Aspirin protects patients at high risk of heart attack or stroke

January 10, 2002

Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients BMJ Volume 324, pp 71-86

Aspirin (or another antiplatelet drug) protects patients at high risk of serious vascular events, such as heart attack or stroke, and should be considered routinely for all such patients, concludes a study in this week's BMJ.

Researchers reviewed 287 trials, involving over 200,000 patients, that compared an antiplatelet drug with a control or compared different antiplatelet drugs.

They found that antiplatelet therapy reduced the risk of any serious vascular event by about one quarter; risk of non-fatal heart attack was reduced by one third, non-fatal stroke by one quarter, and vascular death by one sixth. Low dose aspirin (75-150mg daily) seemed to be as effective as higher doses for long term use.

In each of these high risk categories, the benefits of antiplatelet therapy far outweighed any hazards, yet only about half (or less) of all patients with a history of heart attack, angina, or heart disease are currently receiving antiplatelet therapy, say the authors. These results clearly show that it should be considered routinely for all patients at high or intermediate risk of vascular disease, and it should be continued for as long as the risk remains high.

In some clinical circumstances, adding a second antiplatelet drug to aspirin may produce additional benefits, but more research into this strategy is needed, they conclude.

An editorial and debate article accompanies this study.


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