Low-dose aspirin increases risk of major haemorrhages
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Low-dose aspirin increases risk of major haemorrhages The use of low-dose aspirin appears to be associated with an increased risk of major haemorrhage, GI haemorrhage or intracranial haemorrhage compared with placebo, and an increased risk of GI haemorrhage compared with clopidogrel, for primary or secondary prevention of cardiovascular (CV) disease, according to US-based researchers. To determine the risks of haemorrhagic events and other non-CV adverse events with aspirin and clopidogrel, they performed a systematic review and identified 55 randomised controlled trials of low-dose aspirin (75–325 mg/day or 150–325 mg every other day) or clopidogrel, administered for the primary or secondary prevention of CV disease.* They then conducted meta-analyses on trials comparing aspirin with placebo (22 trials), as well as analyses of trials that compared clopidogrel with low-dose aspirin (one trial), clopidogrel with combined clopidogrel and aspirin (one trial), and aspirin with combined clopidogrel and aspirin (one trial). Aspirin use was associated with an increased risk of any major haemorrhage (relative risk [RR] 1.71; 95% CI 1.41, 2.08), and a significantly increased risk of major GI haemorrhage (2.07; 1.61, 2.66) and intracranial haemorrhage (1.65; 1.12, 2.44), compared with placebo; the risk of fatal intracranial haemorrhage was also significantly increased with aspirin use. The absolute rate increase with aspirin versus placebo was 0.13% per year for any major haemorrhage, 0.12% per year for major GI haemorrhage and 0.03% per year for intracranial haemorrhage; the risk of non-CV deaths was not increased with aspirin use. Compared with clopidogrel, aspirin use was associated with an increased risk of major GI haemorrhage (RR 1.45; 1.00, 2.10). The absolute risk increase in major GI haemorrhage was 0.12% per year for aspirin versus clopidogrel. Compared with combined aspirin and clopidogrel, both aspirin alone and clopidogrel alone were associated with reduced risks of any major haemorrhage and any major GI haemorrhage; the relative risk reductions were greater with clopidogrel than with aspirin. * supported by a grant from Bayer Healthcare LLC McQuaid KR, et al. Systematic review and meta-analysis of adverse events of lowdose aspirin and clopidogrel in randomized controlled trials. American Journal of 801046688 Medicine 119: 624-638, No. 8, Aug 2006
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Reactions 14 Oct 2006 No. 1123
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