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Relation between aspirin dose, all-cause mortality, and bleeding in patients with recent cerebrovascular or coronary ischemic events (from the bravo trial)

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Overview

authors

  • Aronow, H. D.
  • Califf, R. M.
  • Harrington, R. A.
  • Vallee, M.
  • Graffagnino, C.
  • Shuaib, A.
  • Fitzgerald, D. J.
  • Easton, J. D.
  • Van de Werf, F.
  • Diener, H. C.
  • Ferguson, J.
  • Koudstaal, P. J.
  • Amarenco, P.
  • Theroux, P.
  • Davis, S.
  • Topol, Eric
  • Investigators, Bravo Trial

publication date

  • November 2008

journal

  • American Journal of Cardiology  Journal

abstract

  • Despite aspirin's established role in the treatment of atherosclerotic vascular disease, considerable controversy exists regarding its most effective dosing strategy. In a retrospective observational study, we examined the relation between prescribed aspirin dose (<162 mg vs > or =162 mg/day aspirin) and clinical outcome in 4,589 placebo-treated patients enrolled in the Blockage of the Glycoprotein IIb/IIIa Receptor to Avoid Vascular Occlusion (BRAVO) trial over a median follow-up of 366 days. Standard Cox regression analysis was employed because propensity analysis was not feasible. Compared with lower aspirin doses, higher doses were associated with lower unadjusted all-cause mortality (2.9 vs 1.6%, respectively; log rank chi-square 8.6, p = 0.0034). Higher aspirin dose remained independently predictive of lower all-cause mortality in a multivariable Cox proportional hazards model (hazard ratio 0.64, 95% confidence interval 0.42 to 0.97, p = 0.037). However, there was no significant difference in the incidence of the composite endpoint death, nonfatal myocardial infarction, or nonfatal stroke (6.1% vs 6.2%, p = 0.74). Higher aspirin dose was a significant independent predictor of any (hazard ratio 1.32, 95% confidence interval 1.12 to 1.55, p = 0.001) but not serious bleeding. In conclusion, our findings suggest that aspirin doses of > or =162 mg/day may be more beneficial than those <162 mg/day at preventing death.

subject areas

  • Aged
  • Aspirin
  • Cause of Death
  • Coronary Disease
  • Female
  • Fibrinolytic Agents
  • Hemorrhage
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Stroke
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Identity

International Standard Serial Number (ISSN)

  • 0002-9149

Digital Object Identifier (DOI)

  • 10.1016/j.amjcard.2008.07.019

PubMed ID

  • 18993142
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Additional Document Info

start page

  • 1285

end page

  • 1290

volume

  • 102

issue

  • 10

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