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OP Kapoor

Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

Aspirin has become a daily prescription for a family physician. All patients of IHD and cerebro-vascular disease are taking Aspirin. Following three conditions are now added where Aspirin has to be prescribed, life time:-

1. Peripheral Arterial Disease now known as PAD is very common in smokers, in patients having diabetes or hypertension. Even if the symptoms are atypical, new doppler machines can pick up narrowing of the peripheral arteries.

Aspirin then can prevent future events. Also PAD is a risk factor for coronary artery disease which means that many of these patients will also develop coronary heart disease and therefore Aspirin will do additional good.

2. Atrial Fibrillation : Aspirin is a poor man's anti-coagulant. Now the new studies have shown that, even in rich patients, Aspirin has properties equal to an anti-coagulant. Thus Aspirin should be given life time for patients having atrial fibrillation to prevent thrombosis and embolisation.

3. Rheumatic Heart Disease : Till now every prescription of rheumatic heart disease included Penicillin, (which is prescribed up to the age of 30, 40 or even more) Digoxin and diuretics (which may be continued life time, even after the surgery or valvuloplasty).
Since rheumatic heart disease is a continuous chronic inflammation in the heart, majority of these patients, as they grow old, will develop atrial fibrillation and thus have tendency to thrombus formation and embolisation. Before developing atrial fibrillation, the dilated atrium invites thrombus formation. Thus, Aspirin can now be given as a life time drug for rheumatic heart disease, just as it is being given to patients of IHD.

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