Decision support only. Not medical advice. Consult a licensed clinician before initiating or changing therapy.

Patient 023

72y·male·white·ASCVD 6.8%

2 active reversal flags

  1. CardiologyHigh

    Aspirin for primary CVD prevention

    Why flagged

    On aspirin for primary prevention at age 60+, reversed by USPSTF 2022 (Grade D).

    1. Prior guidance2016

      Routine low-dose aspirin for primary prevention in adults 50-59 years with >= 10% 10-year ASCVD risk (USPSTF, 2016).

    2. ASPREE2018

      Increased major hemorrhage (HR 1.38; 95% CI 1.18-1.62) and higher all-cause mortality (5.9% vs. 5.7%) in elderly patients, with no CVD benefit.

    3. Reversal2022

      Guidelines updated

    4. Current recommendation

      USPSTF (2022): Grade D against initiating aspirin for primary prevention in adults >= 60 years. Grade C (individualized decision) for adults 40-59 years with >= 10% ASCVD risk.

  2. OrthopedicsModerate

    Arthroscopic partial meniscectomy for degenerative knee OA

    Why flagged

    Arthroscopic meniscectomy referral for knee OA patient age 72 with Kellgren-Lawrence grade 4; Moseley 2002 sham RCT showed no benefit over placebo.

    1. Prior guidance2002

      Routine arthroscopic debridement and partial meniscectomy for pain relief in degenerative knee osteoarthritis.

    2. Moseley2002

      Sham-controlled surgery showed no benefit over placebo or physical therapy in pain or functional outcomes at 2 years.

    3. Reversal2022

      Guidelines updated

    4. Current recommendation

      AAOS Guidelines: Non-operative management (physical therapy, NSAIDs, weight loss) is strongly recommended over arthroscopy for patients with degenerative meniscal tears and OA.