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Latest & greatest articles for aspirin
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Acetylsalicylic acid (ASA) more commonly known as aspirin is a painkiller that has a wide range of uses. It is frequently used to treat fever, mild pain, tooth aches, headaches and muscle aches. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) and can be used in the management of conditions such as heart attack, arthritis, blood clots and stroke. Aspirin, has been used for thousands of years, initially extracted from the leaves of willow trees.
Aspirin works in much the same way as other NSAIDs but has additional properties, such as antiplatelet activity which can make it additionally useful. More recently aspirin has been linked with cancer prevention. But the potential benefits of aspirin need to be weighed against the potential side effects, which includes gastrointestinal bleeding and Reye’s syndrome. It should be noted that aspirin should not be used in people who are allergic to drugs such as ibuprofen or a more generalized intolerance to NSAIDs. It should also be used cautiously in asthmatics and/or those with bronchospasm associated with NSAID use.
Research evidence, clinical trials and guidelines on Aspirin
Use of Low-Dose Aspirin and Mortality After Prostate Cancer Diagnosis: A Nationwide Cohort Study. Recent studies suggest that aspirin use may improve survival in patients with prostate cancer.To assess the association between postdiagnosis use of low-dose aspirin and prostate cancer mortality.Nationwide cohort study.Denmark.Men with incident prostate adenocarcinoma between 2000 and 2011.Nationwide registry data on tumor characteristics, drug use, primary prostate cancer therapy, comorbidity (...) , and socioeconomic parameters. Postdiagnosis use of low-dose aspirin (75 to 150 mg) was defined as 2 or more prescriptions filled within 1 year after prostate cancer diagnosis. Follow-up started 1 year after prostate cancer diagnosis. In secondary analyses, low-dose aspirin use was assessed within exposure periods of 5 or 7.5 years after prostate cancer diagnosis.Of 29 136 patients (median age, 70 years), 7633 died of prostate cancer and 5575 died of other causes during a median follow-up of 4.9 years
Predicting Bleeding Risk to Guide Aspirin Use for the Primary Prevention of Cardiovascular Disease: A Cohort Study. Many prognostic models for cardiovascular risk can be used to estimate aspirin's absolute benefits, but few bleeding risk models are available to estimate its likely harms.To develop prognostic bleeding risk models among persons in whom aspirin might be considered for the primary prevention of cardiovascular disease (CVD).Prospective cohort study.New Zealand primary care.The study (...) cohort comprised 385 191 persons aged 30 to 79 years whose CVD risk was assessed between 2007 and 2016. Those with indications for or contraindications to aspirin and those who were already receiving antiplatelet or anticoagulant therapy were excluded.For each sex, Cox proportional hazards models were developed to predict major bleeding risk; participants were censored at the earliest of the date on which they first met an exclusion criterion, date of death, or study end date (30 June 2017). The main
Prediction of individual life-years gained without cardiovascular events from lipid, blood pressure, glucose, and aspirin treatment based on data of more than 500 000 patients with Type 2 diabetes mellitus Although group-level effectiveness of lipid, blood pressure, glucose, and aspirin treatment for prevention of cardiovascular disease (CVD) has been proven by trials, important differences in absolute effectiveness exist between individuals. We aim to develop and validate a prediction tool
Rivaroxaban, Aspirin, or Both to Prevent Early Coronary Bypass Graft Occlusion: The COMPASS-CABG Study Patients with recent coronary artery bypass graft (CABG) surgery are at risk for early graft failure, which is associated with a risk of myocardial infarction and death. In the COMPASS (Cardiovascular OutcoMes for People Using Anticoagulation StrategieS) trial, rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily compared with aspirin 100 mg once daily reduced the primary major (...) adverse cardiovascular events (MACE) outcome of cardiovascular death, stroke, or myocardial infarction. Rivaroxaban 5 mg twice daily alone did not significantly reduce MACE.This pre-planned substudy sought to determine whether the COMPASS treatments are more effective than aspirin alone for preventing graft failure and MACE after CABG surgery.The substudy randomized 1,448 COMPASS trial patients 4 to 14 days after CABG surgery to receive the combination of rivaroxaban plus aspirin, rivaroxaban alone
Aspirin reduces a woman’s chance of developing pre-eclampsia in pregnancy Aspirin reduces a woman’s chance of developing pre-eclampsia in pregnancy Discover Portal Discover Portal Aspirin reduces a woman’s chance of developing pre-eclampsia in pregnancy Published on 31 October 2017 doi: Giving low dose aspirin to high-risk women reduced their risk of pre-eclampsia before 37 weeks of pregnancy. Preterm pre-eclampsia developed in 1.6% of women given 150mg aspirin daily compared with 4.3% who took (...) a placebo. Pre-eclampsia is a condition which can harm mother and baby. In the mother, it causes high blood pressure and protein in the urine, which can show in pregnancy after 20 weeks. Women with risk factors, such as previous pre-eclampsia, diabetes or high blood pressure, are often prescribed 75mg aspirin from 12 weeks onwards. This study aimed to test double this dose (still classified as a `low dose’) after using a new risk assessment with additional clinical tests to better identify those at high
Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding Discover Portal Discover Portal Rivaroxaban plus aspirin may reduce heart attack and strokes in people with peripheral arterial disease, but with an added risk of bleeding Published on 14 February 2018 doi: People (...) with peripheral arterial disease who took rivaroxaban plus aspirin daily over an average of 21 months reduced their risk of cardiovascular death, heart attack or stroke from seven to five in every 100 people treated compared with those given aspirin alone. The rivaroxaban plus aspirin group also reduced their risk of major limb problems or amputation but increased their risk of bleeding from one to two for every hundred people treated. Peripheral arterial disease is a condition in which the arteries
Daily aspirin reduces pre-eclampsia for ‘at-risk’ women Daily aspirin reduces pre-eclampsia for ‘at-risk’ women Discover Portal Discover Portal Daily aspirin reduces pre-eclampsia for ‘at-risk’ women Published on 24 January 2017 doi: Starting daily low-dose aspirin before 16 weeks of pregnancy in women at risk reduces pre-eclampsia, severe pre-eclampsia and foetal growth restriction. Aspirin started after 16 weeks is less beneficial, giving smaller risk reduction for pre-eclampsia and no effect (...) on other outcomes. Defining who is ‘at risk’ remains challenging. Pre-eclampsia is a rare pregnancy complication, but one that can be dangerous for both mother and baby. Pregnant women are screened for pre-eclampsia risk factors at the antenatal booking appointment. NICE recommend women identified to be at risk are given preventative treatment with 75mg of aspirin from 12 weeks onwards. This large systematic review assessed doses between 50 and 150mg daily and suggests the higher of these low dose
Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery Aspirin may be a follow-on option to prevent blood clots, starting five days after surgery Discover Portal Discover Portal Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery Published on 5 June 2018 doi: In a recent trial, switching to low-dose aspirin was just as effective at preventing blood clots after joint replacement surgery (...) as continuing the anti-clotting drug rivaroxaban. Six per 1,000 people taking aspirin experienced a blood clot, compared with seven per 1,000 taking rivaroxaban. Three to five per 1,000 patients experienced major bleeding with either drug. Rivaroxaban or similar drugs are usually prescribed for two or five weeks after knee or hip surgery, respectively, to reduce the risk of blood clots in the legs or lungs. This trial included over 3,000 adults who received rivaroxaban for the first five days after surgery
Early aspirin reduces stroke recurrence following warning symptoms Early aspirin reduces stroke recurrence following warning symptoms Discover Portal Discover Portal Early aspirin reduces stroke recurrence following warning symptoms Published on 7 July 2016 doi: Aspirin taken as soon as possible after a stroke or symptoms of a stroke reduces the risk of further stroke within the next six weeks by about 60%. This is much better than the 13% reduction previously estimated. People with warning (...) strokes, where symptoms resolve within 24 hours, stand to benefit by self-administering aspirin even before a scan can be organised. This analysis of 12 large randomised controlled trials compared outcomes for adults taking aspirin, other drugs that prevent blood clots and no treatment. Aspirin importantly and significantly reduced the risk of early recurrent stroke in people with warning strokes and strokes perceived as less severe. The results support current recommendations that aspirin should
The benefits and harms of aspirin for people with type 2 diabetes are finely balanced Aspirin benefits and harms balanced in type 2 diabetes Discover Portal Discover Portal The benefits and harms of aspirin for people with type 2 diabetes are finely balanced Published on 4 December 2018 doi: Daily aspirin reduced the risk of serious vascular events among people with diabetes, while increasing the risk of major bleeding to a similar extent. Aspirin prevented one person in every 100 from having (...) a heart attack or stroke over seven years, but an additional person per 100 experienced a major bleed. The ASCEND study is one of three large placebo-controlled trials investigating the effects of 100mg daily aspirin for primary prevention in people without established cardiovascular disease. However, unlike other trials (in healthy older adults), this study found that aspirin had no effect on cancer risk during the study period. The finding supports NICE recommendations that aspirin shouldn’t
The best dose of aspirin for cardiovascular protection may depend on body weight The best dose of aspirin for cardiovascular protection may depend on body weight Discover Portal Discover Portal The best dose of aspirin for cardiovascular protection may depend on body weight Published on 18 December 2018 doi: Low dose aspirin only appears to be effective at preventing stroke or heart attack for people weighing less than 70kg, while higher doses are better for people who weigh over 70kg (...) . Researchers analysed data from 13 trials of aspirin for primary or secondary prevention of cardiovascular events, totalling over 115,000 participants. They found that 75 to 100mg aspirin only benefitted people who weighed less than 70kg, while only those who weighed 70kg or more benefited from doses of 325mg or above. This NIHR-funded trial suggests that prescribing the same dose to people of all weights is unlikely to be ideal and, if aspirin is indicated, dose adjustments by weight are required. UK
Aspirin did not prevent deaths or disability in healthy older adults Aspirin did not prevent deaths or disability in healthy older adults Discover Portal Discover Portal Aspirin did not prevent deaths or disability in healthy older adults Published on 18 December 2018 doi: In the ASPREE trial, older adults with no apparent cardiovascular disease who took daily aspirin saw no benefit in terms of reducing the chance of dying or having dementia or disability. Instead, it slightly increased (...) their mortality and bleeding risk - aspirin was associated with an excess of 1.6 deaths per 1,000 people per year. Half of these deaths were due to cancer. Aspirin is an established ‘secondary’ preventative treatment for people who have known cardiovascular disease. However, the risk-benefit balance of aspirin for ‘primary’ prevention in people without known cardiovascular disease is debated. This large trial enrolled over 19,000 community-dwelling adults aged over 70 years and assigned them to aspirin
Association of Aspirin Use for Primary Prevention With Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-analysis. The role for aspirin in cardiovascular primary prevention remains controversial, with potential benefits limited by an increased bleeding risk.To assess the association of aspirin use for primary prevention with cardiovascular events and bleeding.PubMed and Embase were searched on Cochrane Library Central Register of Controlled Trials from the earliest (...) available date through November 1, 2018.Randomized clinical trials enrolling at least 1000 participants with no known cardiovascular disease and a follow-up of at least 12 months were included. Included studies compared aspirin use with no aspirin (placebo or no treatment).Data were screened and extracted independently by both investigators. Bayesian and frequentist meta-analyses were performed.The primary cardiovascular outcome was a composite of cardiovascular mortality, nonfatal myocardial infarction
Efficacy and safety of aspirin for primary prevention of cardiovascular events: a meta-analysis and trial sequential analysis of randomized controlled trials The role of aspirin in the primary prevention setting is continuously evolving. Recent randomized trials have challenged the role of aspirin in the primary prevention setting.Electronic databases were searched for randomized trials that compared aspirin vs. placebo (or control) in subjects without established atherosclerotic disease (...) . The primary efficacy outcome was all-cause mortality, while the primary safety outcome was major bleeding. Summary estimates were reported using a DerSimonian and Laird random effects model. A total of 11 trials with 157 248 subjects were included. At a mean follow-up of 6.6 years, aspirin was not associated with a lower incidence of all-cause mortality [risk ratio (RR) 0.98, 95% confidence interval (CI) 0.93-1.02; P = 0.30]; however, aspirin was associated with an increased incidence of major bleeding
Clopidogrel plus aspirin versus aspirin alone for acute minor ischaemic stroke or high risk transient ischaemic attack: systematic review and meta-analysis. To assess the effectiveness and safety of dual agent antiplatelet therapy combining clopidogrel and aspirin to prevent recurrent thrombotic and bleeding events compared with aspirin alone in patients with acute minor ischaemic stroke or transient ischaemic attack (TIA).Systematic review and meta-analysis of randomised, placebo controlled (...) considered important, clarification and additional information was sought from the authors. The analysis was conducted in RevMan 5.3 and MAGICapp based on GRADE methodology.Three eligible trials involving 10 447 participants were identified. Compared with aspirin alone, dual antiplatelet therapy with clopidogrel and aspirin that was started within 24 hours of symptom onset reduced the risk of non-fatal recurrent stroke (relative risk 0.70, 95% confidence interval 0.61 to 0.80, I2=0%, absolute risk
Dual antiplatelet therapy with aspirin and clopidogrel for acute high risk transient ischaemic attack and minor ischaemic stroke: a clinical practice guideline. WHAT IS THE ROLE OF DUAL ANTIPLATELET THERAPY AFTER HIGH RISK TRANSIENT ISCHAEMIC ATTACK OR MINOR STROKE? SPECIFICALLY, DOES DUAL ANTIPLATELET THERAPY WITH A COMBINATION OF ASPIRIN AND CLOPIDOGREL LEAD TO A GREATER REDUCTION IN RECURRENT STROKE AND DEATH OVER THE USE OF ASPIRIN ALONE WHEN GIVEN IN THE FIRST 24 HOURS AFTER A HIGH RISK
Interim Guidance: Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer 1 Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer Interim Guidance from the Kaiser Permanente National Integrated Cardiovascular Health (ICVH) Work Group October 5, 2018 Three randomized clinical trials (ARRIVE 1 , ASCEND 2 , and ASPREE 3 ) recently published results on aspirin use in patients without known Atherosclerotic Cardiovascular Disease (ASCVD). The studies looked at benefits (...) including cardiovascular event prevention, and risks including serious bleeding events. Overall the studies suggest that aspirin lacks net benefit (total benefits minus total harms) beyond age 70, and there is low net benefit in younger adults. USPSTF 2016 aspirin recommendations point to highest net benefit for aspirin in adults age 50-59 (lower bleeding risk than older patients) with 10-year ASCVD risk* >10%. The National Kaiser Permanente Aspirin recommendations will be formally updated following
Aspirin in coronary artery surgery: 1-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery trial Aspirin may reduce the risk of vascular graft thrombosis after cardiovascular surgery. We previously reported the 30-day results of a trial evaluating aspirin use before coronary artery surgery. Here we report the 1-year outcomes evaluating late thrombotic events and disability-free survival.Using a factorial design, we randomly assigned patients undergoing coronary artery (...) surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the aspirin comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score < 8. Secondary outcomes included a composite of myocardial infarction, stroke and death from any cause through to 1 year after surgery.Patients were randomly assigned to aspirin (1059 patients) or placebo (1068 patients). The rate
Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial Tranexamic acid reduces blood loss and transfusion requirements in cardiac surgery but may increase the risk of coronary graft thrombosis. We previously reported the 30-day results of a trial evaluating tranexamic acid for coronary artery surgery. Here we report the 1-year clinical outcomes.Using a factorial design, we randomly assigned patients undergoing (...) coronary artery surgery to receive aspirin or placebo and tranexamic acid or placebo. The results of the tranexamic acid comparison are reported here. The primary 1-year outcome was death or severe disability, the latter defined as living with a modified Katz activities of daily living score of less than 8. Secondary outcomes included a composite of myocardial infarction, stroke, and death from any cause through to 1 year after surgery.The rate of death or disability at 1 year was 3.8
Eicosapentaenoic acid and aspirin, alone and in combination, for the prevention of colorectal adenomas (seAFOod Polyp Prevention trial): a multicentre, randomised, double-blind, placebo-controlled, 2 × 2 factorial trial. The omega-3 polyunsaturated fatty acid eicosapentaenoic acid (EPA) and aspirin both have proof of concept for colorectal cancer chemoprevention, aligned with an excellent safety profile. Therefore, we aimed to test the efficacy of EPA and aspirin, alone and in combination (...) randomly allocated (1:1:1:1) using a secure web-based server to receive 2 g EPA-free fatty acid (FFA) per day (either as the FFA or triglyceride), 300 mg aspirin per day, both treatments in combination, or placebo for 12 months using random permuted blocks of randomly varying size, and stratified by BCSP site. Research staff and participants were masked to group assignment. The primary endpoint was the adenoma detection rate (ADR; the proportion of participants with any adenoma) at 1 year surveillance