose Aspirin Use During Pregnancy ABSTRACT: Low-dose aspirin has been used during pregnancy (...) , although the list of indications for low-dose aspirin use was more expansive. Daily low-dose aspirin use in pregnancy is considered safe and is associated with a low likelihood of serious maternal, or fetal complications, or both, related to use. The AmericanCollege of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine support the U.S. Preventive Services Task Force guideline criteria for prevention of preeclampsia. Low-dose aspirin (81 mg/day) prophylaxis is recommended

2018 American College of Obstetricians and Gynecologists

4. Low-Dose Aspirin Use During Pregnancy

Low-Dose Aspirin Use During Pregnancy ACOGCOMMITTEEOPINION Number 743 Committee on Obstetric Practice Society for Maternal–Fetal Medicine This Committee Opinion was developed by the Committee on Obstetric Practice in collaboration with committee member T. Flint Porter, MD, and the Society for Maternal–Fetal Medicine in collaboration with members Cynthia Gyamfi-Bannerman, MD, MS, and Tracy Manuck, MD. Low-Dose Aspirin Use During Pregnancy ABSTRACT: Low-dose aspirin has been used during pregnancy (...) , although the list of indications for low-dose aspirin use was more expansive. Daily low-dose aspirin use in pregnancy is considered safe and is associated with a low likelihood of serious maternal, or fetal complications, or both, related to use. The AmericanCollege of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine support the U.S. Preventive Services Task Force guideline criteria for prevention of preeclampsia. Low-dose aspirin (81 mg/day) prophylaxis is recommended

2018 American College of Obstetricians and Gynecologists

5. Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication

Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication Final Update Summary: Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication - US Preventive Services Task Force Search USPSTF Website Text size: Assembly version: 1.0.0.308 Last Build: 11/16/2018 6:27:19 PM You are here: Final Summary Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication Release Date: April 2016 Recommendation (...) Summary Population Recommendation Grade Adults aged 50 to 59 years with a ≥10% 10-year CVD risk The USPSTF recommends initiating low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged 50 to 59 years who have a 10% or greater 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. Adults aged 60 to 69 years with a ≥10

2016 U.S. Preventive Services Task Force

6. Low-Dose Aspirin Use for the Prevention of Morbidity and Mortality From Preeclampsia: Preventive Medication

Low-Dose Aspirin Use for the Prevention of Morbidity and Mortality From Preeclampsia: Preventive Medication Final Update Summary: Low-Dose Aspirin Use for the Prevention of Morbidity and Mortality From Preeclampsia: Preventive Medication - US Preventive Services Task Force Search USPSTF Website Text size: Assembly version: 1.0.0.308 Last Build: 11/16/2018 6:27:19 PM You are here: Final Summary Low-Dose Aspirin Use for the Prevention of Morbidity and Mortality From Preeclampsia: Preventive (...) Medication Release Date: September 2014 Recommendation Summary Low-Dose Aspirin Use for the Prevention of Morbidity and Mortality From Preeclampsia Population Recommendation Grade Pregnant Women Who Are At High Risk for Preeclampsia The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia. ( ) Related Information for Consumers Related Information for Health Professionals There is no related information

2014 U.S. Preventive Services Task Force

7. Hypertension in pregnancy: diagnosis and management

-eclampsia. [2010, amended 2019] [2010, amended 2019] Antiplatelet agents Antiplatelet agents 1.1.2 Advise pregnant women at high risk of pre-eclampsia to take 75–150 mg of aspirin [1] daily from 12 weeks until the birth of the baby. Women at high risk are those with any of the following: hypertensive disease during a previous pregnancy chronic kidney disease autoimmune disease such as systemic lupus erythematosus or antiphospholipid Hypertension in pregnancy: diagnosis and management (NG133) © NICE 2019 (...) . All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 6 of 54syndrome type 1 or type 2 diabetes chronic hypertension. [2010, amended 2019] [2010, amended 2019] 1.1.3 Advise pregnant women with more than 1 moderate risk factor for pre- eclampsia to take 75–150 mg of aspirin [1] daily from 12 weeks until the birth of the baby. Factors indicating moderate risk are: first pregnancy age 40 years or older pregnancy interval of more than

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

8. Twin and triplet pregnancy

on antenatal care for uncomplicated pregnancies. [2011] [2011] 1.6.2 Advise women with a twin or triplet pregnancy to take low-dose aspirin [1] daily from 12 weeks until the birth of the babies if they have 2 or more of the risk factors specified in NICE's guideline on hypertension in pregnancy. [2011, [2011, amended 2019] amended 2019] Twin and triplet pregnancy (NG137) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 20

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

9. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management

1.7 Optimal positioning and early mobilisation for people with acute stroke 16 1.8 Avoiding aspiration pneumonia 17 1.9 Surgery for people with acute stroke 17 T erms used in this guideline 18 Recommendations for research 21 Key recommendations for research 21 Rationale and impact 22 Initial management of suspected and confirmed transient ischaemic attack (aspirin) 22 Initial management of suspected and confirmed transient ischaemic attack 22 Imaging for people who have had a suspected TIA (...) to the emergency department with a suspected stroke or TIA, establish the diagnosis rapidly using a validated tool, such as ROSIER (Recognition of Stroke in the Emergency Room). [2008] [2008] Initial management of suspected and confirmed TIA Initial management of suspected and confirmed TIA 1.1.4 Offer aspirin (300 mg daily), unless contraindicated, to people who have had a suspected TIA, to be started immediately. [2019] [2019] 1.1.5 Refer immediately people who have had a suspected TIA for specialist

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

10. Sore throat (acute): antimicrobial prescribing

medicines, unless otherwise stated. 3 Erythromycin is preferred in young women who are pregnant. See the evidence and committee discussion on choice of antibiotic and antibiotic course length. Sore throat (acute): antimicrobial prescribing (NG84) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 9 of 24Summary of the e Summary of the evidence vidence Self-care Or Oral analgesia al analgesia Overall aspirin, paracetamol (...) and diclofenac potassium (not available to buy over the counter) were all more effective than placebo at reducing pain and fever in adults with sore throat associated with an upper respiratory tract infection. This was based on low to moderate quality evidence from 3 randomised controlled trials (RCTs) (Eccles et al. 2003, Gehanno et al. 2003 and Voelker et al. 2016). Overall, adverse events for aspirin, paracetamol and diclofenac potassium in the 3 RCTs did not appear to be significantly different from

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

11. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism

for people who are obese 35 Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism (NG89) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 413 Direct oral anticoagulants for people with lower limb immobilisation 36 4 Aspirin prophylaxis for people with fragility fractures of the pelvis, hip or proximal femur 37 5 Duration of prophylaxis for elective total (...) 2018] Pharmacological proph Pharmacological prophylaxis ylaxis 1.3.12 For pharmacological VTE prophylaxis in people under 18, follow the recommendations on apixaban, aspirin, dabigatran etexilate, fondaparinux sodium, low-molecular-weight heparin (LMWH) and rivaroxaban in this guideline. At the time of publication (March 2018), these drugs did not have a UK marketing authorisation for use in young people under 18 for this indication. The prescriber should follow relevant professional guidance

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

12. Rheumatoid arthritis in adults: management

, including age and pregnancy. [2018] [2018] 1.6.2 When treating symptoms of RA with oral NSAIDs: offer the lowest effective dose for the shortest possible time offer a proton pump inhibitor (PPI), and and review risk factors for adverse events regularly. [2018] [2018] 1.6.3 If a person with RA needs to take low-dose aspirin, healthcare professionals should consider other treatments before adding an NSAID (with a PPI) if pain relief is ineffective or insufficient. [2009, amended 2018] [2009, amended 2018

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

13. Dementia: assessment, management and support for people living with dementia and their carers

-steroidal anti-inflammatory drugs (NSAIDs), including aspirin. Pharmacological management of non-Alzheimer's dementia Pharmacological management of non-Alzheimer's dementia 1.5.10 Offer donepezil or rivastigmine to people with mild to moderate dementia with Lewy bodies. [1] 1.5.11 Only consider galantamine [2] for people with mild to moderate dementia with Lewy bodies if donepezil and rivastigmine [1] are not tolerated. 1.5.12 Consider donepezil or rivastigmine for people with severe dementia with Lewy

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

15. Recommendations for good practice in Ultrasound: Oocyte retrieval

. There is no evidence suggesting value for FBC or any additional test before OPU with regard to preventing complications. - Taking accurate patient history before OPU is essential to highlight potential comorbidities and take actions to prevent any possible associated complications. Patients should at least be asked about the use of medications - more specifically the use of blood thinning agents (aspirin and others) -, relevant previous surgeries, and any relevant disease or deficit of coagulation factors

2019 European Society of Human Reproduction and Embryology

16. Guidelines on Chronic Coronary Syndromes

antithrombotic therapy in combination with aspirin 75-100 mg daily in alphabetical order in patients who have a high or moderate risk of ischaemic events, and do not have a high bleeding risk. 34 Table 10 Blood pressure thresholds for definition of hypertension with different types of blood pressure measurement 44 Table 11 Potential treatment options for refractory angina and summary of trial data 47 List of figures Figure 1 Schematic illustration of the natural history of chronic coronary syndromes 7 Figure (...) at chronic coronary syndrome outpatient clinics 39 Abbreviations and acronyms ABI Ankle−brachial index ACE Angiotensin-converting enzyme ACS Acute coronary syndrome(s) ACTION A Coronary disease Trial Investigating Outcome with Nifedipine gastrointestinal therapeutic system AF Atrial fibrillation ARB Angiotensin receptor blocker AUGUSTUS An Open-label, 2 × 2 Factorial, Randomized Controlled, Clinical Trial to Evaluate the Safety of Apixaban vs. Vitamin K Antagonist and Aspirin vs. Aspirin Placebo

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2019 European Society of Cardiology

17. Guidelines on Diabetes, Pre-Diabetes and Cardiovascular Diseases developed in collaboration with the EASD

Management of blood pressure lowering 20 6.3.2.1 Effects of lifestyle intervention and weight loss 20 6.3.2.2 Pharmacological treatments 20 6.3.2.3 Blood pressure changes with glucose-lowering treatments 20 6.4 Lipids 21 6.4.1 Lipid-lowering agents 21 6.4.1.1 Statins 21 6.4.1.2 Ezetimibe 22 6.4.1.3 Proprotein convertase subtilisin/kexin type 22 6.4.1.4 Fibrates 22 6.5 Platelets 23 6.5.1 Aspirin 23 6.5.1.1 Primary prevention 24 6.5.1.2 Secondary prevention 24 6.6 Multifactorial approaches 24 6.6.1 (...) OGTT Oral glucose tolerance test ORIGIN Outcome Reduction With Initial Glargine Intervention PAD Peripheral arterial disease PCI Percutaneous coronary intervention PEGASUS- TIMI 54 Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin−Thrombolysis In Myocardial Infarction 54 PCSK9 Proprotein convertase subtilisin/kexin type 9 PIONEER 6 A Trial Investigating the Cardiovascular Safety of Oral Semaglutide in Subjects

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2019 European Society of Cardiology

18. National Adult Diabetes Clinician Guide

• Simultaneous use of an ACEI, ARB, and/or renin inhibitor is potentially harmful and is not recommended. • Do not prescribe ACEIs/ARBs, to women of childbearing potential, unless there is a compelling indication. Additional Details CLINICAL PRACTICE GUIDELINES | NATL February 2019 • For additional details, see KP Blood Pressure guideline. CHOLESTEROL THERAPY • See Cholesterol and Cardiovascular Risk guideline. ASPIRIN THERAPY • See Integrated Cardiovascular Health Clinical Leads interim guidance on aspirin

2019 Kaiser Permanente National Guideline Program

19. Iron deficiency anaemia in adults

and a comprehensive list will allow identification of any type of medicine that might cause gastrointestinal bleeding (bleeding from the stomach and intestines), such as ibuprofen or aspirin. Menstrual pattern Particularly heavy or prolonged periods can lead to anaemia, but this may go unreported if the patient has always had periods of this kind and has not seen a marked difference in what they are used to. Establishing an idea of volume of loss and length of bleeding in days, as well as what is a normal pattern

2019 Royal College of Nursing

20. Diagnosis and Management of Acute Pulmonary Embolism

weeks post-partum 38 Figure 8 Follow-up strategy and diagnostic workup for long-term sequelae of pulmonary embolism 44 Abbreviations and acronyms AcT Right ventricular outflow Doppler acceleration time AFE Amniotic fluid embolism ALT Alanine aminotransferase AMPLIFY Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-line Therapy ASPIRE Aspirin to Prevent Recurrent Venous Thromboembolism trial AV Arteriovenous b.i.d Bis in die (twice a day) BNP B-type (...) Transoesophageal echocardiography/echocardiogram TTE Transthoracic echocardiography/echocardiogram TV Tricuspid valve U Unit UFH Unfractionated heparin VKA(s) Vitamin K antagonist(s) V/Q Ventilation/perfusion (lung scintigraphy) VTE Venous thromboembolism VTE-BLEED ActiVe cancer, male with uncontrolled hyperTension at baseline, anaEmia, history of BLeeding, agE ≥60 years, rEnal Dysfunction WARFASA Warfarin and Aspirin study 1 Preamble Guidelines summarize and evaluate available evidence with the aim

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2019 European Society of Cardiology

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