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Association of Adding #Aspirin to #Warfarin Therapy Without an Apparent Indication With Bleeding and Other Adverse Events
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2726050
At 1 year, patients receiving combination warfarin and aspirin compared with those receiving warfarin only had higher rates of overall bleeding (cumulative incidence, 26.0%; 95% CI, 23.8%-28.3% vs 20.3%; 95% CI, 18.3%-22.3%; P < .001), major bleeding (5.7%; 95% CI, 4.6%-7.1% vs 3.3%; 95% CI, 2.4%-4.3%; P < .001), emergency department visits for bleeding (13.3%; 95% CI, 11.6%-15.1% vs 9.8%; 95% CI, 8.4%-11.4%; P = .001), and hospitalizations for bleeding (8.1%; 6.8%-9.6% vs 5.2%; 4.1%-6.4%; P = .001). Rates of thrombosis were similar
Conclusions and Relevance Compared with warfarin monotherapy, receipt of combination warfarin and aspirin therapy was associated with increased bleeding and similar observed rates of thrombosis. Further research is needed to better stratify which patients may benefit from aspirin while anticoagulated with warfarin for atrial fibrillation or venous thromboembolism; clinicians should be judicious in selecting patients for combination therapy
Association of Adding #Aspirin to #Warfarin Therapy Without an Apparent Indication With Bleeding and Other Adverse Events
https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2726050
At 1 year, patients receiving combination warfarin and aspirin compared with those receiving warfarin only had higher rates of overall bleeding (cumulative incidence, 26.0%; 95% CI, 23.8%-28.3% vs 20.3%; 95% CI, 18.3%-22.3%; P < .001), major bleeding (5.7%; 95% CI, 4.6%-7.1% vs 3.3%; 95% CI, 2.4%-4.3%; P < .001), emergency department visits for bleeding (13.3%; 95% CI, 11.6%-15.1% vs 9.8%; 95% CI, 8.4%-11.4%; P = .001), and hospitalizations for bleeding (8.1%; 6.8%-9.6% vs 5.2%; 4.1%-6.4%; P = .001). Rates of thrombosis were similar
Conclusions and Relevance Compared with warfarin monotherapy, receipt of combination warfarin and aspirin therapy was associated with increased bleeding and similar observed rates of thrombosis. Further research is needed to better stratify which patients may benefit from aspirin while anticoagulated with warfarin for atrial fibrillation or venous thromboembolism; clinicians should be judicious in selecting patients for combination therapy
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Frequency of Intracranial #Hemorrhage With Low-Dose #Aspirin in Individuals Without Symptomatic Cardiovascular Disease
https://jamanetwork.com/journals/jamaneurology/article-abstract/2732929
Use of low-dose aspirin for the primary prevention of cardiovascular events remains controversial because increased risk of bleeding may offset the overall benefit. Among major bleeding events, intracranial hemorrhage is associated with high mortality rates and functional dependency
Pooling the results from the random-effects model showed that low-dose aspirin, compared with control, was associated with an increased risk of any intracranial bleeding (8 trials; relative risk, 1.37; 95% CI, 1.13-1.66; 2 additional intracranial hemorrhages in 1000 people), with potentially the greatest relative risk increase for subdural or extradural hemorrhage (4 trials; relative risk, 1.53; 95% CI, 1.08-2.18) and less for intracerebral hemorrhage and subarachnoid hemorrhage. Patient baseline features associated with heightened risk of intracerebral hemorrhage with low-dose aspirin, compared with control, were Asian race/ethnicity and low body mass index.
Conclusions and Relevance Among people without symptomatic cardiovascular disease, use of low-dose aspirin was associated with an overall increased risk of intracranial hemorrhage, and heightened risk of intracerebral hemorrhage for those of Asian race/ethnicity or people with a low body mass index.
Frequency of Intracranial #Hemorrhage With Low-Dose #Aspirin in Individuals Without Symptomatic Cardiovascular Disease
https://jamanetwork.com/journals/jamaneurology/article-abstract/2732929
Use of low-dose aspirin for the primary prevention of cardiovascular events remains controversial because increased risk of bleeding may offset the overall benefit. Among major bleeding events, intracranial hemorrhage is associated with high mortality rates and functional dependency
Pooling the results from the random-effects model showed that low-dose aspirin, compared with control, was associated with an increased risk of any intracranial bleeding (8 trials; relative risk, 1.37; 95% CI, 1.13-1.66; 2 additional intracranial hemorrhages in 1000 people), with potentially the greatest relative risk increase for subdural or extradural hemorrhage (4 trials; relative risk, 1.53; 95% CI, 1.08-2.18) and less for intracerebral hemorrhage and subarachnoid hemorrhage. Patient baseline features associated with heightened risk of intracerebral hemorrhage with low-dose aspirin, compared with control, were Asian race/ethnicity and low body mass index.
Conclusions and Relevance Among people without symptomatic cardiovascular disease, use of low-dose aspirin was associated with an overall increased risk of intracranial hemorrhage, and heightened risk of intracerebral hemorrhage for those of Asian race/ethnicity or people with a low body mass index.
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Daily #aspirin use associated with reduced risk for fibrosis progression in patients with nonalcoholic fatty #liver disease
https://www.cghjournal.org/article/S1542-3565(19)30493-8/fulltext
Compared with non-regular use, daily aspirin use was associated with significantly lower odds of NASH (adjusted odds ratio, 0.68; 95% CI, 0.37–0.89) and fibrosis (adjusted odds ratio, 0.54; 95% CI, 0.31–0.82). Among individuals with baseline F0–F2 fibrosis (n=317), 86 developed advanced fibrosis over 3692 person-years. Daily aspirin users had significantly lower risk for developing incident advanced fibrosis vs non-regular users (adjusted hazard ratio aHR, 0.63; 95% CI. 0.43–0.85). This relationship appeared to be duration dependent (adjusted P trend=.026), with the greatest benefit found with at least 4 years or more of aspirin use (aHR, 0.50; 95% CI, 0.35–0.73). Conversely, use of nonaspirin NSAIDs was not associated with risk for advanced fibrosis (aHR, 0.93; 95% CI, 0.81–1.05).
Conclusions
In a prospective study of patients with biopsy-proven NAFLD, daily aspirin use was associated with less severe histologic features of NAFLD and NASH, and lower risk for progression to advanced fibrosis with time.
Daily #aspirin use associated with reduced risk for fibrosis progression in patients with nonalcoholic fatty #liver disease
https://www.cghjournal.org/article/S1542-3565(19)30493-8/fulltext
Compared with non-regular use, daily aspirin use was associated with significantly lower odds of NASH (adjusted odds ratio, 0.68; 95% CI, 0.37–0.89) and fibrosis (adjusted odds ratio, 0.54; 95% CI, 0.31–0.82). Among individuals with baseline F0–F2 fibrosis (n=317), 86 developed advanced fibrosis over 3692 person-years. Daily aspirin users had significantly lower risk for developing incident advanced fibrosis vs non-regular users (adjusted hazard ratio aHR, 0.63; 95% CI. 0.43–0.85). This relationship appeared to be duration dependent (adjusted P trend=.026), with the greatest benefit found with at least 4 years or more of aspirin use (aHR, 0.50; 95% CI, 0.35–0.73). Conversely, use of nonaspirin NSAIDs was not associated with risk for advanced fibrosis (aHR, 0.93; 95% CI, 0.81–1.05).
Conclusions
In a prospective study of patients with biopsy-proven NAFLD, daily aspirin use was associated with less severe histologic features of NAFLD and NASH, and lower risk for progression to advanced fibrosis with time.
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Personalized Prediction of #Cardiovascular Benefits and Bleeding Harms From #Aspirin for Primary Prevention: A Benefit–Harm Analysis
https://annals.org/aim/article-abstract/2751452/personalized-prediction-cardiovascular-benefits-bleeding-harms-from-aspirin-primary-prevention
2.5% of women and 12.1% of men were likely to have a net benefit from aspirin treatment for 5 years if 1 CVD event was assumed to be equivalent in severity to 1 major bleed, increasing to 21.4% of women and 40.7% of men if 1 CVD event was assumed to be equivalent to 2 major bleeds. Net benefit subgroups had higher baseline CVD risk, higher levels of most established CVD risk factors, and lower levels of bleeding-specific risk factors than net harm subgroups.
For some persons without CVD, aspirin is likely to result in net benefit
Personalized Prediction of #Cardiovascular Benefits and Bleeding Harms From #Aspirin for Primary Prevention: A Benefit–Harm Analysis
https://annals.org/aim/article-abstract/2751452/personalized-prediction-cardiovascular-benefits-bleeding-harms-from-aspirin-primary-prevention
2.5% of women and 12.1% of men were likely to have a net benefit from aspirin treatment for 5 years if 1 CVD event was assumed to be equivalent in severity to 1 major bleed, increasing to 21.4% of women and 40.7% of men if 1 CVD event was assumed to be equivalent to 2 major bleeds. Net benefit subgroups had higher baseline CVD risk, higher levels of most established CVD risk factors, and lower levels of bleeding-specific risk factors than net harm subgroups.
For some persons without CVD, aspirin is likely to result in net benefit
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#Ticagrelor with or without #Aspirin in High-Risk Patients after #PCI
https://www.nejm.org/doi/full/10.1056/NEJMoa1908419
Monotherapy with a P2Y12 inhibitor after a minimum period of dual antiplatelet therapy is an emerging approach to reduce the risk of bleeding after percutaneous coronary intervention (PCI).
..The difference in risk between the groups was similar for BARC type 3 or 5 bleeding (incidence, 1.0% among patients receiving ticagrelor plus placebo and 2.0% among patients receiving ticagrelor plus aspirin; hazard ratio, 0.49; 95% CI, 0.33 to 0.74). The incidence of death from any cause, nonfatal myocardial infarction, or nonfatal stroke was 3.9% in both groups (difference, −0.06 percentage points; 95% CI, −0.97 to 0.84; hazard ratio, 0.99; 95% CI, 0.78 to 1.25; P<0.001 for noninferiority).
CONCLUSIONS
Among high-risk patients who underwent PCI and completed 3 months of dual antiplatelet therapy, ticagrelor monotherapy was associated with a lower incidence of clinically relevant bleeding than ticagrelor plus aspirin, with no higher risk of death, myocardial infarction, or stroke
#Ticagrelor with or without #Aspirin in High-Risk Patients after #PCI
https://www.nejm.org/doi/full/10.1056/NEJMoa1908419
Monotherapy with a P2Y12 inhibitor after a minimum period of dual antiplatelet therapy is an emerging approach to reduce the risk of bleeding after percutaneous coronary intervention (PCI).
..The difference in risk between the groups was similar for BARC type 3 or 5 bleeding (incidence, 1.0% among patients receiving ticagrelor plus placebo and 2.0% among patients receiving ticagrelor plus aspirin; hazard ratio, 0.49; 95% CI, 0.33 to 0.74). The incidence of death from any cause, nonfatal myocardial infarction, or nonfatal stroke was 3.9% in both groups (difference, −0.06 percentage points; 95% CI, −0.97 to 0.84; hazard ratio, 0.99; 95% CI, 0.78 to 1.25; P<0.001 for noninferiority).
CONCLUSIONS
Among high-risk patients who underwent PCI and completed 3 months of dual antiplatelet therapy, ticagrelor monotherapy was associated with a lower incidence of clinically relevant bleeding than ticagrelor plus aspirin, with no higher risk of death, myocardial infarction, or stroke
The New England Journal of Medicine
Ticagrelor with or without Aspirin in High-Risk Patients after PCI | NEJM
Monotherapy with a P2Y12 inhibitor after a minimum period of dual antiplatelet therapy
is an emerging approach to reduce the risk of bleeding after percutaneous coronary
intervention (PCI). In a do...
is an emerging approach to reduce the risk of bleeding after percutaneous coronary
intervention (PCI). In a do...
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#Aspirin for primary #prevention of cardiovascular disease: a meta-analysis with a particular focus on subgroups
..major adverse cardiovascular events (MACE)
..Aspirin use did not translate into a net clinical benefit adjusted for event-associated mortality risk (mean 0.034%; 95% CI, − 0.18 to 0.25%). There was an interaction for aspirin effect in three patient subgroups: (i) in patients under statin treatment, aspirin was associated with a 12% RRR of MACE (RR 0.88; 95% CI, 0.80–0.96), and this effect was lacking in the no-statin group; (ii) in non-smokers, aspirin was associated with a 10% RRR of MACE (RR 0.90; 95% CI, 0.82–0.99), and this effect was not present in smokers; and (iii) in males, aspirin use resulted in a 11% RRR of MACE (RR 0.89; 95% CI, 0.83–0.95), with a non-significant effect in females.
Conclusions
Aspirin use does not reduce all-cause or cardiovascular mortality and results in an insufficient benefit-risk ratio for CVD primary prevention. Non-smokers, patients treated with statins, and males had the greatest risk reduction of MACE across subgroups.
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1428-0
#Aspirin for primary #prevention of cardiovascular disease: a meta-analysis with a particular focus on subgroups
..major adverse cardiovascular events (MACE)
..Aspirin use did not translate into a net clinical benefit adjusted for event-associated mortality risk (mean 0.034%; 95% CI, − 0.18 to 0.25%). There was an interaction for aspirin effect in three patient subgroups: (i) in patients under statin treatment, aspirin was associated with a 12% RRR of MACE (RR 0.88; 95% CI, 0.80–0.96), and this effect was lacking in the no-statin group; (ii) in non-smokers, aspirin was associated with a 10% RRR of MACE (RR 0.90; 95% CI, 0.82–0.99), and this effect was not present in smokers; and (iii) in males, aspirin use resulted in a 11% RRR of MACE (RR 0.89; 95% CI, 0.83–0.95), with a non-significant effect in females.
Conclusions
Aspirin use does not reduce all-cause or cardiovascular mortality and results in an insufficient benefit-risk ratio for CVD primary prevention. Non-smokers, patients treated with statins, and males had the greatest risk reduction of MACE across subgroups.
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-019-1428-0
BioMed Central
Aspirin for primary prevention of cardiovascular disease: a meta-analysis with a particular focus on subgroups - BMC Medicine
Background The role of aspirin in primary prevention of cardiovascular disease (CVD) remains unclear. We aimed to investigate the benefit-risk ratio of aspirin for primary prevention of CVD with a particular focus on subgroups. Methods Randomized controlled…
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Low‐Dose #Aspirin for Primary Prevention of #Cardiovascular Disease: Use Patterns and Impact Across Race and Ethnicity in the Southern Community Cohort Study
..Over a median follow‐up of 11.3 years, low‐dose aspirin use was associated with a trend toward decreased risk of ischemic cardiac death in white participants (adjusted hazard ratio: 0.86; 95% CI, 0.68–1.10), especially in women (adjusted hazard ratio: 0.72; 95% CI, 0.51–1.02), but not in black participants (adjusted hazard ratio: 1.18; 95% CI, 0.98–1.40). Similar trends were observed when the analysis was restricted to high‐risk individuals aged 50 to 69 or 50 to 59 years, ages for which guidelines consider aspirin for CVD primary prevention.
Conclusions
Low‐dose aspirin use for primary prevention of CVD is lower among black than white patients. Its use might be associated with a disparate impact on ischemic cardiac death according to race and ethnicity. Although additional studies are required, these findings provide no evidence of a beneficial effect of aspirin among black patients for CVD primary prevention.
https://bit.ly/38rArAl
Low‐Dose #Aspirin for Primary Prevention of #Cardiovascular Disease: Use Patterns and Impact Across Race and Ethnicity in the Southern Community Cohort Study
..Over a median follow‐up of 11.3 years, low‐dose aspirin use was associated with a trend toward decreased risk of ischemic cardiac death in white participants (adjusted hazard ratio: 0.86; 95% CI, 0.68–1.10), especially in women (adjusted hazard ratio: 0.72; 95% CI, 0.51–1.02), but not in black participants (adjusted hazard ratio: 1.18; 95% CI, 0.98–1.40). Similar trends were observed when the analysis was restricted to high‐risk individuals aged 50 to 69 or 50 to 59 years, ages for which guidelines consider aspirin for CVD primary prevention.
Conclusions
Low‐dose aspirin use for primary prevention of CVD is lower among black than white patients. Its use might be associated with a disparate impact on ischemic cardiac death according to race and ethnicity. Although additional studies are required, these findings provide no evidence of a beneficial effect of aspirin among black patients for CVD primary prevention.
https://bit.ly/38rArAl
www.ahajournals.org
Low‐Dose Aspirin for Primary Prevention of Cardiovascular Disease: Use Patterns and Impact Across Race and Ethnicity in the Southern…
Background Data are limited on use patterns of low‐dose aspirin and its role for primary prevention of cardiovascular disease (CVD) in different racial and ethnic groups. Methods and Results Overal...
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#Aspirin and #fracture risk: a systematic review and exploratory meta-analysis of observational studies
This review provides insights into the potential for aspirin to preserve bone mineral density (BMD) and reduce fracture risk, building knowledge of the risk-benefit profile of aspirin.
..Aspirin use was associated with a 17% lower odds for any fracture (OR 0.83, 95% CI 0.70 to 0.99; I2=71%; six studies; n=511 390). Aspirin was associated with a higher total hip BMD for women (SMD 0.03, 95% CI −0.02 to 0.07; I2=0%; three studies; n=9686) and men (SMD 0.06, 95% CI −0.02 to 0.13, I2=0%; two studies; n=4137) although these associations were not significant. Similar results were observed for lumbar spine BMD in women (SMD 0.03, 95% CI −0.03 to 0.09; I2=34%; four studies; n=11 330) and men (SMD 0.08; 95% CI −0.01 to 0.18; one study; n=432).
Conclusions While the benefits of reduced fracture risk and higher BMD from aspirin use may be modest for individuals, if confirmed in prospective controlled trials, they may confer a large population benefit given the common use of aspirin in older people.
https://bit.ly/2VnYufh
#Aspirin and #fracture risk: a systematic review and exploratory meta-analysis of observational studies
This review provides insights into the potential for aspirin to preserve bone mineral density (BMD) and reduce fracture risk, building knowledge of the risk-benefit profile of aspirin.
..Aspirin use was associated with a 17% lower odds for any fracture (OR 0.83, 95% CI 0.70 to 0.99; I2=71%; six studies; n=511 390). Aspirin was associated with a higher total hip BMD for women (SMD 0.03, 95% CI −0.02 to 0.07; I2=0%; three studies; n=9686) and men (SMD 0.06, 95% CI −0.02 to 0.13, I2=0%; two studies; n=4137) although these associations were not significant. Similar results were observed for lumbar spine BMD in women (SMD 0.03, 95% CI −0.03 to 0.09; I2=34%; four studies; n=11 330) and men (SMD 0.08; 95% CI −0.01 to 0.18; one study; n=432).
Conclusions While the benefits of reduced fracture risk and higher BMD from aspirin use may be modest for individuals, if confirmed in prospective controlled trials, they may confer a large population benefit given the common use of aspirin in older people.
https://bit.ly/2VnYufh
BMJ Open
Aspirin and fracture risk: a systematic review and exploratory meta-analysis of observational studies
Objectives This review provides insights into the potential for aspirin to preserve bone mineral density (BMD) and reduce fracture risk, building knowledge of the risk-benefit profile of aspirin.
Methods We conducted a systematic review and exploratory meta…
Methods We conducted a systematic review and exploratory meta…
Clinical Effectiveness and Safety of #Aspirin for Venous #Thromboembolism Prophylaxis After Total Hip and Knee Replacement
https://2medical.news/2020/03/12/clinical-effectiveness-and-safety-of-aspirin-for-venous-thromboembolism-prophylaxis-after-total-hip-and-knee-replacement/
Patients undergoing total hip replacement (THR) and total knee replacement (TKR) receive venous thromboembolism (VTE) pharmacoprophylaxis. It is unclear which anticoagulant is preferable. Observational data suggest aspirin provides effective VTE prophylaxis.. ..The RR of VTE after THR and TKR was 1.12 (95% CI, 0.78-1.62) for aspirin compared with other anticoagulants. Comparable findings were observed for deep vein thrombosis (DVT) (RR, 1.04; 95% CI, 0.72-1.51) and …
https://2medical.news/2020/03/12/clinical-effectiveness-and-safety-of-aspirin-for-venous-thromboembolism-prophylaxis-after-total-hip-and-knee-replacement/
Patients undergoing total hip replacement (THR) and total knee replacement (TKR) receive venous thromboembolism (VTE) pharmacoprophylaxis. It is unclear which anticoagulant is preferable. Observational data suggest aspirin provides effective VTE prophylaxis.. ..The RR of VTE after THR and TKR was 1.12 (95% CI, 0.78-1.62) for aspirin compared with other anticoagulants. Comparable findings were observed for deep vein thrombosis (DVT) (RR, 1.04; 95% CI, 0.72-1.51) and …
Clinical Influence of Nonadherence With Prophylactic #Aspirin in Preventing #Preeclampsia in High-Risk Pregnancies
https://2medical.news/2020/03/13/clinical-influence-of-nonadherence-with-prophylactic-aspirin-in-preventing-preeclampsia-in-high-risk-pregnancies/
..Women with inadequate adherence had higher incidence of early-onset preeclampsia (17% versus 2%; odds ratio [OR], 1.9 [95% CI, 1.1–8.7]; P=0.04), late-onset preeclampsia (41% versus 5%; OR, 4.2 [95% CI, 1.4–19.8]; P=0.04), intrauterine growth restriction (29% versus 5%; OR, 5.8; [95% CI, 1.2–8.3]; P=0.001), preterm delivery (27% versus 10%; OR, 5.2 [95% CI, 1.5–8.7]; P=0.008), and higher likelihood of increase in antihypertensives antenatally (60% versus …
https://2medical.news/2020/03/13/clinical-influence-of-nonadherence-with-prophylactic-aspirin-in-preventing-preeclampsia-in-high-risk-pregnancies/
..Women with inadequate adherence had higher incidence of early-onset preeclampsia (17% versus 2%; odds ratio [OR], 1.9 [95% CI, 1.1–8.7]; P=0.04), late-onset preeclampsia (41% versus 5%; OR, 4.2 [95% CI, 1.4–19.8]; P=0.04), intrauterine growth restriction (29% versus 5%; OR, 5.8; [95% CI, 1.2–8.3]; P=0.001), preterm delivery (27% versus 10%; OR, 5.2 [95% CI, 1.5–8.7]; P=0.008), and higher likelihood of increase in antihypertensives antenatally (60% versus …