BMJ 2002;324:71-86 ( 12 January )

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Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients

Antithrombotic Trialists' Collaboration. 

Correspondence to: Antithrombotic Trialists' Secretariat, Clinical Trial Service Unit, Radcliffe Infirmary, Oxford OX2 6HE www.ctsu.ox.ac.uk

Objective: To determine the effects of antiplatelet therapy among patients at high risk of occlusive vascular events.
Design: Collaborative meta-analyses (systematic overviews).
Inclusion criteria: Randomised trials of an antiplatelet regimen versus control or of one antiplatelet regimen versus another in high risk patients (with acute or previous vascular disease or some other predisposing condition) from which results were available before September 1997. Trials had to use a method of randomisation that precluded prior knowledge of the next treatment to be allocated and comparisons had to be unconfounded---that is, have study groups that differed only in terms of antiplatelet regimen.
Studies reviewed: 287 studies involving 135 000 patients in comparisons of antiplatelet therapy versus control and 77 000 in comparisons of different antiplatelet regimens.
Main outcome measure: "Serious vascular event": non-fatal myocardial infarction, non-fatal stroke, or vascular death.
Results: Overall, among these high risk patients, allocation to antiplatelet therapy reduced the combined outcome of any serious vascular event by about one quarter; non-fatal myocardial infarction was reduced by one third, non-fatal stroke by one quarter, and vascular mortality by one sixth (with no apparent adverse effect on other deaths). Absolute reductions in the risk of having a serious vascular event were 36 (SE 5) per 1000 treated for two years among patients with previous myocardial infarction; 38 (5) per 1000 patients treated for one month among patients with acute myocardial infarction; 36 (6) per 1000 treated for two years among those with previous stroke or transient ischaemic attack; 9 (3) per 1000 treated for three weeks among those with acute stroke; and 22 (3) per 1000 treated for two years among other high risk patients (with separately significant results for those with stable angina (P=0.0005), peripheral arterial disease (P=0.004), and atrial fibrillation (P=0.01)). In each of these high risk categories, the absolute benefits substantially outweighed the absolute risks of major extracranial bleeding. Aspirin was the most widely studied antiplatelet drug, with doses of 75-150 mg daily at least as effective as higher daily doses. The effects of doses lower than 75 mg daily were less certain. Clopidogrel reduced serious vascular events by 10% (4%) compared with aspirin, which was similar to the 12% (7%) reduction observed with its analogue ticlopidine. Addition of dipyridamole to aspirin produced no significant further reduction in vascular events compared with aspirin alone. Among patients at high risk of immediate coronary occlusion, short term addition of an intravenous glycoprotein IIb/IIIa antagonist to aspirin prevented a further 20 (4) vascular events per 1000 (P<0.0001) but caused 23 major (but rarely fatal) extracranial bleeds per 1000.
Conclusions: Aspirin (or another oral antiplatelet drug) is protective in most types of patient at increased risk of occlusive vascular events, including those with an acute myocardial infarction or ischaemic stroke, unstable or stable angina, previous myocardial infarction, stroke or cerebral ischaemia, peripheral arterial disease, or atrial fibrillation. Low dose aspirin (75-150 mg daily) is an effective antiplatelet regimen for long term use, but in acute settings an initial loading dose of at least 150 mg aspirin may be required. Adding a second antiplatelet drug to aspirin may produce additional benefits in some clinical circumstances, but more research into this strategy is needed.


What is already known on this topic
Antiplatelet therapy is effective for short term treatment of patients with suspected acute myocardial infarction and unstable angina

Long term treatment is beneficial for patients who have had a myocardial infarction, stroke, or transient ischaemic attack

Daily aspirin doses of 75-325 mg are effective

What this study adds
Antiplatelet therapy protects against vascular events among patients with stable angina, intermittent claudication, and (if oral anticoagulants are unsuitable) atrial fibrillation

Antiplatelet therapy can be started promptly during acute presumed ischaemic stroke and continued long term

Daily aspirin doses of 75-150 mg seem to be as effective as higher doses for long term treatments (and clopidrogel is an appropriate alternative for patients with a contraindication to aspirin)

Short term addition of a glycoprotein IIb/IIIa antagonist to aspirin prevents vascular events in patients having percutaneous coronary intervention and those with unstable angina but causes increased bleeding




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  • Kurth, T., Bousser, M.-G. (2009). Stroke in Women: An Evolving Topic. Stroke 40: 1027-1028 [Full text]  
  • Steinhubl, S. R., Bhatt, D. L., Brennan, D. M., Montalescot, G., Hankey, G. J., Eikelboom, J. W., Berger, P. B., Topol, E. J., on behalf of the CHARISMA Investigators, (2009). Aspirin to Prevent Cardiovascular Disease: The Association of Aspirin Dose and Clopidogrel With Thrombosis and Bleeding. ANN INTERN MED 150: 379-386 [Abstract] [Full text]  
  • Mehta, S. R. (2009). Aspirin for Prevention and Treatment of Cardiovascular Disease. ANN INTERN MED 150: 414-416 [Full text]  
  • Budaj, A., Eikelboom, J. W., Mehta, S. R., Afzal, R., Chrolavicius, S., Bassand, J.-P., Fox, K. A.A., Wallentin, L., Peters, R. J.G., Granger, C. B., Joyner, C. D., Yusuf, S., on behalf of OASIS 5 Investigators, (2009). Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes. Eur Heart J 30: 655-661 [Abstract] [Full text]  
  • Mora, S. (2009). Aspirin Therapy in Women: Back to the ABCs. Circ Cardiovasc Qual Outcomes 2: 63-64 [Full text]  
  • Hopkins, J., Limacher, M. (2009). The Role of Aspirin in Cardiovascular Disease Prevention in Women. AMERICAN JOURNAL OF LIFESTYLE MEDICINE 3: 123-134 [Abstract]  
  • Fletcher, E. H., Newton, J. L., Gray, C. S. (2009). Commencing antiplatelet therapy in older people after an acute ischaemic stroke. Age Ageing 38: 142-144 [Full text]  
  • Tay, K. H., Lane, D. A., Lip, G. Y. H. (2009). Challenges facing anticoagulation among the elderly and frail. Age Ageing 38: 140-142 [Full text]  
  • Berger, J. S., Brown, D. L., Burke, G. L., Oberman, A., Kostis, J. B., Langer, R. D., Wong, N. D., Wassertheil-Smoller, S. (2009). Aspirin Use, Dose, and Clinical Outcomes in Postmenopausal Women With Stable Cardiovascular Disease: The Women's Health Initiative Observational Study. Circ Cardiovasc Qual Outcomes 2: 78-87 [Abstract] [Full text]  
  • Ovbiagele, B. (2009). Medications Impair Kidney Function in Stroke Population--Reply. Arch Neurol 66: 416-416 [Full text]  
  • Bailey, A. L., Scantlebury, D. C., Smyth, S. S. (2009). Thrombosis and Antithrombotic Therapy in Women. Arterioscler. Thromb. Vasc. Bio. 29: 284-288 [Abstract] [Full text]  
  • Josephson, C. B, Salman, R. A.-S., Phillips, S. J (2009). An episode of transient neurological symptoms. BMJ 338: b616-b616 [Full text]  
  • Santilli, F., Rocca, B., De Cristofaro, R., Lattanzio, S., Pietrangelo, L., Habib, A., Pettinella, C., Recchiuti, A., Ferrante, E., Ciabattoni, G., Davi, G., Patrono, C. (2009). Platelet cyclooxygenase inhibition by low-dose aspirin is not reflected consistently by platelet function assays implications for aspirin "resistance".. J Am Coll Cardiol 53: 667-677 [Abstract] [Full text]  
  • Ross, J. S., Gross, C. P. (2009). Policy Research: Using Evidence to Improve Healthcare Delivery Systems. Circulation 119: 891-898 [Full text]  
  • Kuliczkowski, W., Witkowski, A., Polonski, L., Watala, C., Filipiak, K., Budaj, A., Golanski, J., Sitkiewicz, D., Pregowski, J., Gorski, J., Zembala, M., Opolski, G., Huber, K., Arnesen, H., Kristensen, S. D., De Caterina, R. (2009). Interindividual variability in the response to oral antiplatelet drugs: a position paper of the Working Group on antiplatelet drugs resistance appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, endorsed by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J 30: 426-435 [Abstract] [Full text]  
  • Patrono, C., Baigent, C. (2009). Low-Dose Aspirin, Coxibs, and other NSAIDS: A Clinical Mosaic Emerges. Mol. Interv. 9: 31-39 [Abstract] [Full text]  
  • Akay, O. M., Canturk, Z., Akin, E., Bal, C., Gulbas, Z. (2009). Aspirin-Resistance Frequency: A Prospective Study in 280 Healthy Turkish Volunteers. CLIN APPL THROMB HEMOST 15: 98-102 [Abstract]  
  • Cohen, M. (2009). Expanding the Recognition and Assessment of Bleeding Events Associated With Antiplatelet Therapy in Primary Care. Mayo Clin Proc. 84: 149-160 [Abstract] [Full text]  
  • Cacoub, P. P., Bhatt, D. L., Steg, P.G., Topol, E. J., Creager, M. A., for the CHARISMA Investigators, (2009). Patients with peripheral arterial disease in the CHARISMA trial. Eur Heart J 0: ehn534v1-10 [Abstract] [Full text]  
  • Gresele, P., Migliacci, R. (2009). The peripheral arterial disease subgroup in the CHARISMA trial: does it tell us anything new?. Eur Heart J 0: ehn565v1-2 [Full text]  
  • Bhattacharyya, O. K., Estey, E. A., Cheng, A. Y.Y. (2009). Update on the Canadian Diabetes Association 2008 clinical practice guidelines. cfp 55: 39-43 [Full text]  
  • Kim, H., Lee, H. K., Han, K., Jeon, H.-K. (2009). Prevalence and Risk Factors for Aspirin and Clopidogrel Resistance in Patients with Coronary Artery Disease or Ischemic Cerebrovascular Disease. Annals of Clinical & Laboratory Science 39: 289-294 [Abstract] [Full text]  
  • O'Riordan, J. M., Margey, R. J., Blake, G., O'Connell, P. R. (2009). Antiplatelet Agents in the Perioperative Period. Arch Surg 144: 69-76 [Abstract] [Full text]  
  • Adams, H. P. Jr (2009). Secondary Prevention of Atherothrombotic Events After Ischemic Stroke. Mayo Clin Proc. 84: 43-51 [Abstract] [Full text]  
  • Scott, D. M., Norwood, R. M, Parra, D. (2009). P2Y12 Inhibitors in Cardiovascular Disease: Focus on Prasugrel. The Annals of Pharmacotherapy 43: 64-76 [Abstract] [Full text]  
  • American Diabetes Association, (2009). Standards of Medical Care in Diabetes--2009. Diabetes Care 32: S13-S61 [Full text]  
  • Cosentino, F., Rydén, L., Francia, P., Mellbin, L. G. (2009). CHAPTER 14 Diabetes Mellitus and Metabolic Syndrome. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [Abstract] [Full text]  
  • Hamm, C. W., Möllmann, H., Bassand, J.-P., van de Werf, F. (2009). CHAPTER 16 Acute Coronary Syndromes. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [Abstract] [Full text]  
  • Crea, F., Camici, P. G., De Caterina, R., Lanza, G. A. (2009). CHAPTER 17 Chronic Ischaemic Heart Disease. ESC Textbook of Cardiovascular Medicine 2: med-9780199566990-chapter-med-9780199566990-chapter [Abstract] [Full text]  
  • Lordkipanidze, M., Pharand, C., Nguyen, T. A., Schampaert, E., Palisaitis, D. A., Diodati, J. G. (2008). Comparison of four tests to assess inhibition of platelet function by clopidogrel in stable coronary artery disease patients. Eur Heart J 29: 2877-2885 [Abstract] [Full text]  
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  • Wang, T. Y., Xiao, L., Alexander, K. P., Rao, S. V., Kosiborod, M. N., Rumsfeld, J. S., Spertus, J. A., Peterson, E. D. (2008). Antiplatelet Therapy Use After Discharge Among Acute Myocardial Infarction Patients With In-Hospital Bleeding. Circulation 118: 2139-2145 [Abstract] [Full text]  
  • Ogawa, H., Nakayama, M., Morimoto, T., Uemura, S., Kanauchi, M., Doi, N., Jinnouchi, H., Sugiyama, S., Saito, Y., for the Japanese Primary Prevention of Atheroscler, (2008). Low-Dose Aspirin for Primary Prevention of Atherosclerotic Events in Patients With Type 2 Diabetes: A Randomized Controlled Trial. JAMA 300: 2134-2141 [Abstract] [Full text]  
  • Nicolucci, A. (2008). Aspirin for Primary Prevention of Cardiovascular Events in Diabetes: Still an Open Question. JAMA 300: 2180-2181 [Full text]  

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Limit journal space for bloated meta-analyses
Niall A Herity
bmj.com, 12 Jan 2002 [Full text]
Clinical audit of aspirin use in diabetes
Stephanie E. Baldeweg, et al.
bmj.com, 15 Jan 2002 [Full text]
ASPIRIN FOR CHD PREVENTION IN LOWER RISK ADULTS
Michael Pignone, et al.
bmj.com, 15 Jan 2002 [Full text]
Not even 4th place for the risk of antiplatelet drugs?
Peter N Trewby, et al.
bmj.com, 25 Jan 2002 [Full text]
Antithrombotic trialists - Have they shortchanged aspirin with extended-release dipyridamole for str
Louis R Caplan, et al.
bmj.com, 6 Feb 2002 [Full text]
ANTIPLATELET THERAPY IN PREVENTION OF PLATELET AGGREGABILITY, BUT WHEN?
Sergio Sensi, et al.
bmj.com, 7 Feb 2002 [Full text]
Antiplatelet therapy and atrial fibrillation: some caution needed
Gregory YH Lip, et al.
bmj.com, 8 Feb 2002 [Full text]
Is the addition of dipyridamole to aspirin really of no value?
James M Gebel
bmj.com, 25 Feb 2002 [Full text]
A lot of outcomes without anwering the main question
Jesús A. Gallego, et al.
bmj.com, 2 Mar 2002 [Full text]
Gender difference in the results of thrombolytic therapy in acute myocardial infarction
manzar hussain akbar
bmj.com, 6 Dec 2005 [Full text]
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