Low-dose aspirin as effective as higher dose after percutaneous coronary
intervention — and safer
Patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) experience similarly low rates of cardiovascular events with low-dose aspirin as those treated with higher doses, but with less risk of major bleeding, according to results from a major study.
A sub-analysis of the PCI-CURE study compared the safety and efficacy
of low (<=100mg), intermediate (101–199mg) and high (>=200mg)
doses of aspirin in 2,658 patients with ACS undergoing PCI.
Data presented earlier this week at the American
College of Cardiology 56th Annual Scientific Session, held in New
Orleans, Louisiana, reveal similar rates of cardiovascular death, myocardial
infarction or stroke
in all of the aspirin dose groups at 30 days and at eight months (4.1
per cent with <=100mg aspirin versus 4.0 per cent with >=200mg
at 30 days).
The incidence of major bleeding was not significantly different between
the groups at 30 days (1.5 per cent with <=100mg aspirin versus 2.1
per cent with >=200mg), but was noticeably reduced with low-dose
aspirin after eight months (1.9 per cent with <=100mg aspirin versus
3.9 per cent with >=200mg; hazard ratio 2.21, 95 per cent confidence
interval 1.25–3.89).
Shamir Mehta, associate professor of medicine at McMaster University,
Canada, and one of the study investigators, said that the data warranted
further investigation, particularly since higher doses of aspirin tend
to be used routinely in the US, while lower doses are prescribed in post-PCI
patients in Europe.
Dr Mehta has started a large randomised trial, known as CURRENT-OASIS
7, recruiting 16,000 patients from more than 40 countries to answer definitively
the question of optimal aspirin dose.
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