title: Contemporary patterns of discharge aspirin dosing after acute myocardial infarction in the United States: results from the National Cardiovascular Data Registry (NCDR).
abstract: BACKGROUND
  Accumulated data suggest that low-dose aspirin after myocardial infarction (MI) may offer similar efficacy to higher dose aspirin with reduced risk of bleeding. Few data are available on contemporary aspirin dosing patterns after MI in the United States
  
  
  RESULTS
  Aspirin dosing from 221 199 patients with MI (40.2% ST-segment-elevation MI) from 525 US hospitals enrolled in the National Cardiovascular Data Registry's (NCDR's) Acute Coronary Treatment and Intervention Outcomes Network Registry-Get with the Guidelines were described, overall and in clinically relevant subgroups. High-dose aspirin was defined as 325 mg and low dose as 81 mg. Between January 2007 and March 2011, 60.9% of patients with acute MI were discharged on high-dose aspirin, 35.6% on low-dose aspirin, and 3.5% on other doses. High-dose aspirin was prescribed at discharge to 73.0% of patients treated with percutaneous coronary intervention and 44.6% of patients managed medically. Among 9075 patients discharged on aspirin, thienopyridine, and warfarin, 44.0% were prescribed high-dose aspirin. Patients with an in-hospital major bleeding event were also frequently discharged on high-dose aspirin (56.7%). A 25-fold variation in the proportion prescribed high-dose aspirin at discharge was observed across participating centers.
  
  
  CONCLUSIONS
  Most US patients with MI continue to be discharged on high-dose aspirin. Although aspirin dosing after percutaneous coronary intervention largely reflected prevailing guidelines before 2012, high-dose aspirin was prescribed with similar frequency in medically managed patients and to those in categories expected to be at high risk for bleeding. Wide variability in the proportional use of high-dose aspirin across centers suggests significant influence from local practice habits and uncertainty about appropriate aspirin dosing.
authors.affiliation: From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (H.M.H., J.A.d.L., D.K.M., S.R.D.); Division of Cardiology, University of Missouri-Kansas City (J.R.E.); Duke Clinical Research Institute, Durham, NC (S.A.P., K.P.A., M.T.R.); and Division of Cardiology, Brigham and Women's Hospital, Boston, MA (N.D., S.D.W.).
authors.forename: Hurst M
authors.initials: HM
authors.lastname: Hall
authors.affiliation: From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (H.M.H., J.A.d.L., D.K.M., S.R.D.); Division of Cardiology, University of Missouri-Kansas City (J.R.E.); Duke Clinical Research Institute, Durham, NC (S.A.P., K.P.A., M.T.R.); and Division of Cardiology, Brigham and Women's Hospital, Boston, MA (N.D., S.D.W.).
authors.forename: James A
authors.initials: JA
authors.lastname: de Lemos
authors.affiliation: From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (H.M.H., J.A.d.L., D.K.M., S.R.D.); Division of Cardiology, University of Missouri-Kansas City (J.R.E.); Duke Clinical Research Institute, Durham, NC (S.A.P., K.P.A., M.T.R.); and Division of Cardiology, Brigham and Women's Hospital, Boston, MA (N.D., S.D.W.).
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Enriquez
authors.affiliation: From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (H.M.H., J.A.d.L., D.K.M., S.R.D.); Division of Cardiology, University of Missouri-Kansas City (J.R.E.); Duke Clinical Research Institute, Durham, NC (S.A.P., K.P.A., M.T.R.); and Division of Cardiology, Brigham and Women's Hospital, Boston, MA (N.D., S.D.W.).
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.affiliation: From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (H.M.H., J.A.d.L., D.K.M., S.R.D.); Division of Cardiology, University of Missouri-Kansas City (J.R.E.); Duke Clinical Research Institute, Durham, NC (S.A.P., K.P.A., M.T.R.); and Division of Cardiology, Brigham and Women's Hospital, Boston, MA (N.D., S.D.W.).
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Peng
authors.affiliation: From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (H.M.H., J.A.d.L., D.K.M., S.R.D.); Division of Cardiology, University of Missouri-Kansas City (J.R.E.); Duke Clinical Research Institute, Durham, NC (S.A.P., K.P.A., M.T.R.); and Division of Cardiology, Brigham and Women's Hospital, Boston, MA (N.D., S.D.W.).
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
authors.affiliation: From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (H.M.H., J.A.d.L., D.K.M., S.R.D.); Division of Cardiology, University of Missouri-Kansas City (J.R.E.); Duke Clinical Research Institute, Durham, NC (S.A.P., K.P.A., M.T.R.); and Division of Cardiology, Brigham and Women's Hospital, Boston, MA (N.D., S.D.W.).
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.affiliation: From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (H.M.H., J.A.d.L., D.K.M., S.R.D.); Division of Cardiology, University of Missouri-Kansas City (J.R.E.); Duke Clinical Research Institute, Durham, NC (S.A.P., K.P.A., M.T.R.); and Division of Cardiology, Brigham and Women's Hospital, Boston, MA (N.D., S.D.W.).
authors.forename: Nihar
authors.initials: N
authors.lastname: Desai
authors.affiliation: From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (H.M.H., J.A.d.L., D.K.M., S.R.D.); Division of Cardiology, University of Missouri-Kansas City (J.R.E.); Duke Clinical Research Institute, Durham, NC (S.A.P., K.P.A., M.T.R.); and Division of Cardiology, Brigham and Women's Hospital, Boston, MA (N.D., S.D.W.).
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Wiviott
authors.affiliation: From the Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (H.M.H., J.A.d.L., D.K.M., S.R.D.); Division of Cardiology, University of Missouri-Kansas City (J.R.E.); Duke Clinical Research Institute, Durham, NC (S.A.P., K.P.A., M.T.R.); and Division of Cardiology, Brigham and Women's Hospital, Boston, MA (N.D., S.D.W.). sandeep.das@utsouthwestern.edu.
authors.forename: Sandeep R
authors.initials: SR
authors.lastname: Das
mesh_terms: D000208:Acute Disease; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D054796:Drug Dosage Calculations; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D015588:Observer Variation; D010351:Patient Discharge / Q000706:statistics & numerical data*; D062645:Percutaneous Coronary Intervention; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D001241:Aspirin
keywords: acute coronary syndrome; aspirin