By RxPG news, [RxPG] Low dose aspirin has been shown to be of benefit in the secondary prevention of cardiovascular events in various studies. But a recent meta-analysis published in the Lancet shows no overwhelming benefit of aspirin in primary prevention of cardiovascular events. But as the risk of major bleeding is significant, decisions for aspirin use in this setting need to be decided on individual basis.
Antithrombotic Trialists' (ATT) Collaboration undertook meta-analyses of 6 major clinical trials and 16 secondary prevention trials comparing long-term aspirin versus control. They looked at the occurence of the first event during the treatment period.
Findings
In the primary prevention trials, aspirin use caused a 12% reduction in serious vascular events (0·51% aspirin vs 0·57% control per year, p=0·0001). This was mainly due to a reduction in non fatal myocardial infarction. There was a 0·20% reduction per year in stroke in aspirin users versus a 0·21% reduction per year in the controls which was not significant. There was no significant difference in vascular mortality as well. Major gastrointestinal and extracranial bleeds was significantly higher in those on aspirin versus the control group.(p<0·0001), and the main risk factors for coronary disease were also risk factors for bleeding. In the secondary prevention trials, aspirin use caused a greater reduction in serious vascular events (6·7% vs 8·2% per year, p<0.0001)
The primary prevention of serious cardiovascular events with the use of aspirin is therefore not significant enough to recommend it as a blanket treatment for all, according to the results of this study. There is a need to weight the need for aspirin against the risk of major bleeds which is significantly high.
Publication:
The Lancet, May 30th 2009
Funding information and declaration of competing interests:Funding
UK Medical Research Council, British Heart Foundation, Cancer Research UK, and the European Community Biomed Programme.
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This news story has been reviewed by Dr. Sanjukta Acharya before its publication on RxPG News website. Dr. Sanjukta Acharya, MBBS MRCP is the chief editor for RxPG News website. She oversees all the medical news submissions and manages the medicine section of the website. She has a special interest in nephrology. She can be reached for corrections and feedback at [email protected]
RxPG News is committed to promotion and implementation of Evidence Based Medical Journalism in all channels of mass media including internet.
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