Two meta-analyses compare aspirin to alternative medications
One study found that P2Y12 inhibitors reduced cardiovascular events more than aspirin after percutaneous coronary intervention, while another found that apixaban was associated with similar risk of intracranial bleeding as aspirin in patients treated for stroke prevention.
Two recent studies found better outcomes with alternatives to aspirin.
The first study compared P2Y12 inhibitors and aspirin for patients with coronary artery disease for long term prevention. Researchers analyzed individual patient data from five randomized clinical trials involving 16,117 patients assigned to either aspirin or clopidogrel or ticagrelor after completing dual antiplatelet therapy following percutaneous coronary intervention. Results were published June 4 by The BMJ.
Overall, after four years of follow-up, P2Y12 inhibitor therapy was associated with a 23% lower risk of a composite outcome of cardiovascular death, heart attack, or stroke compared with aspirin, with no significant difference in major bleeding. The number needed to treat was 46 to prevent one cardiovascular death, heart attack, or stroke. When outcomes were assessed individually, P2Y12 inhibitor therapy reduced heart attacks and stroke compared with aspirin. However, all-cause death, cardiovascular death, and stent thrombosis were similar between treatments. Results were consistent after accounting for age, sex, geographic region, smoking, previous heart attack or stroke, underlying conditions, and medication history.
An editorial observed that the study results support “preferential prescription of P2Y12 inhibitor monotherapy over aspirin” due to reductions in major adverse cardiac and cerebrovascular events without any increase in major bleeding.
The other meta-analysis compared intracranial hemorrhage risk with apixaban versus aspirin. It included three trials comparing apixaban with aspirin for ischemic stroke prevention, with 10,626 patients and 74 intracranial hemorrhage events. Results were published as a brief report by Stroke on June 4.
The relative risk of intracranial hemorrhage with apixaban versus aspirin was 0.67 (95% CI, 0.43 to 1.08) (P=0.10). The findings were consistent in sensitivity analyses, in analyses limited to primary prevention trials, and in analyses using the outcome of hemorrhagic stroke (relative risk, 0.72 [95% CI, 0.39 to 1.31]; P=0.28). The authors concluded that intracranial hemorrhage rates were comparable or lower with apixaban compared with aspirin therapy, with confidence intervals ruling out a clinically significant increase in risk.