Latest & greatest articles for aspirin

The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on aspirin or other clinical topics then use Trip today.

This page lists the very latest high quality evidence on aspirin and also the most popular articles. Popularity measured by the number of times the articles have been clicked on by fellow users in the last twelve months.

What is Trip?

Trip is a clinical search engine designed to allow users to quickly and easily find and use high-quality research evidence to support their practice and/or care.

Trip has been online since 1997 and in that time has developed into the internet’s premier source of evidence-based content. Our motto is ‘Find evidence fast’ and this is something we aim to deliver for every single search.

As well as research evidence we also allow clinicians to search across other content types including images, videos, patient information leaflets, educational courses and news.

For further information on Trip click on any of the questions/sections on the left-hand side of this page. But if you still have questions please contact us via jon.brassey@tripdatabase.com

Aspirin

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

The Trip Database has an extensive collection of articles on aspirin ranging from clinical trials, systematic reviews, clinical guidelines and case reports. These can be found via searching the site.

Top results for aspirin

1. Comparison of the Effect of Age (< 75 Versus >/= 75) on the Efficacy and Safety of Dual Therapy (Dabigatran+Clopidogrel or Ticagrelor) Versus Triple Therapy (Warfarin+Aspirin+Clopidogrel or Ticagrelor) in Patients With Atrial Fibrillation After Percutaneo Full Text available with Trip Pro

Comparison of the Effect of Age (< 75 Versus >/= 75) on the Efficacy and Safety of Dual Therapy (Dabigatran+Clopidogrel or Ticagrelor) Versus Triple Therapy (Warfarin+Aspirin+Clopidogrel or Ticagrelor) in Patients With Atrial Fibrillation After Percutaneo Comparison of the Effect of Age ( - PubMed This site needs JavaScript to work properly. Please enable it to take advantage of the complete set of features! Welcome to the new PubMed. For legacy PubMed go to . Clipboard, Search History (...) Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. 10 Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden. PMID: 31924322 DOI: Item in Clipboard Full-text links Cite Abstract The RE-DUAL PCI trial reported that dabigatran dual therapy (110/150 mg twice daily, plus clopidogrel or ticagrelor) reduced bleeding events versus warfarin triple therapy (warfarin plus aspirin and clopidogrel or ticagrelor) in patients with atrial

2020 EvidenceUpdates

2. Clopidogrel / Acetylsalicylic acid Mylan

/Acetylsalicylic acid Mylan contains two active substances, clopidogrel and acetylsalicylic acid (also known as aspirin) and is a ‘generic medicine’. This means that Clopidogrel/Acetylsalicylic acid Mylan contains the same active substance and works in the same way as a ‘reference medicine’ already authorised in the EU called DuoPlavin. For more information on generic medicines, see the question-and-answer document here. How is Clopidogrel/Acetylsalicylic acid Mylan used? The medicine is available as tablets (...) Clopidogrel / Acetylsalicylic acid Mylan Official address Domenico Scarlattilaan 6 ? 1083 HS Amsterdam ? The Netherlands An agency of the European Union Address for visits and deliveries Refer to www.ema.europa.eu/how-to-find-us Send us a question Go to www.ema.europa.eu/contact Telephone +31 (0)88 781 6000 © European Medicines Agency, 2020. Reproduction is authorised provided the source is acknowledged. EMA/628773/2019 EMEA/H/C/004996 Clopidogrel/Acetylsalicylic acid Mylan (clopidogrel

2020 European Medicines Agency - EPARs

3. Kaiser Permanente National Aspirin Clinician Guide

Kaiser Permanente National Aspirin Clinician Guide This Clinician Guide expires within two years of the posted month. 1 See National Clinical Library for current version (https://cl.kp.org). Aspirin Clinician Guide October 2018 Introduction These recommendations were developed to assist primary care physicians and other clinicians in aspirin use. The KP National Integrated Cardiovascular Health Guideline team adopted the 2016 aspirin recommendations developed by the United States Preventive (...) Services Task Force (USPSTF) on “Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: Preventive Medication” for patients without Atherosclerotic Cardiovascular Disease (ASCVD). It is not intended or designed as a substitute for the reasonable exercise of independent clinical judgment by practitioners. Aspirin Therapy at 81 mg Orally Daily for Adults without ASCVD Risk Assessment ? 10-year ASCVD Risk is risk of fatal or nonfatal myocardial infarctions or strokes in adults. A region may

2019 Kaiser Permanente National Guideline Program

4. Major Bleeding in Patients With Coronary or Peripheral Artery Disease Treated With Rivaroxaban Plus Aspirin Full Text available with Trip Pro

Major Bleeding in Patients With Coronary or Peripheral Artery Disease Treated With Rivaroxaban Plus Aspirin In patients with coronary or peripheral artery disease, the combination of rivaroxaban 2.5 mg twice daily and aspirin 100 mg once daily compared with aspirin 100 mg once daily reduced major adverse cardiovascular events and mortality and increased bleeding.This study sought to explore the effects of the combination of rivaroxaban and aspirin compared with aspirin on sites, timing (...) to the combination of rivaroxaban and aspirin or to aspirin alone and followed for a mean of 23 months. Compared with aspirin alone, the combination increased modified International Society on Thrombosis and Hemostasis major bleeding (288 of 9,152 [3.1%] vs. 170 of 9,126 [1.9%]), (HR: 1.70; 95% CI: 1.40 to 2.05; p < 0.001), International Society on Thrombosis and Hemostasis major bleeding (206 of 9,152 [2.3%] vs. 116 of 9,126 [1.3%]), (HR: 1.78; 95% CI: 1.41 to 2.23; p < 0.0001), and minor bleeding (838 of 9,152

2019 EvidenceUpdates

5. Acetylsalicylic Acid for Primary Prevention of Cardiovascular Events: Clinical Effectiveness and Guidelines

Acetylsalicylic Acid for Primary Prevention of Cardiovascular Events: Clinical Effectiveness and Guidelines Acetylsalicylic Acid for Primary Prevention of Cardiovascular Events: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Acetylsalicylic Acid for Primary Prevention of Cardiovascular Events: Clinical Effectiveness and Guidelines Acetylsalicylic Acid for Primary Prevention of Cardiovascular Events: Clinical Effectiveness and Guidelines Last updated: August 19 (...) , 2019 Project Number: RB1368-000 Product Line: Research Type: Drug Report Type: Summary of Abstracts Result type: Report Question What is the clinical effectiveness for the use of acetylsalicylic acid in primary prevention of cardiovascular disease? What are the evidence-based guidelines for the use of acetylsalicylic acid in primary prevention of cardiovascular disease? Key Message Twenty-two systematic reviews and meta-analyses, eight randomized controlled trials, and eleven non-randomized studies

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

6. Estimating individual lifetime benefit and bleeding risk of adding rivaroxaban to aspirin for patients with stable cardiovascular disease: results from the COMPASS trial Full Text available with Trip Pro

Estimating individual lifetime benefit and bleeding risk of adding rivaroxaban to aspirin for patients with stable cardiovascular disease: results from the COMPASS trial Adding rivaroxaban to aspirin in patients with stable atherosclerotic disease reduces the recurrence of cardiovascular disease (CVD) but increases the risk of major bleeding. The aim of this study was to estimate the individual lifetime treatment benefit and harm of adding low-dose rivaroxaban to aspirin in patients with stable (...) cardiovascular disease.Patients with established CVD from the COMPASS trial (n = 27 390) and SMART prospective cohort study (n = 8139) were used. Using the pre-existing lifetime SMART-REACH model for recurrent CVD, and a newly developed Fine and Gray competing risk-adjusted lifetime model for major bleeding, individual treatment effects from adding low-dose rivaroxaban to aspirin in patients with stable CVD were estimated, expressed in terms of (i) life-years free of stroke or myocardial infarction (MI

2019 EvidenceUpdates

7. Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin Full Text available with Trip Pro

Safety of Proton Pump Inhibitors Based on a Large, Multi-Year, Randomized Trial of Patients Receiving Rivaroxaban or Aspirin Proton pump inhibitors (PPIs) are effective at treating acid-related disorders. These drugs are well tolerated in the short term, but long-term treatment was associated with adverse events in observational studies. We aimed to confirm these findings in an adequately powered randomized trial.We performed a 3 × 2 partial factorial double-blind trial of 17,598 participants (...) with stable cardiovascular disease and peripheral artery disease randomly assigned to groups given pantoprazole (40 mg daily, n = 8791) or placebo (n = 8807). Participants were also randomly assigned to groups that received rivaroxaban (2.5 mg twice daily) with aspirin (100 mg once daily), rivaroxaban (5 mg twice daily), or aspirin (100 mg) alone. We collected data on development of pneumonia, Clostridium difficile infection, other enteric infections, fractures, gastric atrophy, chronic kidney disease

2019 EvidenceUpdates

8. Topical Cantharidin/ Salicylic Acid/ Podophyllin for the Treatment of Warts: Clinical Effectiveness and Guidelines

Topical Cantharidin/ Salicylic Acid/ Podophyllin for the Treatment of Warts: Clinical Effectiveness and Guidelines Topical Cantharidin/ Salicylic Acid/ Podophyllin for the Treatment of Warts: Clinical Effectiveness and Guidelines | CADTH.ca Find the information you need Topical Cantharidin/ Salicylic Acid/ Podophyllin for the Treatment of Warts: Clinical Effectiveness and Guidelines Topical Cantharidin/ Salicylic Acid/ Podophyllin for the Treatment of Warts: Clinical Effectiveness (...) and Guidelines Last updated: January 21, 2019 Project Number: RA1006-000 Product Line: Research Type: Drug Report Type: Reference List Result type: Report Question What is the comparative clinical effectiveness of topical cantharidin/salicylic acid/podophyllin versus other topical treatments for warts? What are the evidence-based guidelines for the topical treatment of warts? Key Message One non-randomized study and two evidence-based guidelines were identified regarding topical cantharidin/ salicylic acid

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

9. Ticagrelor with or without Aspirin in High-Risk Patients after PCI. (Abstract)

Ticagrelor with or without Aspirin in High-Risk Patients after PCI. Monotherapy with a P2Y12 inhibitor after a minimum period of dual antiplatelet therapy is an emerging approach to reduce the risk of bleeding after percutaneous coronary intervention (PCI).In a double-blind trial, we examined the effect of ticagrelor alone as compared with ticagrelor plus aspirin with regard to clinically relevant bleeding among patients who were at high risk for bleeding or an ischemic event and had undergone (...) PCI. After 3 months of treatment with ticagrelor plus aspirin, patients who had not had a major bleeding event or ischemic event continued to take ticagrelor and were randomly assigned to receive aspirin or placebo for 1 year. The primary end point was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding. We also evaluated the composite end point of death from any cause, nonfatal myocardial infarction, or nonfatal stroke, using a noninferiority hypothesis with an absolute margin

2019 NEJM

10. Personalized Prediction of Cardiovascular Benefits and Bleeding Harms From Aspirin for Primary Prevention: A Benefit-Harm Analysis. (Abstract)

Personalized Prediction of Cardiovascular Benefits and Bleeding Harms From Aspirin for Primary Prevention: A Benefit-Harm Analysis. Whether the benefits of aspirin for the primary prevention of cardiovascular disease (CVD) outweigh its bleeding harms in some patients is unclear.To identify persons without CVD for whom aspirin would probably result in a net benefit.Individualized benefit-harm analysis based on sex-specific risk scores and estimates of the proportional effect of aspirin on CVD (...) and major bleeding from a 2019 meta-analysis.New Zealand primary care.245 028 persons (43.6% women) aged 30 to 79 years without established CVD who had their CVD risk assessed between 2012 and 2016.The net effect of aspirin was calculated for each participant by subtracting the number of CVD events likely to be prevented (CVD risk score × proportional effect of aspirin on CVD risk) from the number of major bleeds likely to be caused (major bleed risk score × proportional effect of aspirin on major

2019 Annals of Internal Medicine

11. Rivaroxaban versus Aspirin in Prevention of Venous Thromboembolism: A Meta-Analysis of 9 Randomized Controlled Trials comprising 7,656 Patients Full Text available with Trip Pro

Rivaroxaban versus Aspirin in Prevention of Venous Thromboembolism: A Meta-Analysis of 9 Randomized Controlled Trials comprising 7,656 Patients  This article evaluates the preventive effects of rivaroxaban versus aspirin on venous thromboembolism (VTE) through meta-analysis of recent randomized controlled trials (RCTs). RCTs were retrieved from medical literature databases. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to compare the primary and safety endpoints. In total (...) , 9 trials (11 trial comparisons) were retrieved which contained 7,656 patients. Among these patients, 4,383 patients (57.2%) received rivaroxaban, whereas 3,273 patients (42.8%) received aspirin. Compared with aspirin, rivaroxaban significantly reduced VTE (1.3% vs. 3.5%) (RR: 0.36, 95% CI, 0.26-0.48, I2 = 27.9%), but significantly increased nonmajor bleeding (11.5% vs. 7.5%) (RR: 1.28, 95% CI, 1.13-1.44, I2 = 38.6%). There were no significant differences in the all-cause mortality (0.3% vs. 0.3

2019 EvidenceUpdates

12. A Meta-analysis of Aspirin for the Primary Prevention of Cardiovascular Diseases in the Context of Contemporary Preventive Strategies Full Text available with Trip Pro

A Meta-analysis of Aspirin for the Primary Prevention of Cardiovascular Diseases in the Context of Contemporary Preventive Strategies The role of aspirin for primary prevention of cardiovascular diseases remains controversial, particularly in the context of contemporary aggressive preventive strategies.Relevant randomized clinical trials were included, and risk ratios (RRs) were calculated using random-effects models. Additional moderator analyses were performed to compare the pooled treatment (...) effects from recent trials (those reported after the guidelines of the National Cholesterol Education Program Third Adult Treatment Panel were published in 2001; thus, conducted on the background of contemporary preventive strategies) to the results of older trials.Data from 14 randomized controlled trials involving 164,751 patients were included. Aspirin use decreased myocardial infarction risk by 16% compared with placebo (RR 0.84; 95% confidence interval [CI], 0.75-0.94); however, in the moderator

2019 EvidenceUpdates

13. Rivaroxaban With or Without Aspirin in Patients With Heart Failure and Chronic Coronary or Peripheral Artery Disease Full Text available with Trip Pro

Rivaroxaban With or Without Aspirin in Patients With Heart Failure and Chronic Coronary or Peripheral Artery Disease Patients with chronic coronary artery disease or peripheral artery disease and history of heart failure (HF) are at high risk for major adverse cardiovascular events. We explored the effects of rivaroxaban with or without aspirin in these patients.The COMPASS trial (Cardiovascular Outcomes for People Using Anticoagulation Strategies) randomized 27 395 participants with chronic (...) coronary artery disease or peripheral artery disease to rivaroxaban 2.5 mg twice daily plus aspirin 100 mg daily, rivaroxaban 5 mg twice daily alone, or aspirin 100 mg alone. Patients with New York Heart Association functional class III or IV HF or left ventricular ejection fraction (EF) <30% were excluded. The primary major adverse cardiovascular events outcome comprised cardiovascular death, stroke, or myocardial infarction, and the primary safety outcome was major bleeding using modified

2019 EvidenceUpdates

14. Acetylsalicylic acid (aspirin) for schizophrenia. (Abstract)

Acetylsalicylic acid (aspirin) for schizophrenia. Schizophrenia is a serious chronic mental illness affecting an estimated 21 million people worldwide and there is increasing evidence linking inflammation in the brain to the pathophysiology of schizophrenia. Antipsychotic drugs are the conventional treatment for people with schizophrenia but are not always fully effective. Acetylsalicylic acid (aspirin) is a non-steroidal anti-inflammatory drug (NSAID) with properties that inhibit (...) the proinflammatory status of the brain. Using aspirin as an adjunct (add-on) treatment to antipsychotics or as a stand-alone treatment could be a novel, relatively inexpensive option for people with schizophrenia.To review the effects of acetylsalicylic acid (aspirin) as adjunct (add-on) or as stand-alone treatment for people with schizophrenia.We searched the Cochrane Schizophrenia Group's Trials Register (last search 8 March 2018) which is based on regular searches of MEDLINE, Embase, PubMed, CINAHL, BIOSIS

2019 Cochrane

15. Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial Full Text available with Trip Pro

Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial Antiplatelets and anticoagulants are associated with increased upper gastrointestinal bleeding. We evaluated whether proton pump inhibitor therapy could reduce this risk.We performed a 3 × 2 partial factorial double-blind trial of 17,598 participants with stable cardiovascular disease and peripheral artery disease. Participants were randomly (...) assigned to groups given pantoprazole 40 mg daily or placebo, as well as rivaroxaban 2.5 mg twice daily with aspirin 100 mg once daily, rivaroxaban 5 mg twice daily, or aspirin 100 mg alone. The primary outcome was time to first upper gastrointestinal event, defined as a composite of overt bleeding, upper gastrointestinal bleeding from a gastroduodenal lesion or of unknown origin, occult bleeding, symptomatic gastroduodenal ulcer or ≥5 erosions, upper gastrointestinal obstruction, or perforation.There

2019 EvidenceUpdates

16. Genetic variation at the coronary artery disease risk locus GUCY1A3 modifies cardiovascular disease prevention effects of aspirin Full Text available with Trip Pro

Genetic variation at the coronary artery disease risk locus GUCY1A3 modifies cardiovascular disease prevention effects of aspirin Efficacy of aspirin in primary prevention of cardiovascular disease (CVD) may be influenced by a common allele in guanylate cyclase GUCY1A3, which has been shown to modify platelet function and increase CVD risk.We investigated whether homozygotes of the GUCY1A3 rs7692387 risk (G) allele benefited from aspirin in two long-term, randomized placebo-controlled trials (...) of aspirin in primary CVD prevention: the Women's Genome Health Study (WGHS, N = 23 294) and a myocardial infarction (MI, N = 550) and stroke (N = 382) case-control set from the Physician's Health Study (PHS, N = 22 071). Bleeding risk was evaluated in the WGHS. In the placebo group of the WGHS, the GUCY1A3 risk (G) allele was confirmed to increase CVD risk [hazard ratio 1.38; 95% confidence interval (CI) 1.08-1.78; P = 0.01]. Random-effects meta-analysis of the WGHS and PHS revealed that aspirin reduced

2019 EvidenceUpdates

17. Randomized trial of ticagrelor vs. aspirin in patients after coronary artery bypass grafting: the TiCAB trial (Abstract)

Randomized trial of ticagrelor vs. aspirin in patients after coronary artery bypass grafting: the TiCAB trial The antiplatelet treatment strategy providing optimal balance between thrombotic and bleeding risks in patients undergoing coronary artery bypass grafting (CABG) is unclear. We prospectively compared the efficacy of ticagrelor and aspirin after CABG.We randomly assigned in double-blind fashion patients scheduled for CABG to either ticagrelor 90 mg twice daily or 100 mg aspirin (1:1 (...) endpoint occurred in 86 out of 931 patients (9.7%) in the ticagrelor group and in 73 out of 928 patients (8.2%) in the aspirin group [hazard ratio 1.19; 95% confidence interval (CI) 0.87-1.62; P = 0.28]. All-cause mortality (ticagrelor 2.5% vs. aspirin 2.6%, hazard ratio 0.96, CI 0.53-1.72; P = 0.89), cardiovascular death (ticagrelor 1.2% vs. aspirin 1.4%, hazard ratio 0.85, CI 0.38-1.89; P = 0.68), MI (ticagrelor 2.1% vs. aspirin 3.4%, hazard ratio 0.63, CI 0.36-1.12, P = 0.12), and stroke (ticagrelor

2019 EvidenceUpdates

18. Aspirin for Primary Prevention of Cardiovascular Events (Abstract)

Aspirin for Primary Prevention of Cardiovascular Events The efficacy and safety of aspirin for primary prevention of cardiovascular disease (CVD) remain debatable.The purpose of this study was to examine the clinical outcomes with aspirin for primary prevention of CVD after the recent publication of large trials adding >45,000 individuals to the published data.Randomized controlled trials comparing clinical outcomes with aspirin versus control for primary prevention with follow-up duration (...) of ≥1 year were included. Efficacy outcomes included all-cause death, cardiovascular (CV) death, myocardial infarction (MI), stroke, transient ischemic attack (TIA), and major adverse cardiovascular events. Safety outcomes included major bleeding, intracranial bleeding, fatal bleeding, and major gastrointestinal (GI) bleeding. Random effects DerSimonian-Laird risk ratios (RRs) for outcomes were calculated.A total of 15 randomized controlled trials including 165,502 participants (aspirin n = 83,529

2019 EvidenceUpdates

19. Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. Full Text available with Trip Pro

Ticagrelor plus aspirin versus clopidogrel plus aspirin for platelet reactivity in patients with minor stroke or transient ischaemic attack: open label, blinded endpoint, randomised controlled phase II trial. To test the hypothesis that ticagrelor plus aspirin is safe and superior to clopidogrel plus aspirin for reducing high platelet reactivity at 90 days and stroke recurrence in patients with minor stroke or transient ischaemic attack, particularly in carriers of the CYP2C19 loss-of-function (...) allele and patients with large artery atherosclerosis.Open label, blinded endpoint, randomised controlled phase II trial.Prospective studies conducted at 26 centres in China, August 2015 to March 2017.675 patients with acute minor stroke or transient ischaemic attack.Ticagrelor (180 mg loading dose, 90 mg twice daily thereafter) or clopidogrel (300 mg loading dose, 75 mg daily thereafter) on a background of aspirin (100 mg daily for the first 21 days) within 24 hours of symptom onset.Primary outcome

2019 BMJ Controlled trial quality: predicted high

20. The rise and fall of aspirin in the primary prevention of cardiovascular disease. Full Text available with Trip Pro

The rise and fall of aspirin in the primary prevention of cardiovascular disease. Aspirin is one of the most frequently used drugs worldwide and is generally considered effective for the secondary prevention of cardiovascular disease. By contrast, the role of aspirin in primary prevention of cardiovascular disease is controversial. Early trials evaluating aspirin for primary prevention, done before the turn of the millennium, suggested reductions in myocardial infarction and stroke (although (...) not mortality), and an increased risk of bleeding. In an effort to balance the risks and benefits of aspirin, international guidelines on primary prevention of cardiovascular disease have typically recommended aspirin only when a substantial 10-year risk of cardiovascular events exists. However, in 2018, three large randomised clinical trials of aspirin for the primary prevention of cardiovascular disease showed little or no benefit and have even suggested net harm. In this narrative Review, we reappraise

2019 Lancet