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In primary and secondary prevention, what are the benefits and risks of aspirin?
Included studies compared aspirin with no aspirin in primary or secondary prevention. Primary prevention trials had to include ⩾1000 patients who did not have diabetes and were scheduled for ⩾2 years of treatment. Secondary prevention trials included patients with previous myocardial infarction (MI), stroke, or transient cerebral ischaemia. Outcomes were serious vascular events (composite end point of non-fatal MI, stroke, or vascular death) and major extracranial bleeding.
Individual patient data meta-analysis of 6 randomised controlled trials (RCTs) (n = 95 456) of primary prevention and 16 RCTs (n = 17 029) of secondary prevention.
Meta-analysis of primary prevention RCTs showed that aspirin reduced serious vascular events and non-fatal MI but did not reduce stroke or vascular death, and increased major bleeding (table). In secondary prevention, aspirin led to a greater reduction of serious vascular events, MI, …
Source of funding: UK Medical Research Council; British Heart Foundation; Cancer Research UK; European Community Biomed Programme.