In Reply: Drs Takagi and Umemoto address the potential influence of publication bias in our meta-analysis of aspirin for secondary prevention in patients with PAD and suggest the use of a trim and fill adjustment. We calculated this adjustment using Stata 10.1 (metatrim from STB-61, sbe39.2; StataCorp, College Station, Texas) and did not find any change to the results reported in our article (pooled RR, 0.64; 95% CI, 0.42-0.99). Because there are several approaches to this adjustment, other software packages may give different results. However, trim and fill adjustment will not remove other forms of selection bias, particularly when component studies are heterogeneous1 (as was the case in our meta-analysis).
Kittelson JM, Krantz MJ, Hiatt WR. Aspirin for Prevention of Stroke and Cardiovascular Events Among Patients With Peripheral Artery Disease—Reply. JAMA. 2009;302(11):1165-1166. doi:10.1001/jama.2009.1326