Brief report
Analysis of Risk of Bleeding Complications After Different Doses of Aspirin in 192,036 Patients Enrolled in 31 Randomized Controlled Trials

https://doi.org/10.1016/j.amjcard.2005.01.049Get rights and content

We sought to compare the risk of hemorrhage due to the low (<100 mg), moderate (100 to 200 mg), and high (>200 mg) doses of aspirin (acetylsalicylic acid [ASA]) in 192,036 patients enrolled in 31 clinical trials. Despite substantial differences in the reporting patterns of bleeding complications, low-dose ASA was associated with the lowest risk, and moderate doses caused a relatively high hemorrhagic event rate, especially with regard to minor, gastrointestinal, and total bleeding, and stroke. These findings should be considered when using combination antiplatelets, anticoagulant therapy, or both, with ASA, especially with the daily dose of >100 mg.

References (39)

  • Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients

    BMJ

    (2002)
  • An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction

    N Engl J Med

    (1993)
  • A comparison of two doses of aspirin (30 mg vs. 283 mg a day) in patients after a transient ischemic attack or minor ischemic stroke

    N Engl J Med

    (1991)
  • Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk

    Lancet

    (1998)
  • Swedish Aspirin Low-dose Trial (SALT) of 75 mg aspirin as secondary prophylaxis after cerebrovascular ischaemic events

    Lancet

    (1991)
  • Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice

    Lancet

    (2001)
  • Randomized trial of aspirin, sibrafiban, or both for secondary prevention after acute coronary syndromes

    Circulation

    (2001)
  • Comparison of sibrafiban with aspirin for prevention of cardiovascular events after acute coronary syndromes: a randomized trial

    Lancet

    (2000)
  • Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial

    Lancet

    (2000)
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      Furthermore, Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent Events/Optimal Antiplatelet Strategy for Interventions (CURRENT-OASIS 7)14 did not show any difference with respect to primary endpoint of cardiovascular death, myocardial infarction (MI), or stroke based on ASA dosing. Similar results are also seen in meta-analysis involving 31 trials15 as well as in subgroup analysis involving Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS AMI)16 and Treatment With Adenosine Diphosphate (ADP) Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome (TRANSLATE ACS)17 trials, which showed similar reductions in cardiovascular events with high- or low-dose aspirin and similar or greater risks of bleeding with higher doses of ASA. In summary, based on the clinical trial data, current ACC/AHA guidelines recommend ASA 81-325 mg indefinitely after percutaneous coronary intervention (PCI; Class I, Level of Evidence [LOE] A).

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    Drs. Serebruany and Topol are consultants for McNeil Consumer & Specialty Pharmaceuticals. This study was not funded by McNeil.

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