title: Relation between aspirin dose, all-cause mortality, and bleeding in patients with recent cerebrovascular or coronary ischemic events (from the BRAVO Trial).
abstract: Despite aspirin's established role in the treatment of atherosclerotic vascular disease, considerable controversy exists regarding its most effective dosing strategy. In a retrospective observational study, we examined the relation between prescribed aspirin dose (<162 mg vs > or =162 mg/day aspirin) and clinical outcome in 4,589 placebo-treated patients enrolled in the Blockage of the Glycoprotein IIb/IIIa Receptor to Avoid Vascular Occlusion (BRAVO) trial over a median follow-up of 366 days. Standard Cox regression analysis was employed because propensity analysis was not feasible. Compared with lower aspirin doses, higher doses were associated with lower unadjusted all-cause mortality (2.9 vs 1.6%, respectively; log rank chi-square 8.6, p = 0.0034). Higher aspirin dose remained independently predictive of lower all-cause mortality in a multivariable Cox proportional hazards model (hazard ratio 0.64, 95% confidence interval 0.42 to 0.97, p = 0.037). However, there was no significant difference in the incidence of the composite endpoint death, nonfatal myocardial infarction, or nonfatal stroke (6.1% vs 6.2%, p = 0.74). Higher aspirin dose was a significant independent predictor of any (hazard ratio 1.32, 95% confidence interval 1.12 to 1.55, p = 0.001) but not serious bleeding. In conclusion, our findings suggest that aspirin doses of > or =162 mg/day may be more beneficial than those <162 mg/day at preventing death.
authors.affiliation: Clinical Scholars Program, Michigan Heart and Vascular Institute at St Joseph Mercy Hospital, Ann Arbor, MI, USA. haronow@michiganheart.com
authors.forename: Herbert D
authors.initials: HD
authors.lastname: Aronow
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Robert A
authors.initials: RA
authors.lastname: Harrington
authors.forename: Marc
authors.initials: M
authors.lastname: Vallee
authors.forename: Carmelo
authors.initials: C
authors.lastname: Graffagnino
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
authors.forename: Desmond J
authors.initials: DJ
authors.lastname: Fitzgerald
authors.forename: J Donald
authors.initials: JD
authors.lastname: Easton
authors.forename: Frans
authors.initials: F
authors.lastname: Van de Werf
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
authors.forename: James
authors.initials: J
authors.lastname: Ferguson
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: Pierre
authors.initials: P
authors.lastname: Amarenco
authors.forename: Pierre
authors.initials: P
authors.lastname: Theroux
authors.forename: Stephen
authors.initials: S
authors.lastname: Davis
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D002423:Cause of Death; D003327:Coronary Disease / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000401:mortality
chemical_list: D005343:Fibrinolytic Agents; D001241:Aspirin