Last week, we reviewed the ASPREE trial on the effects of aspirin in healthy older adults. Prior to that, the ASCEND study was published in the NEJM on Aug 26, 2018, looking at the balance of benefits and hazards for the prevention of first cardiovascular events in patients with diabetes (for access to the article, see our Quick Links section).
Cardiovascular events are defined as the "first serious vascular event - myocardial infarction, stroke or transient ischemic attack, or death from any vascular cause, excluding any confirmed intracranial hemorrhage."
Bleeding events are defined as the "first major bleeding event - intracranial hemorrhage, sight-threatening bleeding event in the eye, gastrointestinal bleeding, or other serious bleeding." They also looked at secondary outcomes including gastrointestinal tract cancer.
The conclusion was: “The absolute benefits were largely counterbalanced by the bleeding hazard.”
The use of low-dose aspirin did not result in a lower risk of gastrointestinal tract cancer or other cancer over the mean follow-up of 7.4 years, but further follow-up is needed to assess any longer-term effects on cancer reliably.
The study was supported by grants to the University of Oxford from the British Heart Foundation and by Bayer (Germany and the United States), Solvay, Abbott, and Mylan.
As far as how we apply this information in our practices, it bears keeping in mind the following quote from the iBook
How to Critically Appraise an RCT in 10 Minutes
by James McCormack, Professor Faculty of Pharmaceutical Science at UBC:
“Evidence
doesn't
make decisions. It can only
inform
a decision. Evidence based health care has been defined as the integration of best research
evidence
with
clinical expertise
and
patient values.
Critical Appraisal just allows you to understand the best available research in a more complete way. It doesn’t give you an answer.”
McCormack and Dr. Michael Allan, Associate Professor in the Department of Family Practice at the University of Alberta host a weekly podcast on various drug therapy topics. Find more information about Dr. McCormack's iBook and his podcast with Dr. Allen by visiting our Quick Links section!
