Moment of truth for aspirin use in variant angina: a meta-analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P Sousa ◽  
L Puga ◽  
J Lopes ◽  
C Saleiro ◽  
R Gomes ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Low Dose ◽  
Hospital Admissions ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Variant Angina ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
All Cause Mortality ◽  
Revascularization Procedures

Abstract Background Aspirin has been a mainstay of antiplatelet therapy for coronary artery disease (CAD). However, in the context of variant angina (VA), high-dose aspirin was reported to exacerbate coronary spasms. Consequently, the value of traditional low-dose aspirin in VA, especially if not associated with atherosclerotic CAD, may be disputed. Purpose To perform a meta-analysis aimed at evaluating the extent to which low-dose aspirin therapy influences cardiovascular (CV) prognosis in VA. Methods We systematically searched MEDLINE, Embase, Web of Science, Cochrane Library and Google Scholar for studies addressing the long-term impact of low-dose aspirin on main CV outcomes of VA patients, published up until February 1, 2020. The primary endpoint was all-cause mortality, whereas secondary endpoints included CV mortality, acute coronary syndrome (ACS) events, revascularization procedures and hospital admissions for angina. The subgroup of patients with no significant epicardial CAD was further investigated separately, underneath similar outcomes. Study-specific odds ratios (ORs) were pooled using traditional meta-analytic techniques, under a random-effects model. Results One prospective multicenter and two retrospective single-center studies, encompassing 1652 and 1164 patients, respectively, were regarded as eligible for quantitative evaluation. Median follow-up ranged between 12 and 52.1 months. 1284 patients were allocated to the aspirin arm and 2770 had no epicardial CAD. Absolute number of events for each endpoint may be reported as follows: all-cause mortality, 33; CV mortality, 11; ACS, 57; revascularization, 14; hospital admission for angina, 218. Aspirin was not found to reduce neither all-cause mortality (OR 0.78, 95% CI 0.38–1.58, p=0.49, i2=0%), nor CV mortality (OR 0.98, 95% CI 0.30–3.25, p=0.98, i2=0%), nor ACS events (OR 1.44, 95% CI 0.51–4.10, p=0.49, i2=47%), nor revascularization procedures (OR 2.06, 95% CI 0.63–6.75, p=0.23, i2=0%), nor hospital admissions for angina (OR 1.60, 95% CI 0.67–3.80, p=0.29, i2=86%). Likewise, this comprehensively neutral effect held true in those with VA and no significant atherosclerotic CAD (OR 1.04, 95% CI 0.28–3.92, p=0.95, i2=0%, for CV mortality; OR 1.29, 95% CI 0.19–8.94, p=0.79, i2=33%, for revascularization; OR 1.73, 95% CI 0.81–3.73, p=0.16, i2=75%, for hospital admission for angina). Conclusion Even though scarce, currently available evidence suggests that low-dose aspirin is not effective in shrinking major adverse cardiovascular events in VA patients, particularly in those with no epicardial CAD. On the other hand, lower doses of aspirin may avoid the menace of clinically significant coronary spasms. Funding Acknowledgement Type of funding source: None

scholarly journals The Risk of Gastrointestinal Hemorrhage in Low-Dose Aspirin Users with Diabetes Mellitus: Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Yashuo Wang ◽  
Wei Wang ◽  
Bin Wang ◽  
Yunyang Wang
Keyword(s):  
Diabetes Mellitus ◽  
Low Dose ◽  
Meta Analysis ◽  
Quality Data ◽  
Cochrane Library ◽  
Knowledge Infrastructure ◽  
Dose Aspirin ◽  
Increased Risk ◽  
Low Dose Aspirin ◽  
Patients With Diabetes

Background. Our aim was to assess the risk of gastrointestinal (GI) hemorrhage associated with diabetes among patients taking low-dose aspirin (≤325 mg/day). Methods. A systematic search was conducted for publication in English and Chinese using term equivalents for “GI hemorrhage”, “aspirin”, and “diabetes mellitus” up till April 2020. Electronic databases include PUBMED, EMBASE, Cochrane Library databases, Chinese National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP Database. Two independent authors searched databases and reviewed abstracts for comprehensive studies keeping adequate study quality. Data of weighted odds ratios were statistically evaluated and potential bias was checked. Results. Among 446 publications, eight case-control researches, including 1601 patients, were deemed for this meta-analysis. Patients with diabetes were associated with a higher risk of GI hemorrhage than patients without diabetes: the summary ORs were 3.10 (95% CI, 2.35–4.09). The heterogeneity of the reports was not significant (Chi2=3.39, P=0.85; I2=0%). Conclusion. The meta-analysis showed that aspirin users with diabetes were more likely to have GI hemorrhage. Hence, when treating diabetics with aspirin, the increased risk of GI bleeding should be taken in consideration.

scholarly journals Rationales and uncertainties for aspirin use in COVID-19: a narrative review

2021 ◽  
Vol 9 (2) ◽  
pp. e000741
Author(s):  
Hazem A Sayed Ahmed ◽  
Eric Merrell ◽  
Mansoura Ismail ◽  
Anwar I Joudeh ◽  
Jeffrey B Riley ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Low Dose ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Narrative Review ◽  
Cochrane Library ◽  
Atherosclerotic Cardiovascular Disease ◽  
Dose Aspirin ◽  
Hospitalised Patients ◽  
Low Dose Aspirin

ObjectivesTo review the pathophysiology of COVID-19 disease, potential aspirin targets on this pathogenesis and the potential role of aspirin in patients with COVID-19.DesignNarrative review.SettingThe online databases PubMed, OVID Medline and Cochrane Library were searched using relevant headlines from 1 January 2016 to 1 January 2021. International guidelines from relevant societies, journals and forums were also assessed for relevance.ParticipantsNot applicable.ResultsA review of the selected literature revealed that clinical deterioration in COVID-19 is attributed to the interplay between endothelial dysfunction, coagulopathy and dysregulated inflammation. Aspirin has anti-inflammatory effects, antiplatelet aggregation, anticoagulant properties as well as pleiotropic effects on endothelial function. During the COVID-19 pandemic, low-dose aspirin is used effectively in secondary prevention of atherosclerotic cardiovascular disease, prevention of venous thromboembolism after total hip or knee replacement, prevention of pre-eclampsia and postdischarge treatment for multisystem inflammatory syndrome in children. Prehospital low-dose aspirin therapy may reduce the risk of intensive care unit admission and mechanical ventilation in hospitalised patients with COVID-19, whereas aspirin association with mortality is still debatable.ConclusionThe authors recommend a low-dose aspirin regimen for primary prevention of arterial thromboembolism in patients aged 40–70 years who are at high atherosclerotic cardiovascular disease risk, or an intermediate risk with a risk-enhancer and have a low risk of bleeding. Aspirin’s protective roles in COVID-19 associated with acute lung injury, vascular thrombosis without previous cardiovascular disease and mortality need further randomised controlled trials to establish causal conclusions.

scholarly journals Helicobacter pylori and low-dose aspirin ulcer risk: A meta-analysis

2018 ◽  
Vol 34 (3) ◽  
pp. 517-525 ◽  
Author(s):  
Gino L Sarri ◽  
Sam E Grigg ◽  
Neville D Yeomans
Keyword(s):  
Helicobacter Pylori ◽  
Low Dose ◽  
Meta Analysis ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals Early Administration of Low-Dose Aspirin for the Prevention of Preterm and Term Preeclampsia: A Systematic Review and Meta-Analysis

2012 ◽  
Vol 31 (3) ◽  
pp. 141-146 ◽  
Author(s):  
Stéphanie Roberge ◽  
Pia Villa ◽  
Kypros Nicolaides ◽  
Yves Giguère ◽  
Merja Vainio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Dose ◽  
Meta Analysis ◽  
Early Administration ◽  
Dose Aspirin ◽  
Low Dose Aspirin

scholarly journals What dose of aspirin should be used in the initial treatment of Kawasaki disease? A meta-analysis

Rheumatology ◽  
2020 ◽  
Vol 59 (8) ◽  
pp. 1826-1833
Author(s):  
Xinyi Jia ◽  
Xiao Du ◽  
Shuxian Bie ◽  
Xiaobing Li ◽  
Yunguang Bao ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Random Effects ◽  
Initial Treatment ◽  
Low Dose ◽  
Cochrane Library ◽  
High Dose ◽  
Random Effects Model ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
High Dose Aspirin

Abstract Objective The use of IVIG plus high- or low-dose aspirin for the initial treatment of Kawasaki disease remains controversial. The aim of this study was to evaluate the efficacy of IVIG plus high-dose aspirin compared with IVIG plus low-dose aspirin in the treatment of Kawasaki disease. Methods Studies related to aspirin therapy for Kawasaki disease were selected by searching the databases of Medline (PubMed), Embase and the Cochrane Library before March 2019. Statistical analyses were performed by using a Review Manager Software package and STATA v.15.1. Results Eight retrospective cohort studies, characterizing 12 176 patients, were analysed. Overall, no significant difference was found in the incidence of coronary artery abnormalities between the high- and low-dose aspirin groups [relative risk (RR) 1.15; 95% CI: 0.93, 1.43; P = 0.19; random-effects model]. The patients treated with high-dose aspirin had slightly faster resolution of fever [mean difference (MD) −0.30; 95% CI: −0.58, −0.02; P = 0.04; random-effects model]. but the rates of IVIG resistance (RR, 1.26; 95% CI: 0.55, 2.92; P = 0.59; random-effects model) and days in hospital (MD, 0.22; 95% CI: −0.93, 1.37; P = 0.71; random-effects model) were similar between the two groups. Conclusion Low-dose aspirin plus IVIG might be as effective as high-dose aspirin plus IVIG for the initial treatment of Kawasaki disease. Considering that high-dose aspirin may cause more adverse reactions than low-dose aspirin, low-dose aspirin plus IVIG should be recommended as the first-line therapy in the initial treatment of Kawasaki disease.

Aspirin for primary prevention in diabetes mellitus: from the calculation of cardiovascular risk and risk/benefit profile to personalised treatment

2015 ◽  
Vol 114 (11) ◽  
pp. 876-882 ◽  
Author(s):  
Francesca Santilli ◽  
Pasquale Pignatelli ◽  
Francesco Violi ◽  
Giovanni Davì
Keyword(s):  
Diabetes Mellitus ◽  
Primary Prevention ◽  
Low Dose ◽  
Meta Analysis ◽  
Individual Variability ◽  
Vascular Events ◽  
Dose Aspirin ◽  
Low Dose Aspirin ◽  
Personalised Treatment ◽  
Cox 1

SummaryType 2 diabetes mellitus is characterised by persistent thromboxane (TX)-dependent platelet activation, regardless of disease duration. Low-dose aspirin, that induces a permanent inactivation of platelet cyclooxygenase (COX)-1, thus inhibiting TXA2 biosynthesis, should be theoretically considered the drug of choice. The most up-to-date meta-analysis of aspirin prophylaxis in this setting, which includes three trials conducted in patients with diabetes and six other trials in which such patients represent a subgroup within a broader population, reported that aspirin is associated with a non-significant decrease in the risk of vascular events, although the limited amount of available data precludes a precise estimate of the effect size. An increasing body of evidence supports the concept that less-than-expected response to aspirin may underlie mechanisms related to residual platelet hyper-reactivity despite anti-platelet treatment, at least in a fraction of patients. Among the proposed mechanisms, the variable turnover rate of the drug target (platelet COX-1) appears to represent the most convincing determinant of the inter-individual variability in aspirin response. This review intends to develop the idea that the understanding of the determinants of less-than-adequate response to aspirin in certain individuals, although not changing the paradigm of the indication to low-dose aspirin prescription in primary prevention, may help identifying, in terms of easily detectable clinical or biochemical characteristics, individuals who would attain inadequate protection from aspirin, and for whom different strategies should be challenged.

Sign in / Sign up

Export Citation Format

Share Document