Aspirin for acute coronary syndromes: have we learned the correct dose yet?
Despite its universal use, the optimal dose of aspirin from an efficacy and safety perspective remains unclear. There are wide variations in international practice and a lack of consensus as to the most appropriate dose of aspirin in patients with acute coronary syndromes (ACS), mainly because of the wide range of doses evaluated in early randomized trials of aspirin versus placebo. Comparisons of aspirin dose have been based on observational studies or indirect comparisons from meta-analysis of antiplatelet trials. These studies have suggested that aspirin, in doses>or=300 mg, is similar to aspirin doses 75-100 mg/d for prevention of major vascular events, but that higher doses increase the risk of major bleeding complications. Recently, the CURRENT-OASIS study, a randomized head-to-head comparison of higher-dose (>or=300 mg/d) versus low-dose aspirin (75-81 mg/d) for 1 month in over 25,000 patients with ACS referred for an early invasive strategy demonstrated similar outcomes between higher- and low-dose aspirin for efficacy, with no difference in the risk of major bleeding complications. Results from this mega-trial suggest that low-dose or higher-dose aspirin is a reasonable option in ACS patients undergoing an early invasive strategy.
Bainey
Kevin R
KR
Hamilton Health Sciences, David Braley Cardiac Vascular and Stroke Institute, C3-11A, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada. kbainey@ualberta.ca
Mehta
Shamir R
SR
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D001241:Aspirin / Q000008:administration & dosage* / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000517:prevention & control; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention
D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
N Engl J Med. 2001 Aug 16;345(7):494-502
11519503
N Engl J Med. 2006 Apr 20;354(16):1706-17
16531616
Lancet. 1988 Aug 13;2(8607):349-60
2899772
Circulation. 2007 Aug 14;116(7):e148-304
17679616
BMJ. 2002 Jan 12;324(7329):71-86
11786451
Eur Heart J. 2009 Apr;30(8):900-7
18819961
N Engl J Med. 1985 Nov 28;313(22):1369-75
3903504
Lancet. 1990 Oct 6;336(8719):827-30
1976875
Ann Intern Med. 2009 Mar 17;150(6):379-86
19293071
Eur Heart J. 2007 Jul;28(13):1598-660
17569677
Circulation. 2003 Oct 7;108(14):1682-7
14504182
Circulation. 2003 Jul 29;108(4):399-406
12874182
N Engl J Med. 1983 Aug 18;309(7):396-403
6135989
Circulation. 2006 Feb 14;113(6):e85-151
16407573
Lancet. 2001 Aug 18;358(9281):527-33
11520521
N Engl J Med. 1988 Oct 27;319(17):1105-11
3050522