Adverse clinical outcomes associated with a low dose and a high dose of aspirin following percutaneous coronary intervention: a systematic review and meta-analysis

Abstract

BackgroundGuidelines from the American Heart Association/American College of Cardiology recommend a higher dosage of aspirin daily following Percutaneous Coronary Intervention (PCI), whereas guidelines from the European Society of Cardiology recommend a lower dosage. This study aimed to compare the adverse clinical outcomes associated with a low dose and a high dose of aspirin following PCI.MethodsElectronic databases were searched for studies comparing a low dose with a high dose aspirin following PCI. Adverse clinical outcomes were considered as the endpoints in this study. We calculated Odds Ratios (OR) with 95 % Confidence Intervals (CIs) for categorical variables. The pooled analyses were performed with RevMan 5.3 software.ResultsA total number of 25,083 patients were included. Results from this analysis showed that the combination of Cardiovascular (CV) death/Myocardial Infarction (MI) or stroke was not significantly different between a low and high dose of aspirin with OR: 1.08, 95 % CI: 0.98–1.18; P = 0.11. Mortality and MI were also not significantly different between these two treatment regimens following PCI with OR: 0.95, 95 % CI: 0.74–1.23; P = 0.71 and OR: 1.17, 95 % CI: 0.97–1.41; P = 0.09 respectively. However, a high dose of aspirin was associated with a significantly higher rate of Major Adverse Cardiac Events (MACEs) with OR: 1.20, 95 % CI: 1.02–1.41; P = 0.03. Thrombolysis In Myocardial Infarction (TIMI) defined minor bleeding was also significantly higher with a high dose aspirin with OR: 1.22, 95 % CI: 1.02–1.47; P = 0.03. When Stent thrombosis (ST) was compared, no significant difference was found with OR: 1.28, 95 % CI: 0.59–2.58; P = 0.53. Even if TIMI defined major bleeding favored a low dose of aspirin, with OR: 1.42, 95 % CI: 0.95–2.13; P = 0.09, or even if major bleeding was insignificantly higher with a high dose aspirin, with OR: 1.78, 95 % CI: 1.01–3.13; P = 0.05; I2 = 94 %, higher levels of heterogeneity observed in these subgroups could not be considered significant to any extent.ConclusionAccording to the results of this analysis, a high dose of aspirin following PCI was not associated with any significantly higher rate of CV death/MI/stroke, mortality or MI. However, MACEs significantly favored a low dose of aspirin. In addition, TIMI defined minor bleeding was significantly higher with a high dose of aspirin whereas the results for the major bleeding outcomes were not statistically significant. However, due to limited data availability and since the subgroups analyzing major bleeding were highly heterogeneous, further studies are recommended to completely solve this issue.

Low-Dose Aspirin Is Adequate for Venous Thromboembolism Prevention Following Total Joint Arthroplasty: A Systematic Review

“…Although we expected a higher incidence of major bleeding associated with high-dose aspirin compared to low-dose aspirin, our data did not show any difference in major bleeding between the 2 doses. A prior study found that high-dose aspirin had significantly more Thrombolysis in Myocardial Infarction (TIMI) defined minor bleeding after percutaneous coronary intervention compared to low-dose aspirin [66]. Laine et al [79] did not find an increase in gastric ulceration when low-dose aspirin (81 mg/d) was used in osteoarthritic patients for 12 weeks.…”

“…A systematic review and meta-analysis by Bundhun et al investigated the clinical outcomes after treatment of high-dose vs low-dose aspirin following percutaneous coronary intervention. The study found a higher association of major adverse cardiac events such as death, myocardial infarction (MI), and revascularization when high-dose aspirin was given compared to low-dose aspirin [66]. Additionally, Taylor et al [67] found a decreased risk of stroke, MI, and death within 30 days and 3 months after carotid endarterectomy when patients were treated with low doses of aspirin (81 or 325 mg/d) compared to higher doses (650 or 1300 mg/d).…”

Impact of right coronary dominance on triple-vessel coronary artery disease

“…[ 25 ] Previous guidelines of CAD treatment emphasised on emergency treatment PCI treatment should be supplemented with antiplatelet agents, which may prevent formation of coronary thrombus. [ 26 , 27 ] CAG is also used to detect coronary artery stenosis, and it shows the coronary dominance at the same time. [ 28 ] Scoring system was usually used to evaluated the severity of coronary artery stenosis in clinical practice.…”

Biodegradable polymer drug-eluting stents versus first-generation durable polymer drug-eluting stents

“…However, these adverse outcomes might not always be dependent on the types of stents that were implanted. Several other studies have shown that the types of patients who were involved, [ 28 , 29 ] age of the patients, the comorbidities, and complications which were present before or following PCI, [ 30 – 32 ] the types of anti-platelets that were used and the duration period of DAPT, [ 33 , 34 ] the dosage of aspirin that was used, [ 35 ] could all contribute to and have a great impact on the adverse clinical outcomes following PCI.…”