ASA effective in secondary prevention of vascular disease, uncertain in primary prevention
Clinical Question
Is aspirin effective in the primary or secondary prevention of vascular disease?Clinical Question
Bottom Line
Aspirin is effective in the primary and secondary prevention of vascular events. However, in primary prevention, the rate of bleeding complications nearly offsets the benefits. (LOE = 1a)Bottom Line
Reference
Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373(9678):1849-1860. [PMID:19482214]Reference
Study Design
Meta-analysis (randomized controlled trials)Study Design
Funding
GovernmentFunding
Setting
Various (meta-analysis)Setting
Synopsis
The authors of this collaborative project pooled patient-level data from randomized trials comparing aspirin with no aspirin (or other antiplatelet drugs) for the primary and secondary prevention of vascular occlusive disease (myocardial infarction, coronary heart disease mortality, stroke, and other vascular events). For primary prevention studies to be eligible, they had to have enrolled more than 1000 patients without diabetes and reported at least 2 years of follow-up. The authors report that they looked for unpublished studies but found none. When the individual data were pooled, the authors used intention-to-treat analysis to assess the outcomes. The authors identified 6 primary prevention trials with 95,000 patients, and 16 secondary prevention trials with 17,000 patients. In the primary prevention studies, 0.51% of patients taking aspirin had a vascular event each year compared with 0.57% of control patients. One would need to treat 1560 for 1 year to prevent 1 event (95% CI, 1004 - 3460). In the primary prevention trials, the annual rate of serious extracranial bleeding complications was 0.1% in patients taking aspirin and 0.07% in control patients (number needed to treat to harm [NNTH] = 2840; 2030 - 4710). In the secondary prevention studies, the annual rate of any vascular event was 6.7% in patients taking aspirin and 8.2% in control patients (number needed to treat = 73; 53 - 115). In the secondary prevention trials, the annual rate of major extracranial bleeding was 0.11% in the patients taking aspirin and 0.03% of control patients (NNTH = 1265; 743 - 3280).Synopsis
ASA effective in secondary prevention of vascular disease, uncertain in primary prevention is a sample topic from the EE+ POEM Archive.
To view other topics, please log in or purchase a subscription.
Evidence Central is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research. Complete Product Information.
Citation
Barry, Henry, et al., editors. "ASA Effective in Secondary Prevention of Vascular Disease, Uncertain in Primary Prevention." EE+ POEM Archive, John Wiley & Sons, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/infoPOEMs/426846/all/ASA_effective_in_secondary_prevention_of_vascular_disease__uncertain_in_primary_prevention.
ASA effective in secondary prevention of vascular disease, uncertain in primary prevention. In: Barry HH, Ebell MHM, Shaughnessy AFA, et al, eds. EE+ POEM Archive. John Wiley & Sons; 2019. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426846/all/ASA_effective_in_secondary_prevention_of_vascular_disease__uncertain_in_primary_prevention. Accessed March 29, 2023.
ASA effective in secondary prevention of vascular disease, uncertain in primary prevention. (2019). In Barry, H., Ebell, M. H., Shaughnessy, A. F., & Slawson, D. C. (Eds.), EE+ POEM Archive. John Wiley & Sons. https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426846/all/ASA_effective_in_secondary_prevention_of_vascular_disease__uncertain_in_primary_prevention
ASA Effective in Secondary Prevention of Vascular Disease, Uncertain in Primary Prevention [Internet]. In: Barry HH, Ebell MHM, Shaughnessy AFA, Slawson DCD, editors. EE+ POEM Archive. John Wiley & Sons; 2019. [cited 2023 March 29]. Available from: https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426846/all/ASA_effective_in_secondary_prevention_of_vascular_disease__uncertain_in_primary_prevention.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - ASA effective in secondary prevention of vascular disease, uncertain in primary prevention
ID - 426846
ED - Barry,Henry,
ED - Ebell,Mark H,
ED - Shaughnessy,Allen F,
ED - Slawson,David C,
BT - EE+ POEM Archive
UR - https://evidence.unboundmedicine.com/evidence/view/infoPOEMs/426846/all/ASA_effective_in_secondary_prevention_of_vascular_disease__uncertain_in_primary_prevention
PB - John Wiley & Sons
DB - Evidence Central
DP - Unbound Medicine
ER -