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See Latest ArticlesReview: aspirin reduces vascular events but increases bleeding in primary and secondary prevention
Evidence-Based Medicine, 12/08/09
Meta–analysis of primary prevention RCTs showed that aspirin reduced serious vascular events and non–fatal MI but did not reduce stroke or vascular death, and increased major bleeding. In secondary prevention, aspirin led to a greater reduction of serious vascular events, MI, stroke, and vascular death but increased major bleeding. Overall, the 2 reviews provide valuable insight into the role of aspirin in CV risk reduction. The Antithrombotic Trialists’ collaboration analysis by Baigent and colleagues confirms the net benefit of aspirin in secondary prevention but raises questions about the value of aspirin in primary prevention, including patients with diabetes. Given the multiple limitations of the analysis in PAD patients, the data should not change current recommendations for use of low–dose aspirin and deprive patients of potential benefit. The only way to definitively answer the net incremental value of aspirin in these populations in the era of ubiquitous statin use will be through large, adequately powered RCTs.
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