Meta-analysis: aspirin falls short for primary stroke prevention

  • Judge C & al.
  • Int J Stroke
  • 25/06/2019

  • Susan London
  • Clinical Essentials
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Takeaway

  • Aspirin users free of cardiovascular disease did not have a significant reduction in stroke overall or nonfatal stroke, and showed an increase in hemorrhagic stroke.

Why this matters

Key results

  • Compared with nonusers, aspirin users did not have significant reduction in risks for:
    • All stroke (OR, 0.95; 95% CI, 0.88-1.03).
    • Nonfatal stroke (OR, 0.94; 95% CI, 0.85-1.04).
    • All-cause mortality (OR, 0.97; 95% CI, 0.92-1.03).
    • Cardiovascular mortality (OR, 0.94; 95% CI, 0.85-1.03).
  • Users had increased risks for:
    • Hemorrhagic stroke (OR, 1.29; 95% CI, 1.06-1.56).
    • Major gastrointestinal bleeding (OR, 1.83; 95% CI, 1.43-2.35).
  • Users had reduced risk for nonfatal myocardial infarction (OR, 0.80; 95% CI, 0.69-0.94).
  • When nonfatal events (myocardial infarction, stroke), major bleeding were equally weighted, aspirin did not have net clinical benefit.

Study design

  • Meta-analysis of 11 randomized controlled trials of aspirin vs placebo for primary prevention of cardiovascular disease among 157,054 adults, follow-up >1 year.
  • Main outcomes: cardiovascular outcomes.
  • Funding: Irish Clinical Academic Training Programme, supported by Wellcome Trust, others.

Limitations

  • Exclusion of trials not reporting on stroke.
  • Heterogeneity across trials.
  • Some did not require imaging for stroke diagnosis.