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December 9, 1998

Individualizing Aspirin Therapy for Prevention of Cardiovascular Events

Author Affiliations

From the Clinical Pharmacology Department, Hôpital Neuro-Cardiologique, Lyon, France.

JAMA. 1998;280(22):1949-1950. doi:10.1001/jama.280.22.1949

In this issue of THE JOURNAL, He and colleagues1 present the results of a meta-analysis on the risk of hemorrhagic stroke in patients treated with aspirin at the regimens currently prescribed for the prevention of carotid, coronary, or peripheral artery thrombotic occlusion. This review of a subset of 16 randomized controlled trials of aspirin for the prevention of cerebrovascular accidents, involving more than 55,000 patients, confirms that aspirin, even at the average dosage of 273 mg/d (range, 75-1500 mg/d), increases the risk of cerebral bleeding. Even though the main finding of this study is not new, important lessons can be drawn from this work. First, He et al1 provide a quantitative estimate of the excess risk due to aspirin instead of the vague notion that the risk is increased. This is another example of a useful application of the meta-analytic approach for evaluation of adverse events, ie, to assess the unbiased excess hazards over their natural occurrence when no single trial can sort out excess risk because the trial is sized for showing an efficacy.2 Furthermore, this estimate is obtained from the same patients as those in whom the benefit is measured, thus giving more relevance to the comparison of benefit and risk.

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