Daily aspirin no good for Primary prevention: European Heart Journal

USA: Daily use of aspirin does not reduce mortality in adults with cardiovascular disease, instead, causes additional major bleeding, according to a new study published in the European Heart Journal. The routine use of aspirin for primary prevention, hence, needs to be reconsidered.

The meta-analysis of 11 aspirin therapy clinical trials involved more than 157,000 healthy individuals. The analysis found that the drug does not reduce deaths, strokes and heart attacks. Low-dose aspirin users were 50 per cent more likely to have major bleeding compared vs non-user of aspirin.

Aspirin prevents the formation of blood clots that can reduce the risk of heart attack or stroke. But it can also be a hazard: blood that does not clot easily can raise the risk of a hemorrhagic stroke or internal bleeding.

The analysis affirms more broadly the findings of three large-scale, randomized clinical trials done elsewhere and published earlier this year. Like the current meta-analysis, those studies concluded that aspirin had no effect on death rates but caused more bleeding among otherwise heart-healthy patients. Some studies of aspirin’s potential cardiovascular benefits emerged in the 1980s but subsequent research revealed its limitations and potential hazards.

Because much of the aspirin therapy data come from very old studies that may have less relevance to current practice, a new, in-depth analysis was needed, said Anthony A. Bavry, M.D., an associate professor in the UF College of Medicine’s Department of Medicine.

To establish their findings, Bavry and his collaborators parsed mortality and other data on strokes, heart attacks and bleeding from the earlier studies. All-cause mortality was similar between aspirin and non-aspirin users who had no prior cardiovascular events (i.e., otherwise healthy individuals), which researchers said shows that the drug has no effect on death rates. Aspirin use also increased the incidence of major bleeding compared with non-users, the researchers found. Major bleeding was defined as blood loss that required hospitalization, surgery or transfusion, as well as all brain-related bleeding.

The research team closely scrutinized data from the 11 trials, looking for even small reductions in death and other risks associated with aspirin use.

Despite aspirin’s entrenched status as a cornerstone medication, the most recent clinical studies, and the UF Health-led meta-analysis make a strong case about the drug’s risks and lack of benefits among certain patients, Bavry said.

“Many professionals have a hard time believing that aspirin may not be so beneficial because there has been such a widespread and favorable view of this medication. This certainly does not settle the debate but it does call for a reappraisal of society’s overwhelmingly positive view of aspirin therapy,” he said.

Patients who are on a daily aspirin regimen or considering it for cardiovascular issues should talk to their healthcare provider to help them balance potential risks and benefits, Bavry said.

For further reference log on to https://doi.org/10.1093/eurheartj/ehy813