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Meta-Analysis
. 2020 Jan;15(1):9-17.
doi: 10.1177/1747493019858780. Epub 2019 Jun 25.

Aspirin for primary prevention of stroke in individuals without cardiovascular disease-A meta-analysis

Conor Judge  1   2   3 , Sarah Ruttledge  1 , Robert Murphy  1 , Elaine Loughlin  1 , Sarah Gorey  1 , Maria Costello  1 , Aoife Nolan  1 , John Ferguson  1 , Martin O Halloran  2 , Michelle O'Canavan  1 , Martin J O'Donnell  1
Affiliations
Meta-Analysis

Aspirin for primary prevention of stroke in individuals without cardiovascular disease-A meta-analysis

Conor Judge et al. Int J Stroke. 2020 Jan.

Abstract

Background: The benefits of aspirin for primary prevention of stroke are uncertain.

Methods: We performed a cumulative meta-analysis of trials investigating aspirin for primary prevention of cardiovascular disease with a focus on stroke. We assessed the effects of aspirin on non-fatal stroke, hemorrhagic stroke, non-fatal myocardial infarction, all-cause mortality, cardiovascular mortality, major gastrointestinal bleeding, and an analysis of net clinical effect, in populations without a history of clinical or subclinical cardiovascular disease.

Summary of review results: Among 11 trials (157,054 participants), aspirin was not associated with a statistically significant reduction in non-fatal stroke (odds ratio, 0.94; 95% CI, 0.85 to 1.04) but was associated with an increased risk of hemorrhagic stroke (odds ratio, 1.29; 95% CI, 1.06 to 1.56). Aspirin was not associated with a statistically significant reduction in all-cause mortality (odds ratio, 0.97; 95% CI, 0.92 to 1.03) or cardiovascular mortality (odds ratio, 0.94; 95% CI, 0.85 to 1.03). Aspirin was associated with a reduction in non-fatal myocardial infarction (odds ratio, 0.80; 95% CI, 0.69 to 0.94) and an increased risk of major gastrointestinal bleeding (odds ratio, 1.83; 95% CI, 1.43 to 2.35). Using equal weighting for non-fatal events and major bleeding, we observed no net clinical benefit with aspirin use for primary prevention.

Conclusion: Our meta-analysis reports no benefit of aspirin for primary stroke prevention.

Keywords: Stroke; aspirin; cardiovascular; prevention.

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Figures

Figure 1.
Figure 1.
Aspirin for primary cardiovascular prevention and benefit for non-fatal stroke. Forest plot for non-fatal stroke. Forest plot showing the effect of aspirin therapy on non-fatal stroke. The squares and bars represent the mean values and 95% confidence intervals of the effect sizes, while the size of the squares reflects the weight of the studies. The combined effects appear as diamonds and the vertical dashed line represents the line of no effect.
Figure 2.
Figure 2.
Aspirin for primary cardiovascular prevention and benefit for hemorrhagic stroke. Forest plot for hemorrhagic stroke. Forest plot showing the effect of aspirin therapy on hemorrhagic stroke. The squares and bars represent the mean values and 95% confidence intervals of the effect sizes, while the size of the squares reflects the weight of the studies. The combined effects appear as diamonds and the vertical dashed line represents the line of no effect.
Figure 3.
Figure 3.
Aspirin for primary cardiovascular prevention and benefit for non-fatal myocardial infarction. Forest plot for non-fatal myocardial infarction. Forest plot showing the effect of aspirin therapy on non-fatal myocardial infarction. The squares and bars represent the mean values and 95% confidence intervals of the effect sizes, while the size of the squares reflects the weight of the studies. The combined effects appear as diamonds and the vertical dashed line represents the line of no effect.
Figure 4.
Figure 4.
Aspirin for primary cardiovascular prevention and benefit for all-cause mortality. Forest plot for all-cause mortality. Forest plot showing the effect of aspirin therapy on all-cause mortality. The squares and bars represent the mean values and 95% confidence intervals of the effect sizes, while the size of the squares reflects the weight of the studies. The combined effects appear as diamonds and the vertical dashed line represents the line of no effect.
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