aspirin
DISEASE INTERVENTION COMPARISON RESULTS
Arch Intern Med. 2010 Sep 13;170(16):1433-41 Cohorts
IN anticoagulants, vitamin K antagonists, antiplatelet drugs, aspirin, clopidogrel, bleeding risk The Use of
aspirin and/or clopidogrel associated to warfarin
As Treatment, Chronic
Is worse Than
warfarin alone
To risk of fatal and nonfatal bleeding: 14% per patient-year with warfarin plus clopidogrel, 16% with warfarin plus aspirin plus clopidogrel
Circulation. 2012 Sep 4;126(10):1185-93 Cohorts
IN anticoagulants, vitamin K antagonists, antiplatelet drugs, aspirin, clopidogrel, bleeding risk The Use of
vitamin K antagonist (VKA) +aspirin +clopidogrel
As Treatment, Chronic
Is worse Than
vitamin K antagonist +1 antiplatelet, or dual antiplatelet therapy with aspirin +clopidogrel
To cause bleeding events, specially in the first 30-90 days: 23 events per 100 person-years with triple therapy, 20 with VKA +1 antiplatelet, 14 with dual antiplatelet. Triple therapy was not more effective than VKA +1 antiplatelet
Lancet. 2017 07 29;390(10093):490-499 Cohorts
IN antiplatelet drugs, aspirin, bleeding risk The Use of
any anitplatelet drug, mainly aspirin (95% of included patients)
As Treatment, Chronic
Is worse Than
no antipaltelet therapy
To increase the risk of bleeding. Bleeding rate increased with age from 70 years on, specially major and life-threatening bleeding. Localizations, by frequency: gastrointestinal, genitourinary, intracranial, epistaxis, others
N Engl J Med. 2018 10 18;379(16):1519-1528 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, healthy old patients The Use of
aspirin, 100 mg daily
As Prevention, Primary
Is worse Than
placebo
To carry any benefit: it increased all-cause death (1.3 %/year aspirin VS 1.1%/year placebo, p significant), mainly caused by cancer.
N Engl J Med. 2018 Oct 18;379(16):1499-1508 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, healthy old patients The Use of
aspirin, 100 mg daily
As Prevention, Primary
Is worse Than
placebo
To achieve any clinical benefit (composite of death, dementia or persistent physical disability 2.1%/year in both groups) and caused more major bleeding (3.8% aspirin VS 2.8% placebo)
N Engl J Med. 2018 Oct 18;379(16):1529-1539. doi: 10.1056/NEJMoa1804988 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, cardiovascular disease, primary prevention, high risk patients, diabetes mellitus, type 2 The Use of
aspirin, 100 mg daily
As Treatment, Chronic
Is better Than
placebo
To reduce at 7.4 years cardiovascular events (8.5% VS 9.5% placebo), but it increased major bleeding (4% aspirin VS 3% placebo), most of the excess being gastrointestinal bleeding and other extracranial bleeding.
BMJ. 2002 Jan 12;324(7329):71-86 Meta-Analysis
IN atherosclerosis, coronary disease, ischemic stroke, peripheral arterial disease The Use of
antiplatelet drugs, aspirin, low-dose (75-150 mg/d), adenosine diphosphate (ADP) receptor inhibitors, clopidogrel
As Treatment, Chronic
Is better Than
placebo
To reduce recurrence of ischemic coronary and cerebral events, with absolute reductions of 3 to 4%, depending on specific conditions
Ann Intern Med. 2009 Mar 17;150(6):405-10 Systematic Review
IN atherosclerosis, coronary disease, stroke, ischemic, cardiovascular death The Use of
aspirin
As Prevention, Primary
Is better Than
placebo
To reduce cardiovascular events (myocardial infarction in men and strokes in women) but not cardiovascular death or overall mortality. Aspirin use increases serious bleeding events.
Lancet. 2009 May 30;373(9678):1849-60 Meta-Analysis
IN atherosclerosis, coronary disease, stroke, ischemic, cardiovascular death The Use of
aspirin
As Prevention, Primary
Is better Than
placebo
To reduce, both as primary or secondary prevention, serious cardiovascular events but increasing major bleeding. Benefit for primary prevention was limited: 0.51% events aspirin VS 0.57% placebo, 0.10% major bleedings aspirin VS 0.07% placebo
N Engl J Med. 2006 Apr 20;354(16):1706-17. Epub 2006 Mar 12 Randomized Controlled Trial, Multicenter Study
IN atherosclerosis, coronary disease, stroke, ischemic, peripheral arterial disease, or multiple risk factors The Use of
combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (75 mg/d) added to low-dose aspirin
As Treatment, Chronic
Is equal Than
antiplatelet drugs, low-dose aspirin (75 to 160 mg/d) alone
To reduce, at 2 years, cardiovascular events (myocardial infarction, stroke, or cardiovascular death): 6.8% clopidogrel plus aspirin VS 7.3% aspirin alone. Bleeding was not significantly different. Combined treatment worse for non-symptomatic patients
Canadian Agency for Drugs and Technologies in Health - CADTH. 2013 Mar: 1(1B); 1-142 Systematic Review
IN atrial fibrillation, non valvular, stroke, ischemic, cerebral infarction, embolic The Use of
anticoagulants, oral direct thrombin inhibitors, dabigatran, oral factor Xa inhibitors, apixaban, rivaroxaban, antiplatelet drugs, aspirin, clopidogrel
As Treatment, Chronic
Is equal Than
anticoagulants, antivitamine K, warfarin, aspirin
To modify stroke, embolism or bleedings : there are some differences in some cases but with little absolute risk reduction
N Engl J Med. 2009 May 14;360(20):2066-78 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin
As Treatment, Chronic
Is better Than
aspirin alone
To reduce major cardiovascular events, specially stroke (6.8% clopidogrel+aspirin VS 7.6% aspirin) but increased major haemorrhage (2% clopidogrel+aspirin VS 1.3% aspirin)
Lancet. 2006 Jun 10;367(9526):1903-12 Randomized Controlled Trial, Multicenter Study
IN atrial fibrillation, stroke, ischemic, embolic The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/day) plus aspirin (75-100 mg/day)
As Treatment, Chronic
Is worse Than
oral anticoagulation (target INR 2.0-3.0)
To prevent embolic events (stroke, non-CNS systemic embolus, myocardial infarction, or vascular death): annual risk 3.93% with warfarin VS 5.60% with aspirin plus clopidogrel
Am J Med. 2012 Jun;125(6):560-7 Systematic Review
IN cancer, all types The Use of
aspirin, 75 mg daily or more, for at least 2.8 years
As Prevention, Primary
Is better Than
placebo
To reduce cancer deaths (2% aspirin VS 2.6% placebo) and noncardiovascular mortality (2.3% VS 2.6%)
Lancet. 2011 Jan 1;377(9759):31-41. Epub 2010 Dec 6 Meta-Analysis
IN cancer, all types, gastrointestinal cancers The Use of
aspirin, 75 mg daily or more, for more than 5 years
As Prevention, Primary
Is better Than
placebo
To reduce death due to all cancers (0.79) when treatment maintained for more than 5 years, specially for gastrointestinal cancers (OR 0.46) but also for brain, lung and prostate cancers.
Lancet. 2010 Nov 20;376(9754):1741-50 Meta-Analysis
IN cancer, colorectal The Use of
aspirin dose, 75 mg daily or more, for more than 5 years
As Prevention, Primary
Is better Than
placebo
To reduce the 20-year risk of colon cancer incidence (HR 0.76) and mortality (HR 0.65), specially of proximal colon cancer.
N Engl J Med. 2003 Mar 6;348(10):883-90 Randomized Controlled Trial, Multicenter Study
IN cancer, colorectal The Use of
aspirin (325 mg daily)
As Prevention, Secondary
Is better Than
placebo
To prevent new colorectal adenomes in colonoscopy, at 12,8 months (17% in intv VS 27% in ctrl)
JAMA. 2013 Sep 4;310(9):918-29 Randomized Controlled Trial, Multicenter Study
IN cardiovascular disease The Use of
polypill, fixed-dose combinations of drugs, 75 mg aspirin, 40 mg simvastatin, 10 mg lisinopril, and 50 mg atenolol
As Prevention, Primary
Is better Than
usual care
To improve medication adherence (86% polypill VS 65% usual) and statistically significant but small improvements in blood pressure and LDL-C
JAMA. 1999 Dec 1;282(21):2058-67 Meta-Analysis
IN coronary disease The Use of
vitamin K antagonists, added to aspirin, but not alone
As Treatment, Chronic
Is better Than
aspirin alone
To prevent myocardial infarction or stroke (risk reduction not given), but based in few studies (3 studies, 480 patients) and increasing bleeding risk by about 2 fold.
Circulation. 2003 Feb 25;107(7):966-72 Randomized Controlled Trial
IN coronary disease, acute coronary syndrome The Use of
P2Y12 inhibitors, clopidogrel, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
aspirin alone
To reduce ischemic events (cardiovascular death, myocardial infarction, or stroke) at 30 days (4.3% in intv. VS 5.4% in ctrl.) and at 12 months (5.2% in intv. VS 6.3% in ctrl.) No significant excess in life-threatening bleeds (but yes for total bleeds)
N Engl J Med. 2007 Nov 15;vol(issue):pag [Epub ahead of print Nov 4] Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
P2Y12 inhibitors, prasugrel, added to aspirin, combined anti-platelet drugs
As Treatment, Acute
Is better Than
clopidogrel, added to aspirin, combined anti-platelet therapy
To reduce recurrence of myocardial infarction (7.4% for prasugrel VS 9.7% for clopidogrel) and a derived combined end-point of cardiovascular death and major events.
N Engl J Med. 2009 Sep 10;361(11):1045-57 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome The Use of
P2Y12 inhibitors, ticagrelor, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
clopidogrel, added to aspirin, combined anti-platelet drugs
To reduce at 12 months cardiovascular events (death from vascular causes, myocardial infarction, or stroke): 10% ticagrelor VS 12% clopidogrel. Ticagrelor increased minor bleedings but not major haemorrhages.
N Engl J Med. 2014 Dec 4;371(23):2155-66 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
dual antiplatelet therapy (aspirin + P2Y12 inhibitor (clopidogrel or prasugrel)) for 30 months
As Treatment, Chronic
Is worse Than
dual antiplatelet therapy (aspirin + thienopyridine) for 12 months only
To improve all-cause mortality (2.0% 30 months VS 1.5% 12 months), even if it reduced cardiovascular events (4.3% 30 months VS 5.9% 12 months). Extended treatment increased major bleedings (2.5% vs 1.6%) but that did not explain the mortality difference
N Engl J Med. 2015 May 07;372(19):1791-800 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, after percutaneous coronary intervention, drug eluting stents The Use of
mantaining dual antiplatelet after 1 year with ticagrelor (90 mg twice daily or 60 mg twice daily) plus low-dose aspirin
As Treatment, Chronic
Is better Than
placebo plus low-dose aspirin
To reduce cardiovascular events (8% both doses ticagrelor VS 9% aspirin alone) but increasing major bleeding (2.5% ticagrelor VS 1% aspirin alone)
Ann Intern Med. 2005 Aug 16;143(4):241-50 Meta-Analysis
IN coronary disease, acute coronary syndrome, myocardial infarction The Use of
vitamin K antagonists, warfarin, added to aspirin
As Treatment, Chronic
Is better Than
aspirin alone, NOT compared to aspirin plus clopidrogel
To decrease the annual rate of myocardial infarction (0.022 vs. 0.041) and ischemic stroke (0.004 vs. 0.008) but not to reduce mortality. Major bleeding increased (0.015 vs. 0.006)
N Engl J Med. 2001 Aug 16;345(7):494-502 Randomized Controlled Trial, Multicenter Study
IN coronary disease, acute coronary syndrome, without ST elevation The Use of
adenosine diphosphate (ADP) receptor inhibitors, clopidogrel, added to aspirin, combined anti-platelet therapy
As Treatment, Acute
Is better Than
aspirin alone
To reduce, at 1 year, ischemic events (cardiovascular death, myocardial infarction or stroke): 9.3% in intv VS 11.4% in ctrl. Increase major bleeds (3.7% in intv. VS 2.7% in ctrl.)
N Engl J Med. 2002 Sep 26;347(13):969-74 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction The Use of
vitamin K antagonists, warfarin, added to aspirin or alone
As Treatment, Chronic
Is better Than
aspirin alone
To reduce cardiovascular events (death, MI or ischemic stroke), rates per year: 3.5% warfarin plus aspirin VS 4.2% warfarin VS 5% aspirin.
N Engl J Med. 2005 Mar 24;352(12):1179-89 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (300-mg loading dose, 75 mg/d after) added to fibrinolysis plus aspirin plus heparin
As Treatment, Acute
Is better Than
standard antithrombotic Tt with fibrinolysis + aspirin + heparin alone (+ placebo)
To reduce at 30 days vascular events (cardiovascular death, recurrent infarction, revascularization because recurrent ischemia): 11,6% with clopidogrel VS 14,6% standard Tt, Major bleeding and intracranial hemorrhage similar in the two groups.
Lancet. 2005 Nov 5;366(9497):1607-21 Randomized Controlled Trial, Multicenter Study
IN coronary disease, myocardial infarction, ST-segment elevation The Use of
antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) added to standard Tt (aspirin 100%, fibrinolysis 50%, anticoagulant 75%)
As Treatment, Acute
Is better Than
aspirin alone and standard antithrombotic Tt
To To reduce at 30 days vascular events (death, recurrent infarction, stroke): 9,2% with clopidogrel VS 10,1% aspirin alone.
N Engl J Med. 2017 10 05;377(14):1319-1330 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable The Use of
anticoagulants, oral factor Xa inhibitors, rivaroxaban (2.5 mg twice daily) plus aspirin (100 mg once daily)
As Treatment, Chronic
Is better Than
rivaroxaban (5 mg twice daily) alone, or aspirin (100 mg once daily) alone
To reduce cardiovascular events (death, stroke or MI): 4.1% riva+aspirine VS 5.4% aspirine. But increased major bleeding: 3.1% VS 1.9%. Riva 5 mg/d alone did not better than aspirin and had more bleeding.
Lancet. 1992 Dec 12;340(8833):1421-5 Randomized Controlled Trial, Multicenter Study
IN coronary disease, stable angina The Use of
aspirin, low dose (75 mg/d)
As Treatment, Chronic
Is better Than
placebo
To reduce major cardiovascular events (34% relative reduction)
J Am Coll Cardiol. 1995 Aug;26(2):313-8 Clinical Trial, Randomized Controlled Trial.
IN coronary disease, unstable angina The Use of
low molecular weight heparin (LMWH), added to aspirin
As Treatment, Acute
Is better Than
aspirin alone, or aspirin plus unfractionated heparin
To reduce recurrent angina and myocardial infarction, but not death
N Engl J Med. 2008 Feb 7;358(6):580-91 Randomized Controlled Trial
IN diabetes mellitus, type 2, microalbuminuria, cardiovascular disease The Use of
intensified multifactorial intervention: tight glucose control plus use of renin-angiotensin system blockers, aspirin, and lipid-lowering agents (statins)
As Treatment, Chronic
Is better Than
usual (conventional) therapy
To reduce, at 13 years, all-cause mortality (30% multifactorial Tt VS 50% usual Tt), cardiovascular events (HR 0.54) and advenced reanl disease.
N Engl J Med. 2005 Jan 20;352(3):238-244 Randomized Controlled Trial
IN gastrointestinal bleeding, upper, peptic ulcer, NSAIDs related The Use of
proton-pump inhibitors (PPI) (esomeprazole), added to aspirin
As Prevention, Secondary
Is better Than
clopidogrel, in substitution of aspirin
To reduce recurrent ulcer bleeding: 8,6% in clopidogrel VS 0,7% in aspirin+PPI, at 1 year
Arch Intern Med. 2007 Jan 22;167(2):117-24 Meta-Analysis
IN heart valve disease, mechanical heart valve, atrial fibrillation, coronary disease The Use of
aspirin, added to vitamin K antagonists, warfarin
As Treatment, Chronic
Is better Than
vitamin K antagonists, warfarin, alone
To reduce arterial thromboembolism, but only in patients with mechanical heart valve (OR 0.27) and not for coronary disease or atrial fibrillation. There was not differences in all-cause mortality and major bleeding was higher (OR 1.43)
JAMA. 2000 Nov 22;284(20):2599-2605 Randomized Controlled Trial
IN pain, headache, classic migraine The Use of
stratified care: aspirin if mild migraine, triptan (zolmitriptan) if severe
As Treatment, Acute
Is better Than
step care across attacks or whithin attacks: start always with aspirin and triptan if failure
To improve headache response and disability time
Circulation. 2005 Sep 27;112(13):2012-6 Randomized Controlled Trial
IN pericarditis, acute, various etiologies The Use of
colchicine, added to conventional therapy (aspirin or corticosteroids)
As Treatment, Acute
Is better Than
placebo, added to conventional therapy (aspirin or corticoids)
To reduce recurrence rate at 18 months (10.7% with colchicine VS 32% without) and symptoms persistence at 3 days (12% with colchicine VS 37% without)
N Engl J Med. 2017 Jun 28. doi: 10.1056/NEJMoa1704559. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN preeclampsia The Use of
aspirin, 150 mg/day
As Treatment, Chronic
Is better Than
placebo
To reduce delivery with preeclampsia before 37 weeks of gestation: 1.6% aspirin VS. 4.3% placebo. No differences in the incidence of neonatal adverse outcomes.
Arch Intern Med. 1999 Jun 14;159:1248-53 Meta-Analysis
IN stroke, ischemic The Use of
antiplatelet drugs, low dose aspirin (>50 mg/d)
As Treatment, Chronic
Is equal Than
antiplatelet drugs, higher doses of aspirin
To reduce recurrent stroke
N Engl J Med. 2008 Sep 18;359(12):1238-51 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, thrombotic The Use of
aspirin plus extended-release dipyridamole (25 mg/200mg twice daily)
As Prevention, Secondary
Is worse Than
clopidrogel (75 mg once daily)
To reduce at 2.5 years recurrent ischemic stroke (9% aspirin VS 8.8% clopid) or cardiovascular events (13.1% both groups) and there were more haemorrhagic events (4.1% aspirin VS 3.6% clopid)
Stroke. 2000 Jun;31(6):1240-9 Meta-Analysis
IN stroke, ischemic, cerebral infarction, thrombotic The Use of
antiplatelet drugs, aspirin
As Treatment, Acute
Is better Than
placebo
To reduce early death or recurrent stroke (either ischemic or haemorrhagic): 8.2% aspirin versus 9.1% placebo.
Lancet. 1997 Jun 7;349(9066):1641-1649 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, thrombotic The Use of
antiplatelet drugs, aspirin
As Treatment, Acute
Is better Than
placebo
To reduce death at 1 month: 3.3% with aspirin VS 3.9% placebo
Lancet. 1997 May 31;349(9065):1569-1581 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, cerebral infarction, thrombotic The Use of
antiplatelet drugs, aspirin 300 mg/d
As Treatment, Acute
Is better Than
placebo or unfractionated heparin (UFH), either low or full-dose
To reduce at 14 days recurrent ischaemic strokes (2.8% aspirin VS 3.9% placebo) or death plus non-fatal recurrent stroke (11.3% aspirin vs 12.4% placebo)
N Engl J Med. 2005 Mar 31;352(13):1305-16 Randomized Controlled Trial
IN stroke, ischemic, cerebral infarction, thrombotic, intracranial arterial stenosis The Use of
aspirin
As Treatment, Chronic
Is better Than
anticoagulants, vitamin K antagonists, warfarin
To reduce death at 1,8 years: 4.3% on aspirin vs. 9.7% on warfarin. Combination of stroke (ischemic or hemorrhagic) or vascular death was similar: 22.1% on aspirin VS 21.8% on warfarin
Stroke. 2015 Apr;46(4):1014-23 Meta-Analysis
IN stroke, ischemic, lacunar The Use of
any single antiplatelet agent, aspirin, ticlodipine
As Treatment, Chronic
Is better Than
placebo
To reduce ischemic stroke (RR 0.48) and any stroke (RR 0.77) but not myocardial infarction or death
N Engl J Med. 2012 Aug 30;367(9):817-25 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, lacunar, recent The Use of
combined antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) added to aspirin (325 mg/d)
As Treatment, Chronic
Is equal Than
aspirin alone
To modify the the risk of recurrent stroke: 2.5% per year dual therapy VS 2.7% per year aspirin alone
Lancet. 2004 Jul 24;364(9431):331-7 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, thrombotic, recidivant, high-risk patients The Use of
combined anti-platelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel, added to aspirin,
As Treatment, Chronic
Is worse Than
only one antipletelet drug, clopidogrel
To reduce new stroke or overall ischemic events (10.5 % per year in intv. VS 11.1 % per year in ctrl.) And increased bleedings, included life-threatening bleedings (1.73 % per year in intv. VS 0.86 % per year in ctrl.)
Stroke. 2012 Apr;43(4):1058-66. Epub 2012 Jan 26 Meta-Analysis
IN stroke, ischemic, thrombotic, transient ischemic attack The Use of
combined antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (75 mg/d) plus low-dose aspirin
As Prevention, Secondary
Is equal Than
aspirin alone
To reduce stroke recurrence (aspirin+clopidogrel VS aspirin alone : RR 0.67, 95%CI 0.37-1.23). However, a strong trend to reduce combined major cardiovascular events or death (OR 0.68, 95%CI 0.45-1.03, p=0.07).
Lancet. 2007 Oct 20;370(9596):1432-42 Clinical Trial (non-controlled, non-randomized)
IN stroke, ischemic, transient ischemic attack, cerebral infarction, minor The Use of
urgent assessment and immediate treatment with antiplatelets (aspirin or clopidogrel or both), statin and antihypertensive drugs
As Treatment, Acute
Is better Than
usual delay in assessment and treatment
To reduce at 3 months any stroke recurrence: 2.1% with early Tt VS 10.3% with usual delay
J Neurol Neurosurg Psychiatry. 2008 Nov;79(11):1218-23 Meta-Analysis
IN stroke, ischemic, transient ischemic attack, cerebral infarction, thrombotic The Use of
antiplatelet drugs, aspirin plus dipyridamole combined
As Treatment, Chronic
Is better Than
aspirin alone
To reduce recurrent stroke (HR 0.78) and cardiovascular events (HR 0.82)
Stroke. 2008 Apr;39(4):1358-63 Meta-Analysis
IN stroke, ischemic, transient ischemic attack, cerebral infarction, thrombotic The Use of
antiplatelet drugs, aspirin, dipyridamole
As Treatment, Chronic
Is better Than
aspirin alone
To reduce cardivascular events (stroke, myocardial infarction, or vascular death): RR 0.77
N Engl J Med. 1991 Oct 31;325(18):1261-6 Randomized Controlled Trial
IN stroke, ischemic, transient ischemic attack, cerebral infarction, thrombotic The Use of
antiplatelet drugs, low dose aspirin (30 mg/d)
As Treatment, Chronic
Is equal Than
antiplatelet drugs, higher dose aspirin (300 mg/d)
To reduce, at 2.6 years, recurrent cardiovascular events (stroke myocardial infarction or vascular death): 14.7% with low dose VS 15.2% higher dose
N Engl J Med. 2013 Jul 4;369(1):11-9 Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, transient ischemic attack, or minor cerebral infarction, recents The Use of
combined antiplatelet drugs, adenosine diphosphate (ADP) receptor inhibitors, clopidogrel (initial dose of 300 mg, followed by 75 mg/day) plus aspirin (75 mg/day) for 90 days
As Treatment, Acute
Is better Than
aspirine alone
To reduce, at 3 months, stroke (8% clopidogrel+aspirin VS 12% aspirine alone), while having similar rate of major haemorrage (0.3% both)
N Engl J Med. 2018 May 16. doi: 10.1056/NEJMoa1800410. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN stroke, ischemic, transient ischemic attack, or minor cerebral infarction, recents The Use of
combined antiplatelet drugs, P2Y12 inhibitors, clopidogrel (initial dose of 300 mg, followed by 75 mg/day) plus aspirin (50-300 mg/day) for 90 days
As Treatment, Acute
Is better Than
aspirine alone
To reduce, at 3 months, major ichemic events (5% clopidogrel+aspirin VS 6.5% aspirine alone), but increasing the rate of major haemorrage (0.9% combined VS 0.4% aspirin alone)
Arch Surg. 2009 Jan;144(1):69-76 Review (Narrative)
IN surgical risk, haemorrhagic risk, antiplatelet drugs The Use of
antiplatelet drugs, aspirin, clopidogrel, perioperative use
As Treatment, Acute
Is better Than
withdraw aspirin
To avoid cardiovascular events: 10% risk if antiplatelet drugs withdawn. Aspirin should be maintained. Clopidogrel should be stopped, except if recent drug-eluting stent implantation.
Eur Heart J. 2008 Apr;29(8):1057-71 Meta-Analysis
IN surgical risk, haemorrhagic risk, aspirin, cardiac surgery The Use of
antiplatelet drugs, aspirin, pre-operative use
As Treatment, Acute
Is worse Than
placebo
To haemorrhage: pre-operative aspirin increased post-operative bleeding (Mean difference, 104.9 mL) and reoperation (OR 2.52)
Circulation. 2011 Feb 15;123(6):577-83 Cohorts
IN surgical risk, haemorrhagic risk, aspirin, cardiac surgery The Use of
early discontinuation of aspirin, 6 or more days before surgery
As Treatment, Acute
Is better Than
late discontinuation of aspirin, less than 5 days before surgery
To reduce perioperative bleeding and needs of transfusion (26% early VS. 30% late) while no difference in cardiovascular events (in-hospital mortality, myocardial infarction, and stroke) 1.7% early VS. 1.8% late