Aspirin App Pairs Clinical Studies With Technology to Balance Bleeding, Benefits


Researchers from the Brigham and Women’s Hospital in Boston have joined forces with a mobile software developer to create an app that can calculate personalized aspirin dosages based on a patient’s history and atherosclerotic cardiovascular disease (ASCVD) risk factors.

According to Samia Mora, MD, and JoAnn Manson, MD, who teamed up with developer Jeffrey Ames, the aim was to combine statistics from a clinical review with the easy-to-use format of mobile devices. The free app, called Aspirin Guide, aims to balance the positive effects of prescribing aspirin for primary prevention of (ASCVD) with the potential for more bleeding.

The tool’s main focus is “primary prevention, because that's where the risk and the benefit of aspirin are closely balanced in most individuals,” Mora told TCTMD. “So we wanted to do it in such a way that the clinician can very quickly estimate some of these risks for both cardiovascular events and for bleeding.”

The data used as the backbone of the app came from a review of 11 trials involving more than 115,000 patients on the use of aspirin for primary prevention of ASCVD events. In their paper published online June 20, 2016, in JAMA Internal Medicine, Mora and Manson further divided the findings from those trials into subgroups based on gender, age and risk factors then developed recommendations for aspirin usage based on every combination of those data.

Ames then used that dataset to create the mobile software for a calculator and the user-friendly interface that allows physicians to input the data and receive recommendations for each patient. Those combinations can now be run through the app to produce individualized advice on the use of aspirin to prevent ASCVD events and to estimate the risk of gastrointestinal bleeding.

Getting Personal

One of the reasons prescribing aspirin for primary prevention can be difficult is the lack of specific recommendations in the guidelines, according to Mora. Even among the various documents produced by governments or medical organizations, the recommendations are not detailed enough to allow physician’s easy access to prescription amounts.

According to Mora, the researchers and programmer wanted to give providers a tool to simplify everything that goes into the decision-making process of prescribing aspirin.

“All the guidelines do really [is] recommend individualizing the risk/benefit assessment for each individual and for primary prevention.” Mora said. “The dilemma as a clinician [is that] it's really hard to estimate somebody's CV risks or their bleeding risks in seconds. It's a complicated calculation, so it’s not very easy to do it in your head.”

But the app can “make that [process] really straightforward and easy to calculate,” she said. “Then you as a clinician can discuss those risks and benefits and have a more informed discussion [with the patient].”

The researchers plan to continue updating the data and improving the software based on user feedback, but no there are no plans to conduct a clinical study on the effectiveness of the app in the near future.


Sources:

  • Mora S, Manson JE. Aspirin for primary prevention of atherosclerotic cardiovascular disease: advances in diagnosis and treatment. JAMA Intern Med. 2016.Epub ahead of print.
  • Mora S, Ames JE, Manson JE. Low-dose aspirin in the primary prevention of cardiovascular disease: shared decision making in clinical practice. JAMA. 2016;Epub ahead of print.

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Disclosures
  • Manson and Mora report having received funding from the National Institutes of Health.
  • Mora reports having received research support from Athertech Diagnostics and the National Heart, Lung, and Blood Institute and serving as a consultant to Quest Diagnostics, Lilly, Amgen, Pfizer, and Cerenis Therapeutics.
  • Manson reports receiving support from the National Institutes of Health.

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