- Major bleeding risk with aspirin eclipses any primary prevention benefit in atherosclerotic cardiovascular disease (ASCVD), even in people with high risk.
- The results of this meta-analysis do not support the idea that aspirin might still offer some benefit in higher-risk groups.
Why this matters
- The authors say that other primary prevention therapies are as good as or better than aspirin without the bleeding risk.
- They included 12 randomized controlled trials (n=145,435) comparing aspirin with placebo or control in primary ASCVD prevention.
- Bias risk across trials was low-moderate.
- Mean follow-up was 6.8 years.
- Aspirin dose: range, 75-500 mg.
- With vs without aspirin, ASCVD events per 1000 patient years:
- 4.7 vs 5.3.
- Rate ratio: 0.86 (95% CI, 0.79-0.92).
- Heterogeneity for trials assessing ASCVD events was modest (I2=34%).
- Aspirin had a greater treatment effect in older trials.
- However, major bleeding events per 1000 patient years were increased with aspirin vs without:
- 2.5 vs 1.8.
- Rate ratio: 1.41 (95% CI, 1.29-1.54).
- Heterogeneity for trials assessing major bleeding was low (I2=0%).
- Meta-analysis of randomized controlled trials.
- Funding: None.
- Included some older studies; primary prevention approaches and lifestyle factors (e.g., smoking) have changed.