Raju N et al. – Aspirin prevents deaths, myocardial infarction, and ischemic stroke, and increases hemorrhagic stroke and major bleeding when
used in the primary prevention
of cardiovascular disease. Methods
- Eligible articles were identified by searches of electronic databases and reference lists.
- Outcomes of interest were all–cause mortality, cardiovascular mortality, myocardial infarction, stroke, and bleeding.
- Data were pooled from individual trials using the DerSimonian–Laird random–effects model, and results are presented as relative risk
(RR) and 95% confidence
intervals (CIs).
Results
- Nine randomized controlled trials enrolling 100,076 participants were included.
- Aspirin reduced all–cause mortality (RR 0.94; 95% CI, 0.88–1.00), myocardial infarction (RR 0.83; 95% CI, 0.69–1.00), ischemic
stroke (RR 0.86; 95% CI,
0.75–0.98), and the composite of myocardial infarction, stroke, or cardiovascular death (RR 0.88; 95% CI, 0.83–0.94), but did not reduce
cardiovascular mortality (RR
0.96; 95% CI, 0.84–1.09).
- Aspirin increased the risk of hemorrhagic stroke (RR 1.36; 95% CI, 1.01–1.82), major bleeding (RR 1.66; 95% CI, 1.41–1.95), and
gastrointestinal bleeding (RR
1.37; 95% CI, 1.15–1.62).
- A lack of availability of patient–level data precluded exploration of benefits and risks of aspirin in key subgroups.
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