Debabrata Mukherjee, MD, MS
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 ischemia. Outcomes were serious vascular events (composite endpoint of nonfatal MI, stroke, or vascular death) and major extracranial bleeding.
Individual patient data meta-analysis of 6 randomized 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 nonfatal 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, stroke, and vascular death but increased major bleeding (Table).
Aspirin reduces serious vascular events in primary and secondary prevention but increases major bleeding and is of uncertain net benefit in primary prevention.
Aspirin vs no aspirin (control) in primary and secondary prevention*
*MI = myocardial infarction; other abbreviations defined in Glossary. RRR, RRI, and CI calculated from relative risks in article.
†Composite endpoint of MI, stroke, or vascular death.
Mukherjee D. Review: Aspirin reduces vascular events but increases bleeding in primary and secondary prevention. Ann Intern Med. ;151:JC3–4. doi: 10.7326/0003-4819-151-6-200909150-02004
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Published: Ann Intern Med. 2009;151(6):JC3-4.
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