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June 6, 2012

Hemorrhagic Complications Associated With Aspirin: An Underestimated Hazard in Clinical Practice?

Author Affiliations

Author Affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria.

JAMA. 2012;307(21):2318-2320. doi:10.1001/jama.2012.6152

Aspirin is widely used for primary and secondary prevention of cardiovascular events. Substantial scientific evidence supports the beneficial role of aspirin in reducing the risk of cardiovascular events in secondary prevention.1,2 In a meta-analysis including 135 000 patients considered to be at high risk for vascular events (90% with known coronary artery disease, cerebral artery disease, or peripheral artery disease), aspirin was associated with a reduced relative risk of vascular events (myocardial infarction, stroke, and vascular death) by 22% (absolute risk reduction [ARR], 2.5%) but also was associated with an increased relative risk of major extracranial bleeding events by 60% (absolute risk increase [ARI], 0.42%).1 In another meta-analysis, aspirin used for secondary prevention was associated with a reduced relative risk of myocardial infarction by 31%, ischemic stroke by 22%, and cardiovascular death by 13%.2