Intended for healthcare professionals

Education And Debate

North of England evidence based guideline development project: guideline on the use of aspirin as secondary prophylaxis for vascular disease in primary care

BMJ 1998; 316 doi: (Published 25 April 1998) Cite this as: BMJ 1998;316:1303
  1. Martin Eccles (, professor of clinical effectivenessa,
  2. Nick Freemantle, senior research fellowb,
  3. James Mason, research fellowb,
  4. the North of England Aspirin Guideline Development Group.
  1. a Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA
  2. b Centre for Health Economics, University of York, York YO1 5DD
  1. Correspondence to: Professor Eccles
  • Accepted 16 December 1997

Patients who have had cardiovascular disease and stroke are treated with aspirin to reduce their subsequent risk of vascular events or death and thereby to increase the length and quality of their life. This guideline aims to provide general practitioners with evidence linked recommendations on the use of aspirin as secondary prophylaxis for cardiovascular disease and stroke in patients at high risk of these disorders. It is assumed that doctors will use their knowledge and clinical judgment in managing individual patients in the light of available resources. Recommendations may not be appropriate for use in all circumstances. This is a summary of the full version of the guideline.1

Summary points

The use of aspirin in the secondary prophylaxis of vascular disease is cost effective

Aspirin should be used in patients with acute myocardial infarction, prior myocardial infarction, stable and unstable angina, and prior stroke or transient ischaemic attack

In acute myocardial infarction a dose of 150 mg daily should be used

In the other indications a dose of 75 mg daily should be used


In general practice, patients with a raised risk of vascular disease present with several disorders—acute or previous myocardial infarction, unstable or stable angina, transient ischaemic attacks, and peripheral vascular disease. The incidence and prevalence of these conditions and the workload associated with them in general practice can be estimated from the recent national morbidity survey in general practice for England and Wales, and is shown in the table.2

View this table:

Diseases associated with a raised risk of vascular events—incidence, prevalence, and workload in a general practice, assuming a list size of 2000 patients

Categorising evidence

Throughout this guideline the strength of statements on evidence and of recommendations is categorised according to the scheme discussed in the first paper in the series.3 The box below shows these categories in descending …

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