Clinical use of evidence-based medicine--clinical questions. Is low-dose aspirin a better choice in patients with coronary artery disease and bleeding risks?
This post-hoc analysis of the large, randomized controlled trial (CURE trial) shows a statistically significant increase in the risk of primary end points including CVA, cardiovascular death, and myocardial infarction with the use of high-dose aspirin therapy. Additionally, there was an increased incidence of major and life-threatening bleeding events in the high-dose aspirin group. This study should be interpreted with caution given its significant limitations: patients were not randomized based on ASA dose; patients and doctors were not blinded to the ASA dosage; study population groups were not equal at baseline; groups were treated differently depending on geographic location. Finally, given the nature of a cohort study, we would hope to see a larger magnitude of treatment effect to overcome the unknown confounding variables. There is currently no high quality evidence on the risk of bleeding with high-dose ASA versus low-dose ASA. The current evidence does not support using high-dose ASA therapy in patients with known coronary artery disease and a history of gastrointestinal bleeding.
Hsu
Jennifer
J
Department of Internal Medicine, University of Wisconsin Hospital and Clinics, USA.
Pack
Quinn
Q
Feldstein
David A
DA
D001241:Aspirin / Q000008:administration & dosage*; D003327:Coronary Disease / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin