Study expands indications for aspirin prophylaxis

NEW YORK (Reuters Health) – Aspirin is protective for most types of patients at risk for occlusive vascular events, according to the Antithrombotic Trialists' Collaboration in Oxford, UK. This finding extends the recommendation of antiplatelet therapy to patients with stable angina, peripheral arterial disease, atrial fibrillation and diabetes mellitus.

Previous indications for aspirin treatment included myocardial infarction, stroke, unstable angina, and transient ischemic attack, the collaborators note in the British Medical Journal for January 12.

Led by Dr. Colin Baigent, investigators conducted a meta-analysis of randomized trials available by September 1997 that compared an antiplatelet regimen either with a control or with another antiplatelet regimen among patients with previous occlusive events or predisposing conditions.

Data from 195 trials showed a rate of 10.7% for non-fatal myocardial infarction or stroke or vascular death among approximately 72,000 patients allocated to antiplatelet therapy. This was significantly lower (p < 0.0001) than the 13.2% rate observed among nearly the same number of subjects taking placebo.

In four trials involving approximately 40,000 patients with acute ischemic stroke, antiplatelet therapy caused an excess of 1.9 haemorrhagic strokes per 1000 patients while reducing the number of ischaemic strokes by 6.9 per 1000.

Substantial reductions in adverse outcomes were observed in 14 risk categories: stable and unstable angina, coronary artery bypass grafting, coronary angioplasty, heart failure, non-rheumatic atrial fibrillation, cardiac valve disease, cardiac valve surgery, intermittent claudication, peripheral grafting, peripheral angioplasty, haemodialysis patients with fistula or shunt placement, diabetes mellitus, and carotid disease.

For patients with diabetes, benefit was observed even in the absence of diagnosed cardiovascular disease. However, there appears to be no increased risk of intraocular haemorrhage, the investigators note.

They further note that daily aspirin doses of 75 to 150 mg appear to be as effective as higher doses for patients receiving long-term treatment. The collaborators are concerned that, even among patients with previously established indications for aspirin therapy, only about half are receiving it.

In a press release from The British Heart Foundation, Dr. Baigent states: "What we now need is to ensure that aspirin, or some other antiplatelet drug, is routinely considered for patients who might need it."

BMJ 2002;324:71-86.

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