Aspirin use prevents serious vascular events in diabetics but increases bleeding events


 Aspirin use prevents serious vascular events
in diabetics but increases bleeding events

USA: A recently published study has shown that Aspirin Use Prevents Serious Vascular Events, Increases Major Bleeding Events in Diabetes but is also associated with increased risk of bleeding. In this study, 15,480 participants with diabetes but no evident cardiovascular disease were randomized to receive aspirin 100 mg daily or placebo to assess hazards and benefits for the prevention of first cardiovascular events. Over an average follow-up of 7.4 years, significantly fewer participants taking aspirin reported serious vascular events compared with those in the placebo group. Major bleeding events, specifically gastrointestinal bleeding and extra cranial bleeding, occurred more frequently in the aspirin group. No significant differences in cancer incidence were reported between groups.

These results demonstrate the prevention of serious vascular events with aspirin use; however, these individuals also experienced major bleeding events. The study has been published in New England Journal of Medicine.

A total of 15,480 participants underwent randomization. During a mean follow-up of 7.4 years, serious vascular events occurred in a significantly lower percentage of participants in the aspirin group than in the placebo group (658 participants [8.5%] vs. 743 [9.6%]; rate ratio, 0.88; 95% confidence interval [CI], 0.79 to 0.97; P=0.01). In contrast, major bleeding events occurred in 314 participants (4.1%) in the aspirin group, as compared with 245 (3.2%) in the placebo group (rate ratio, 1.29; 95% CI, 1.09 to 1.52; P=0.003), with most of the excess being gastrointestinal bleeding and other extra cranial bleeding. There was no significant difference between the aspirin group and the placebo group in the incidence of gastrointestinal tract cancer (157 participants [2.0%] and 158 [2.0%], respectively) or all cancers (897 [11.6%] and 887 [11.5%]); long-term follow-up for these outcomes is planned.

The study conclusions were Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events. The absolute benefits were largely counterbalanced by the bleeding hazard.

DOI: 10.1056/NEJMoa1804988 Accessed on August 26, 2018

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