A Metaregression Analysis of the Dose-Response Effect of Aspirin on Stroke

Johnson, Eric S.; Lanes, Stephan; Wentworth, Charles; Satterfield, Margaret H.; Abebe, Bethlehem L.; Dicker, Linda Webster

doi:10.1001/archinte.159.11.1248

Cited by 180 publications

(101 citation statements)

References 24 publications

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“…78-9). [205][206][207][208][209][210] It was assumed that the fatality rates associated with MI were, for men, 35% for ages 55-64 years and 48%, 69% and 82% for age bands 65-74 years, 75-84 years and 85 years and older, respectively; and for women, 31%, 55%, 77% and 90%, respectively. These values were calculated by the authors from data reported by Volmink and colleagues.…”

Section: Risks Of MImentioning

confidence: 99%

“…205 After this period it was assumed that efficacy fell to a 15% relative risk reduction (95% CI 6 to 33%). 206 Patients already taking aspirin at the time of the TIA were assumed to have a constant 15% risk reduction of stroke throughout the duration of the model. The impact of aspirin on MI was assumed to be constant at 27% (95% CI 12 to 39%), calculated using data for combined antiplatelet therapy from the Antithrombotic Trialists' Collaboration trial.…”

Section: Assumed Efficacy Of Aspirinmentioning

confidence: 99%

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Accurate, practical and cost-effective assessment of carotid stenosis in the UK

Wardlaw

Chappell²,

Stevenson³

et al. 2006

Health Technol Assess

137

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. NHS libraries can subscribe free of charge. Public libraries can subscribe at a very reduced cost of £100 for each volume (normally comprising 30-40 titles). The commercial subscription rate is £300 per volume. Please see our website for details. Subscriptions can only be purchased for the current or forthcoming volume. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email. Paying by official purchase orderYou can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NHS R&D HTA ProgrammeT he research findings from the NHS R&D Health Technology Assessment (HTA) Programme directly influence key decision-making bodies such as the National Institute for Health and Clinical Excellence (NICE) and the National Screening Committee (NSC) who rely on HTA outputs to help raise standards of care. HTA findings also help to improve the quality of the service in the NHS indirectly in that they form a key component of the 'National Knowledge Service' that is being developed to improve the evidence of clinical practice throughout the NHS.The HTA Programme was set up in 1993. Its role is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care.The HTA Programme commissions research only on topics where it has identified key gaps in the evidence needed by the NHS. Suggestions for topics are actively sought from people working in the NHS,...

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Section: Risks Of MImentioning

confidence: 99%

Section: Assumed Efficacy Of Aspirinmentioning

confidence: 99%

Accurate, practical and cost-effective assessment of carotid stenosis in the UK

Wardlaw

Chappell²,

Stevenson³

et al. 2006

Health Technol Assess

137

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“…Although there is no evidence from meta-analyses of aspirin trials to suggest that effectiveness decreases with dose, there remains uncertainty about whether doses <75 mg are as effective as daily doses ≥ 75 mg. 15 In particular, experts disagree about the optimal aspirin dose in preventing stroke. 74 Johnson and colleagues 74 conducted a metaregression analysis of RCTs in patients with previous TIA or stroke. They concluded that the effect of aspirin on stroke is uniform across aspirin doses from 50 to 1500 mg/day.…”

Section: The Aspirin Doses Were Different In the Two Trialsmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of clopidogrel and modified-release dipyridamole in the secondary prevention of occlusive vascular events: a systematic review and economic evaluation

Jones

Griffin²,

Palmer³

et al. 2004

Health Technol Assess

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Non-UK purchasers will have to pay a small fee for post and packing. For European countries the cost is £2 per monograph and for the rest of the world £3 per monograph.You can order HTA monographs from our Despatch Agents:-fax (with credit card or official purchase order) -post (with credit card or official purchase order or cheque) -phone during office hours (credit card only).Additionally the HTA website allows you either to pay securely by credit card or to print out your order and then post or fax it. Contact details are as follows: Payment methods Paying by chequeIf you pay by cheque, the cheque must be in pounds sterling, made payable to Direct Mail Works Ltd and drawn on a bank with a UK address. Paying by credit cardThe following cards are accepted by phone, fax, post or via the website ordering pages: Delta, Eurocard, Mastercard, Solo, Switch and Visa. We advise against sending credit card details in a plain email.Paying by official purchase order You can post or fax these, but they must be from public bodies (i.e. NHS or universities) within the UK. We cannot at present accept purchase orders from commercial companies or from outside the UK. How do I get a copy of HTA on CD?Please use the form on the HTA website (www.hta.ac.uk/htacd.htm). Or contact Direct Mail Works (see contact details above) by email, post, fax or phone. HTA on CD is currently free of charge worldwide.The website also provides information about the HTA Programme and lists the membership of the various committees. HTA NHS R&D HTA ProgrammeT he research findings from the NHS R&D Health Technology Assessment (HTA) Programme directly influence key decision-making bodies such as the National Institute for Clinical Excellence (NICE) and the National Screening Committee (NSC) who rely on HTA outputs to help raise standards of care. HTA findings also help to improve the quality of the service in the NHS indirectly in that they form a key component of the 'National Knowledge Service' that is being developed to improve the evidence of clinical practice throughout the NHS.The HTA Programme was set up in 1993. Its role is to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care, rather than settings of care.The HTA programme commissions research only on topics where it has identified key gaps in the evidence needed by the NHS. Suggestions for topics are actively sought from people working in the NHS, the public, consumer groups and professional bodies such as Royal Colleges and NHS Trusts.Research suggestions are carefully considered by panels of independent experts (including consumers) whose advice results in a ranked list of recommended research priorities. The HTA Programme then commissions the research team best suited t...

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“…2,3) On the other hand, depression is the major co-morbid disorders in CI sequelae. Selective serotonin reuptake inhibitors (SSRI) are the major antidepressants used to treat depression.…”

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confidence: 99%

The Coadministration of Paroxetine and Low-Dose Aspirin Synergistically Enhances Gastric Ulcerogenic Risk in Rats

Yamaguchi

Hidaka

Suemaru

et al. 2008

Biological & Pharmaceutical Bulletin

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Cerebral infarction (CI) is one of the highly mortal diseases. It has been reported that the use of an anti-platelet drug for the treatment of CI significantly decreased the patient's risk of a future stroke by 23%.1) Low-dose aspirin, the most frequently used anti-platelet drug in Japan, could reduce the risk of future strokes with dose range in the 50 to 200 mg per day range. 2,3) On the other hand, depression is the major co-morbid disorders in CI sequelae. Selective serotonin reuptake inhibitors (SSRI) are the major antidepressants used to treat depression. Therefore, it is likely to coadminister low-dose aspirin and SSRIs in order to prevent future strokes and to treat depression. Only a few clinical studies have examined the risk associated with the coadministration of low-dose aspirin and SSRIs, 4,5) even though both drugs have similar adverse effects on gastric mucosa. [6][7][8] Former 2 studies indicated that the coadministration of lowdose aspirin and SSRIs increased the risk of abnormal bleeding in stomach, which is closely related to gastric ulcers. In the present study, we investigated the ulcerogenic effect induced by the coadministration of low-dose aspirin and paroxetine, major one of the SSRIs in rats. MATERIALS AND METHODS AnimalsMale Wistar rats (200-250 g) were used. Animals were fed on diet with free access to water under standard humidity and temperature. Animals were fasted for 24 h before ulcerogenic experiments.Drugs Paroxetine hydrochroride (GlaxoSmithKline), low-dose aspirin (Merck), indomethacin (Sigma Chemicals, St. Louis, MO, U.S.A.) and serotonin (Nacalai, Japan) were used. We used Paxil ® tablets as paroxetine hydrochroride. Paxil ® tablets contain calcium hydrogen phosphate, sodium carboxymethylstarch, magnesium stearate, hydroxypropyl methylcellulose 2910, macrogol 400, iron and sesquioxide, polysorbate 80, titanium dioxide. However, these ingredients were not enough to express their actions. A dose of 50 mg/kg of aspirin was selected as low-dose aspirin.9) Low-dose aspirin was suspended and paroxetine and indomethacin were dissolved in the distillated water, and we administrated them (2 ml/kg) orally, and serotonin was subcutaneously administered at 1, 5 or 10 ml/kg. Distillated water (2 ml/kg) or saline (5 ml/kg) were orally or subcutaneously administered to the control animals.Determination of Gastric Acid Secretion In order to measure the gastric acid secretion, a pylorus-ligation method was used. A pylorus ligature was performed 30 min after orally or subcutaneously administration of the drugs. Paroxetine (1, 3 or 10 mg/kg) or serotonin (1, 5 or 10 mg/kg) was selected as proper doses from many published papers. Animals were sacrificed 2 h after pylorus ligature by cervical dislocation, the abdomen was opened and oesophagus was held by clamp. The stomach was removed, and was inspected external apparence. Its content was drained into a centrifuge tube and centrifuged at 3000 rpm for 5 min. The supernatant volume was measured with micropipette and pH was recorded with a digita...

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A Metaregression Analysis of the Dose-Response Effect of Aspirin on Stroke

Abstract: Aspirin reduces the risk of stroke by approximately 15%, and this effect is uniform across aspirin doses from 50 to 1500 mg/d. The lowest effective aspirin dose has not yet been identified, but it could be lower than 50 mg/d.

Cited by 180 publications

References 24 publications

Accurate, practical and cost-effective assessment of carotid stenosis in the UK

Accurate, practical and cost-effective assessment of carotid stenosis in the UK

Clinical effectiveness and cost-effectiveness of clopidogrel and modified-release dipyridamole in the secondary prevention of occlusive vascular events: a systematic review and economic evaluation

The Coadministration of Paroxetine and Low-Dose Aspirin Synergistically Enhances Gastric Ulcerogenic Risk in Rats

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