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Aspirin reduces cardiovascular events in primary prevention of cardiovascular disease but at a near equivalent risk of increased bleeding
Commentary on: Guirguis-Blake JM, Evans CV, Senger CA, et al.. Aspirin for the primary prevention of cardiovascular events: a systematic evidence review for the US Preventive Services Task Force. Ann Intern Med 2016;164:804–13 . Context The use of aspirin in primary prevention of cardiovascular disease (CVD) remains controversial, as randomised controlled trials (RCTs) have produced mixed results. Recently, the United States Preventive Services Task Force (USPSTF) published updated recommendations on the use of aspirin for primary prevention of CVD and colorectal cancer.1 This systematic review and meta-analysis serv...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: Miedema, M. D., Virani, S. S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease Therapeutics/Prevention Source Type: research

Different impact of aspirin on renal progression in patients with predialysis advanced chronic kidney disease with or without previous stroke.
CONCLUSIONS: There was no significant benefit in preventing ischemic stroke in the patients with advanced CKD who received aspirin therapy. Furthermore, the use of aspirin was associated with the risk of renal failure in the patients with advanced CKD without previous stroke. PMID: 27884500 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - November 20, 2016 Category: Internal Medicine Authors: Hsiao KC, Huang JY, Lee CT, Hung TW, Liaw YP, Chang HR Tags: Eur J Intern Med Source Type: research

Review: Aspirin for CVD primary prevention increases gastrointestinal bleeding and hemorrhagic stroke.
PMID: 27538178 [PubMed - in process]
Source: Annals of Internal Medicine - August 15, 2016 Category: Internal Medicine Authors: Fletcher RH Tags: Ann Intern Med Source Type: research

Aspirin for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: A Decision Analysis for the U.S. Preventive Services Task Force.
Conclusion: Lifetime aspirin use for primary prevention initiated at younger ages (40 to 69 years) and in persons with higher CVD risk shows the greatest potential for positive net benefit. Primary Funding Source: Agency for Healthcare Research and Quality. PMID: 27064573 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - April 11, 2016 Category: Internal Medicine Authors: Dehmer SP, Maciosek MV, Flottemesch TJ, LaFrance AB, Whitlock EP Tags: Ann Intern Med Source Type: research

Bleeding Risks With Aspirin Use for Primary Prevention in Adults: A Systematic Review for the U.S. Preventive Services Task Force.
Conclusion: Consideration of the safety of primary prevention with aspirin requires an individualized assessment of aspirin's effects on bleeding risks and expected benefits because absolute bleeding risk may vary considerably by patient. Primary Funding Source: Agency for Healthcare Research and Quality. PMID: 27064261 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - April 11, 2016 Category: Internal Medicine Authors: Whitlock EP, Burda BU, Williams SB, Guirguis-Blake JM, Evans CV Tags: Ann Intern Med Source Type: research

Comparison of aspirin and Naoxintong Capsule (脑心通胶囊) with adjusted-dose warfarin in elderly patients with high-risk of non-valvular atrial fibrillation and genetic variants of vitamin K epoxide reductase
Conclusions Aspirin combined with NXT and warfarin displayed comparable rates of primary end point including ischemic stroke and all-cause death during the 1-year follow-up. However, as compared with warfarin, the combination therapy reduced the rate of serious bleeding. Therefore, aspirin combined with NXT might provide an alternative pharmacotherapy in preventing ischemic stroke for elderly patients with NAVF who cannot tolerate warfarin. (No. ChiCTR-TRC-13003596)
Source: Chinese Journal of Integrative Medicine - February 26, 2016 Category: Internal Medicine Source Type: research

Longer dual antiplatelet therapy (DAPT) after percutaneous coronary intervention has higher anti-ischaemic efficacy than shorter DAPT but is associated with more frequent bleeding
Commentary on: Spencer FA, Prasad M, Vandvik PO, et al.. Longer- versus shorter-duration dual-antiplatelet therapy after drug-eluting stent placement: a systematic review and meta-analysis. Ann Intern Med 2015;163:118–26. Context Dual antiplatelet therapy (DAPT) with aspirin plus a P2Y12 receptor antagonist is recommended after drug eluting stent implantation (DES) for at least 12 months by the American College of Cardiology/American Heart Association1 and for 6–12 months by European guidelines. Recent randomised controlled trials (RCT) suggested comparable efficacy of short-term DAPT versus therapy o...
Source: Evidence-Based Medicine - January 22, 2016 Category: Internal Medicine Authors: Navarese, E. P. Tags: Journalology, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Venous thromboembolism, Radiology, Clinical diagnostic tests, Ethics Therapeutics/Prevention Source Type: research

Long-Term Use of Ticagrelor in Patients with Prior Heart Attack: Ticagrelor Plus Aspirin Versus Aspirin Monotherapy.
Authors: Amico F, Schlesinger A, Mazzoni J Abstract Review of: Bonaca MP, Bhatt DL, Braunwald E et al. Design and rationale for the Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54) trial. Am Heart J. 167(4), 437-444.e5 (2014). This Practice Pearl reviews the recent study Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared With Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction 54 (PEGASUS-TIMI 54). It cha...
Source: Postgraduate Medicine - December 26, 2015 Category: Internal Medicine Tags: Postgrad Med Source Type: research

A Meta-Analysis of Randomized Controlled Trials on Antiplatelet Agents Versus Placebo/Control for Treating Peripheral Artery Disease
Abstract: Effect of aspirin (antiplatelet agents) in patients with peripheral artery disease (PAD) was still controversial. Varying studies reported varying results. Therefore, we did this meta-analysis to investigate if aspirin could reduce cardiovascular events in patients with PAD. A comprehensive literature search (PubMed, CCTR, Embase, Web of Science, CNKI, CBM-disc, and relevant websites) was conducted from 1990 to September 2014. The key search terms (“aspirin,” “PAD,” “peripheral arterial occlusive diseases,” and “claudication”) produced 9 high-quality randomized controlled trials (RCTs) of aspirin ...
Source: Medicine - August 1, 2015 Category: Internal Medicine Tags: Research Article: Systematic Review and Meta-Analysis Source Type: research

Long-term ticagrelor therapy in patients with prior myocardial infarction significantly reduces ischaemic events, albeit with increased bleeding
Commentary on: Bonaca MP, Bhatt DL, Cohen M, et al., PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015;372:1791–800. Context Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 receptor antagonist constitute the cornerstone of treatment in patients with acute coronary syndrome (ACS) with a recommended duration of 1 year.1 Nevertheless, high rates of atherothrombotic events, for which platelet activation is heavily implicated, still occur at later stages.2 Therefore, a longer duration of DAPT appears intuitive, a...
Source: Evidence-Based Medicine - July 24, 2015 Category: Internal Medicine Authors: Alexopoulos, D. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes Therapeutics/Prevention Source Type: research

Efficacy and Safety of Oral Anticoagulants Versus Aspirin for Patients With Atrial Fibrillation: A Meta-Analysis
Abstract: The purpose of this study was to perform a meta-analysis comparing the effectiveness and safety of anticoagulation to antiplatelet therapy for the prevention of thromboembolic events in patients with atrial fibrillation (AF). MEDLINE, Cochrane, EMBASE, and Google Scholar databases were searched for studies published through May 31, 2014. Randomized controlled trials comparing anticoagulants (warfarin) and antiplatelet therapy in patients with AF were included. The primary outcomes were the rates of stroke and systemic embolism. Secondary outcomes included the rates of hemorrhage/major bleeding and death. Pooled o...
Source: Medicine - January 1, 2015 Category: Internal Medicine Tags: Article: Systematic Review and Meta-Analysis Source Type: research

Dual antiplatelet therapy in recurrent stroke prevention: do the benefits outweigh the risks?
This study assessed seven randomised controlled trials, comprising 39 574 patients and comparing dual versus single antiplatelet therapies. Medications used included aspirin (50–325 mg daily), clopidogrel (75 mg daily), aspirin plus dipyridamole (50/400 mg daily) and ticlopidine (100 mg daily). Patients had a history of ischaemic stroke (three trials) or TIA (four...
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Farooq, M. U., Gorelick, P. B. Tags: Clinical trials (epidemiology), Stroke Therapeutics Source Type: research

Adding clopidogrel to aspirin after TIA or minor ischemic stroke reduced stroke without increasing bleeding.
PMID: 24126666 [PubMed - in process]
Source: Annals of Internal Medicine - October 15, 2013 Category: Internal Medicine Authors: Hill MD Tags: Ann Intern Med Source Type: research

Aspirin prophylaxis in people without prior cardiovascular disease does not lead to reductions in cardiovascular death or cancer mortality
Commentary on: Seshasai SR, Wijesuriya S, Sivakumaran R, et al.. Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med 2012;172:209–16. Context Prophylactic antiplatelet therapy with aspirin reduces the risk of non-fatal myocardial infarction (MI), non-fatal stroke and vascular death in patients with known cardiovascular disease (CVD) and is of net benefit. The absolute reduction in recurrent events significantly exceeds the increase in major bleeding.1 However, the role of aspirin in primary prevention of CVD is not clear. According to the Antithrombot...
Source: Evidence-Based Medicine - March 19, 2013 Category: Internal Medicine Authors: Farooq, M. U., Gorelick, P. B. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Prevention, Ischaemic heart disease Online articles Source Type: research

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