Low-Dose versus High-Dose Aspirin after Percutaneous Coronary Intervention: Analysis from the Guthrie Health Off-Label StenT (GHOST) Registry

Harjai, Kishore J.; Shenoy, Chetan; Orshaw, Pam; Usmani, Samer; Singh, Maninder; Boura, Judy; Mehta, Rajendra H.

doi:10.1111/j.1540-8183.2011.00627.x

Cited by 10 publications

(10 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Eight more articles were eliminated: one article was a systematic review of the literature, two article did not report adverse clinical outcomes and two articles which could probably satisfy the inclusion and exclusion criteria of our study were not made available by the authors, one article did not include data which could be used in this analysis, and another two trials were the subset of other trials included in this analysis. Finally, four articles (3 trials and 1 observational study) [4, 10–13] were included in this systematic review and meta-analysis. The flow diagram for the study selection has been represented in Fig.…”

Section: Resultsmentioning

confidence: 99%

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

Bundhun

Janoo

Teeluck

et al. 2016

BMC Cardiovasc Disord

View full text Add to dashboard Cite

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.

show abstract

Section: Resultsmentioning

confidence: 99%

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

Bundhun

Janoo

Teeluck

et al. 2016

BMC Cardiovasc Disord

View full text Add to dashboard Cite

show abstract

“…There is an abundance of data comparing the clinical efficacy of aspirin 81 mg versus aspirin 325 mg [12, [35][36][37][38][39][40][41][42][43]. Most of these data come from indirect comparisons and observational data (Table 1).…”

Section: Efficacy Comparisons Of 75-100 Versus 300-325 Mgmentioning

confidence: 98%

Optimal Aspirin Dose in Acute Coronary Syndromes: an Emerging Consensus

et al. 2014

View full text Add to dashboard Cite

Numerous clinical trials testing the efficacy of aspirin for the secondary prevention of cardiovascular disease have been published. We reviewed the literature pertaining to aspirin dose in acute coronary syndrome patients. Clinical trials assessing the comparative efficacy of different doses of aspirin are scarce. This complex antiplatelet therapy landscape makes it difficult to identify the best aspirin dose for optimizing efficacy and minimizing risk of adverse events, while complying with the various guidelines and recommendations. Despite this fact, current evidence suggests that aspirin doses of 75-100 mg/day may offer the optimal benefit:risk ratio in acute coronary syndrome patients.

show abstract

“…Moreover, many randomized clinical trials have demonstrated the efficacy of dual antiplatelet therapy, aspirin plus a thienopyridine, in patient undergoing PCI, but there is a paucity of data on the optimal dose of aspirin following PCI, leading to wide disparities in guideline-recommended doses and doses used in con- [40] both recommend aspirin at a dose of 75-100 mg daily following PCI with both bare metal and drug-eluting stents. Recent analyses show that low-dose aspirin (81 mg daily) is as efficacious as highdose aspirin (160-325 mg daily) in the prevention of ischemic events following PCI, but with less bleeding compared with increasing aspirin doses [41][42][43].…”

Section: Percutaneous Coronary Interventionmentioning

confidence: 99%

Clinical Use of Aspirin in Ischemic Heart Disease: Past, Present and Future

Caterina¹,

Renda²

2012

CPD

View full text Add to dashboard Cite

Aspirin is an antiplatelet drug, inhibiting the cyclooxygenase activity of platelet prostaglandin H synthase-1 and almost complete suppressing platelet capacity to generate the prothrombotic and proatherogenic thromboxane A2. Antiplatelet therapy with aspirin reduces the risk of serious vascular events by about a quarter in patients who are at high risk because they already have occlusive vascular disease. However, the inhibition of thromboxane-dependent platelet function by aspirin is effective for the prevention of thrombosis, but is also associated with excess bleeding, although the absolute increase in major gastrointestinal or other major extracranial bleeds is an order of magnitude smaller. For secondary prevention of vascular events, the benefits of aspirin therapy substantially exceed the risks. Therefore, aspirin is a cornerstone of antithrombotic therapy in acute coronary syndromes, in chronic ischemic heart disease and in percutaneous coronary intervention. On the other hand, the role of aspirin in primary prevention remains uncertain and it is still debated, because the absolute risk of vascular complications is the major determinant of the absolute benefit of antiplatelet prophylaxis and the reduction in vascular events needs to be weighed against any increase in major bleeds. Future data from ongoing studies will help us to identify people at high vascular risk who take advantage from aspirin therapy for primary prevention or will indicate if specific category of high risk patients, like patients with diabetes, could be better protected from an increase in the frequency of aspirin administration.

show abstract

Low-Dose versus High-Dose Aspirin after Percutaneous Coronary Intervention: Analysis from the Guthrie Health Off-Label StenT (GHOST) Registry

Abstract: Low-dose aspirin, as prescribed in this study of routine practice, was not associated with worse outcomes compared to high-dose aspirin. (J Interven Cardiol 2011;24:307-314).

Cited by 10 publications

References 23 publications

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

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

Optimal Aspirin Dose in Acute Coronary Syndromes: an Emerging Consensus

Clinical Use of Aspirin in Ischemic Heart Disease: Past, Present and Future

Contact Info

Product

Resources

About