Abstract 19880: Is There an Association between Aspirin Dosing and Cardiac and Bleeding Events in Acute Coronary Syndrome After Stent Placement?: A Systematic Review of the Literature
Background and Aim: Use of stents in patients with acute coronary syndrome (ACS) requires long-term antiplatelet therapy with aspirin and an adenosine diphosphate inhibitor. The aim of this systematic review was to evaluate the association between aspirin dose and the incidence of cardiac and bleeding events in ACS patients following stent placement.
Methods: A systematic review of studies published between January 1995 and February 2010 identified through PubMed, EMBASE, and Current Contents was performed. Eligible studies included clinical trials and observational studies, conducted worldwide, that assessed patients with ACS treated with aspirin for at least 30 days after stent placement. Meta-analyses were performed using random-effects modeling to estimate the frequency of pre-specified clinical efficacy and safety outcomes for high dose aspirin (160mg-325mg) and low dose aspirin (75–159mg). Only uncontrolled comparisons between high- and low-dose aspirin were possible, as comparative data were limited.
Results: Sixty-eight studies, 43 randomized trials, 4 non-randomized comparative studies and 21 cohort studies, enrolling 81,807 patients were included. The mean age was 61.8 years and 74% of patients were male. Proportions of patients experiencing major adverse cardiac event (MACE) were 5.8% and 4.2% at 30 days and 13.3% and 13.4% at 6 months with high and low doses, respectively. This pattern was consistent at 8 and 12 months. Major bleeding proportions at 30 days were 1.9% and 2.1% and at 6 months 2.7% and 2.3% with high and low doses, respectively. Target vessel revascularization proportions at 30 days were 1.6% and 1.5% and at 6 months were 10.4% and 10.1% in the high and low doses, respectively. (Table 1)
Conclusions: In patients with ACS undergoing coronary stenting, there were no differences between high- or low-dose aspirin on the percentage of patients experiencing MACE, target vessel revascularization, and bleeding at 30 days and up to 6 months.
- © 2010 by American Heart Association, Inc.