Low-dose aspirin in patients with stable cardiovascular disease: A meta-analysis
Low-dose aspirin in patients with stable cardiovascular disease: A meta-analysis
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DOI：
10.1016/j.amjmed.2007.10.002
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发表时间：
2008-01-01
影响因子：
5.9
通讯作者：
Becker, Richard C.
中科院分区：
文献类型：
--
作者：
Berger, Jeffrey S.;Brown, David L.;Becker, Richard C.
目的：许多关于阿司匹林在稳定型心血管疾病中的应用的建议是基于对所有剂量的抗血小板治疗以及稳定型和不稳定型患者的分析。我们的目的是评估低剂量阿司匹林（50-325 mg/d）在稳定型心血管疾病患者中的获益和风险。方法：通过检索1966年至2006年的MEDLINE数据库，确定了低剂量阿司匹林在稳定型心血管疾病患者中的二级预防试验。确定了6项随机试验，招募了既往心肌梗死（MI）（n = 1）、稳定型心绞痛（n = 1）或卒中/短暂性脑缺血发作（n = 4）患者。随机效应模型被用来结合联合收割机的结果，从个别trials.RESULTS：6项研究随机9853例患者。阿司匹林治疗与心血管事件风险显著降低21%相关（非致死性MI、非致死性卒中和心血管死亡）（95%置信区间[CI]，0.72-0.88），非致死性MI风险降低26%（95% CI，0.60-0.91），卒中风险降低25%（95% CI，0.65-0.87），全因死亡风险降低13%（95% CI，0.76-0.98）。接受阿司匹林治疗的患者更有可能发生严重出血（比值比2.2，95% CI，1.4-3.4）。对1000例患者进行平均33个月的治疗，可预防33例心血管事件、12例非致死性MI、25例非致死性卒中和14例死亡，并导致9例大出血事件。在缺血性心脏病患者中，阿司匹林在降低非致命性心肌梗死和全因死亡率的风险方面最有效;然而，在脑血管疾病患者中，阿司匹林在降低中风风险方面最有效。结论：在稳定的心血管疾病患者中，低剂量阿司匹林治疗可降低心血管不良事件和全因死亡率的发生率，并增加严重出血的风险。(C)2008年爱思唯尔公司All rights reserved.
OBJECTIVE: Many recommendations for aspirin in stable cardiovascular disease are based on analyses of all antiplatelet therapies at all dosages and in both stable and unstable patients. Our objective was to evaluate the benefit and risk of low-dose aspirin (50-325 mg/d) in patients with stable cardiovascular disease.METHODS: Secondary prevention trials of low-dose aspirin in patients with stable cardiovascular disease were identified by searches of the MEDLINE database from 1966 to 2006. Six randomized trials were identified that enrolled patients with a prior myocardial infarction (MI) (n = 1), stable angina (n = 1), or stroke/transient ischemic attack (n = 4). A random effects model was used to combine results from individual trials.RESULTS: Six studies randomized 9853 patients. Aspirin therapy was associated with a significant 21% reduction in the risk of cardiovascular events (nonfatal MI, nonfatal stroke, and cardiovascular death) (95% confidence interval [CI], 0.72-0.88), 26% reduction in the risk of nonfatal MI (95% CI, 0.60-0.91), 25% reduction in the risk of stroke ( 95% CI, 0.65-0.87), and 13% reduction in the risk of all-cause mortality ( 95% CI, 0.76-0.98). Patients treated with aspirin were significantly more likely to experience severe bleeding ( odds ratio 2.2, 95% CI, 1.4-3.4). Treatment of 1000 patients for an average of 33 months would prevent 33 cardiovascular events, 12 nonfatal MIs, 25 nonfatal strokes, and 14 deaths, and cause 9 major bleeding events. Among those with ischemic heart disease, aspirin was most effective at reducing the risk of nonfatal MI and all-cause mortality; however, among those with cerebrovascular disease, aspirin was most effective at reducing the risk of stroke.CONCLUSION: In patients with stable cardiovascular disease, low-dose aspirin therapy reduces the incidence of adverse cardiovascular events and all-cause mortality, and increases the risk of severe bleeding. (C) 2008 Elsevier Inc. All rights reserved.