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Collaborative overview of randomised trials of antiplatelet therapy Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients

Correspondence to: APT Statistical Secretariat, ICRF/BHF/MRC Clinical Trial Service Unit, Nuffield. Department of Clinical Medicine,Radcliffe Infirmary, Oxford OX2 6HE, or APT Clinical Secretariat,Department of Clinical Neurosciences, Western General Hospital, Edinburgh EH4 2XU.

Abstract

Objective : To determine the effects of "prolonged" antiplatelet therapy (that is, given for one month or more) on "vascular events" (non-fatal myocardial infarctions, non-fatal strokes, or vascular deaths) in various categories of patients.
Design : Overviews of 145 randomised trials of "prolonged" antiplatelet therapy versus control and 29 randomised comparisons between such antiplatelet regimens.
Setting : Randomised trials that could have been available by March 1990.
Subjects : Trials of antiplatelet therapy versus control included about 70 000 "high risk" patients (that is, with some vascular disease or other condition implying an increased risk of occlusive vascular disease) and 30 000 "low risk" subjects from the general population. Direct comparisons of different antiplatelet regimens involved about 10 000 high risk patients.
Results : In each of four main high risk categories of patients antiplatelet therapy was definitely protective. The percentages of patients suffering a vascular event among those allocated antiplatelet therapy versus appropriately adjusted control percentages (and mean scheduled treatment durations and net absolute benefits) were: (a) among about 20 000 patients with acute myocardial infarction, 10% antiplatelet therapy v 14% control (one month benefit about 40 vascular events avoided per 1000 patients treated (2P< 0.00001)); (b) among about 20 000 patients with a past history of myocardial infarction, 13% antiplatelet therapy v 17% control (two year benefit about 40/1000 (2P<0.00001)); (c) among about 10 000 patients with a past history of stroke or transient ischaemic attack, 18% antiplatelet therapy v 22% control (three year benefit about 40/1000 (2P<0.00001)); (d) among about 20 000 patients with some other relevant medical history (unstable angina, stable angina, vascular surgery, angioplasty, atrial fibrillation, valvular disease, peripheral vascular disease, etc), 9% v 14% in 4000 patients with unstable angina (six month benefit about 50/1000 (2P<0.00001)) and 6% v 8% in 16 000 other high risk patients (one year benefit about 20/1000 (2P<0.00001)).
Reductions in vascular events were about one quarter in each of these four main categories and were separately statistically significant in middle age and old age, in men and women, in hypertensive and normotensive patients, and in diabetic and non: diabetic patients. Taking all high risk patients together showed reductions of about one third in non-fatal myocardial infarction, about one third in non-fatal stroke, and about one sixth in vascular death (each 2P<0.00001). There was no evidence that non-vascular deaths were increased, so in each of the four main high risk categories overall mortality was significantly reduced. The most widely tested antiplatelet regimen was "medium dose" (75-325 mg/day) aspirin. Doses throughout this range seemed similarly effective (although in an acute emergency it might be prudent to use an initial dose of 160-325 mg rather than about 75 mg). There was no appreciable evidence that either a higher aspirin dose or any other antiplatelet regimen was more effective than medium dose aspirin in preventing vascular events. The optimal duration of treatment for patients with a past history of myocardial infarction, stroke, or transient ischaemic attack could not be determined directly because most trials lasted only one, two, or three years (average about two years). Nevertheless, there was significant (2P<0.00001) further benefit between the end of year 1 and the end of year 3, suggesting that longer treatment might well be more effective.
Among low risk recipients of "primary prevention" a significant reduction of one third in non: fatal myocardial infarction was, however, accompanied by a non-significant increase in stroke. Furthermore, the absolute reduction in vascular events was much smaller than for high risk patients despite a much longer treatment period (4.4% antiplatelet therapy v 4.8% control; five year benefit only about four per 1000 patients treated) and was not significant (2P=0.09).
Conclusions : Among a much wider range of patients at high risk of occlusive vascular disease than is currently treated routinely, some years of antiplatelet therapy - with aspirin 75-325 mg/day or some other antiplatelet regimen (provided there are no contraindications) - offers worthwhile protection against myocardial infarction, stroke, and death. Significant benefit is evident not only among patients with unstable angina, suspected acute myocardial infarction, or a past history of myocardial infarction, stroke, or transient ischaemic attack, but also among many other categories of high risk patients (such as those having vascular procedures and those with stable angina or peripheral vascular disease). There is as yet, however, no clear evidence on the balance of risks and benefits of antiplatelet therapy in primary prevention among low risk subjects.

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• Cooke, G. E., Liu-Stratton, Y., Ferketich, A. K., Moeschberger, M. L., Frid, D. J., Magorien, R. D., Bray, P. F., Binkley, P. F., Goldschmidt-Clermont, P. J. (2006). Effect of Platelet Antigen Polymorphism on Platelet Inhibition by Aspirin, Clopidogrel, or Their Combination. J Am Coll Cardiol 47: 541-546 [Abstract] [Full text]  
• Hiatt, W. R, Krantz, M. J (2006). Masterclass series in peripheral arterial disease: Antiplatelet therapy for peripheral arterial disease and claudication. Vasc Med 11: 55-60 [Abstract]  
• Sacco, R. L., Adams, R., Albers, G., Alberts, M. J., Benavente, O., Furie, K., Goldstein, L. B., Gorelick, P., Halperin, J., Harbaugh, R., Johnston, S. C., Katzan, I., Kelly-Hayes, M., Kenton, E. J., Marks, M., Schwamm, L. H., Tomsick, T. (2006). Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline.. Stroke 37: 577-617 [Abstract] [Full text]  
• Ferreira, I. A., Mocking, A. I.M., Feijge, M. A.H., Gorter, G., van Haeften, T. W., Heemskerk, J. W.M., Akkerman, J.-W. N. (2006). Platelet Inhibition by Insulin Is Absent in Type 2 Diabetes Mellitus. Arterioscler. Thromb. Vasc. Bio. 26: 417-422 [Abstract] [Full text]  
• Juvela, S., Kase, C. S. (2006). Advances in Intracerebral Hemorrhage Management. Stroke 37: 301-304 [Full text]  
• Berger, J. S., Roncaglioni, M. C., Avanzini, F., Pangrazzi, I., Tognoni, G., Brown, D. L. (2006). Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men: A Sex-Specific Meta-analysis of Randomized Controlled Trials. JAMA 295: 306-313 [Abstract] [Full text]  
• Jaiveer, P. K, Jaiveer, S., Jujjavarapu, S. B, Morrissey, J., White, J., Gadsby, R., Patel, V. (2006). Improvements in clinical diabetes care in the first year of the new General Medical Services contract in the UK. British Journal of Diabetes & Vascular Disease 6: 45-48 [Abstract]  
• Poston, R. S., White, C., Gu, J., Brown, J., Gammie, J., Pierson, R. N., Lee, A., Connerney, I., Avari, T., Christenson, R., Tandry, U., Griffith, B. P. (2006). Aprotinin Shows Both Hemostatic and Antithrombotic Effects During Off-Pump Coronary Artery Bypass Grafting. Ann. Thorac. Surg. 81: 104-111 [Abstract] [Full text]  
• Booth, G. L., Kapral, M. K., Fung, K., Tu, J. V. (2006). Recent Trends in Cardiovascular Complications Among Men and Women With and Without Diabetes. Diabetes Care 29: 32-37 [Abstract] [Full text]  
• Bolten, W W (2006). Problem of the atherothrombotic potential of non-steroidal anti-inflammatory drugs. Ann Rheum Dis 65: 7-13 [Abstract] [Full text]  
• Alexander, K. P., Chen, A. Y., Roe, M. T., Newby, L. K., Gibson, C. M., Allen-LaPointe, N. M., Pollack, C., Gibler, W. B., Ohman, E. M., Peterson, E. D., for the CRUSADE Investigators, (2005). Excess Dosing of Antiplatelet and Antithrombin Agents in the Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes. JAMA 294: 3108-3116 [Abstract] [Full text]  
• Prepared by: British Cardiac Society, British Hype, (2005). JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart 91: v1-v52 [Full text]  
• (2005). Part 5: Acute Coronary Syndromes. Circulation 112: III-55-III-72 [Full text]  
• Yang, X., Alexander, K. P., Chen, A. Y., Roe, M. T., Brindis, R. G., Rao, S. V., Gibler, W. B., Ohman, E. M., Peterson, E. D., for the CRUSADE Investigators, (2005). The Implications of Blood Transfusions for Patients With Non-ST-Segment Elevation Acute Coronary Syndromes: Results From the CRUSADE National Quality Improvement Initiative. J Am Coll Cardiol 46: 1490-1495 [Abstract] [Full text]  
• Laatikainen, T., Critchley, J., Vartiainen, E., Salomaa, V., Ketonen, M., Capewell, S. (2005). Explaining the Decline in Coronary Heart Disease Mortality in Finland between 1982 and 1997. Am J Epidemiol 162: 764-773 [Abstract] [Full text]  
• Maree, A. O., Curtin, R. J., Dooley, M., Conroy, R. M., Crean, P., Cox, D., Fitzgerald, D. J. (2005). Platelet Response to Low-Dose Enteric-Coated Aspirin in Patients With Stable Cardiovascular Disease. J Am Coll Cardiol 46: 1258-1263 [Abstract] [Full text]