From rxpgnews.com
Aspirin in primary prevention of cadiovascular events of uncertain value
By RxPG news,
May 30, 2009 - 1:21:06 PM
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.
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