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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
Tinzaparin in acute ischaemic stroke (TAIST): a randomised aspirin-controlled trial. Low-molecular-weight heparins and heparinoids are superior to unfractionated heparin in the prevention and treatment of venous thromboembolism, but their safety and efficacy in acute ischaemic stroke are inadequately defined.This randomised, double-blind, aspirin-controlled trial tested the safety and efficacy of treatment with high-dose tinzaparin (175 anti-Xa IU/kg daily; 487 patients), medium-dose tinzaparin (...) (100 anti-Xa IU/kg daily; 508 patients), or aspirin (300 mg daily; 491 patients) started within 48 h of acute ischaemic stroke and given for up to 10 days. Primary intracerebral haemorrhage was excluded by computed tomography. Outcome was assessed, with treatment allocation concealed, by the modified Rankin scale at 6 months (independence [scores 0-2] vs dependence or death [scores 3-6]).Of 1486 randomised patients, two did not receive treatment and 46 were lost to follow-up. The proportions
2001LancetControlled trial quality: predicted high
Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. Patients with arthritis and vascular disease may receive both low-dose aspirin and other nonsteroidal antiinflammatory drugs. We therefore investigated potential interactions between aspirin and commonly prescribed arthritis therapiesWe administered the following combinations of drugs for six days: aspirin (81 mg every morning) two hours before ibuprofen (400 mg every morning) and the same medications in the reverse order (...) ; aspirin two hours before acetaminophen (1000 mg every morning) and the same medications in the reverse order; aspirin two hours before the cyclooxygenase-2 inhibitor rofecoxib (25 mg every morning) and the same medications in the reverse order; enteric-coated aspirin two hours before ibuprofen (400 mg three times a day); and enteric-coated aspirin two hours before delayed-release diclofenac (75 mg twice daily)Serum thromboxane B(2) levels (an index of cyclooxygenase-1 activity in platelets
A comparison of warfarin and aspirin for the prevention of recurrent ischemic stroke. Despite the use of antiplatelet agents, usually aspirin, in patients who have had an ischemic stroke, there is still a substantial rate of recurrence. Therefore, we investigated whether warfarin, which is effective and superior to aspirin in the prevention of cardiogenic embolism, would also prove superior in the prevention of recurrent ischemic stroke in patients with a prior noncardioembolic ischemic (...) stroke.In a multicenter, double-blind, randomized trial, we compared the effect of warfarin (at a dose adjusted to produce an international normalized ratio of 1.4 to 2.8) and that of aspirin (325 mg per day) on the combined primary end point of recurrent ischemic stroke or death from any cause within two years.The two randomized study groups were similar with respect to base-line risk factors. In the intention-to-treat analysis, no significant differences were found between the treatment groups in any
Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. Despite current treatments, patients who have acute coronary syndromes without ST-segment elevation have high rates of major vascular events. We evaluated the efficacy and safety of the antiplatelet agent clopidogrel when given with aspirin in such patients.We randomly assigned 12,562 patients who had presented within 24 hours after the onset of symptoms to receive clopidogrel (...) (300 mg immediately, followed by 75 mg once daily) (6259 patients) or placebo (6303 patients) in addition to aspirin for 3 to 12 months.The first primary outcome--a composite of death from cardiovascular causes, nonfatal myocardial infarction, or stroke--occurred in 9.3 percent of the patients in the clopidogrel group and 11.4 percent of the patients in the placebo group (relative risk with clopidogrel as compared with placebo, 0.80; 95 percent confidence interval, 0.72 to 0.90; P<0.001
Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Despite the use of aspirin, there is still a risk of ischaemic events after percutaneous coronary intervention (PCI). We aimed to find out whether, in addition to aspirin, pretreatment with clopidogrel followed by long-term therapy after PCI is superior to a strategy of no pretreatment and short-term therapy for only 4 weeks after PCI (...) .2658 patients with non-ST-elevation acute coronary syndrome undergoing PCI in the CURE study had been randomly assigned double-blind treatment with clopidogrel (n=1313) or placebo (n=1345). Patients were pretreated with aspirin and study drug for a median of 6 days before PCI during the initial hospital admission, and for a median of 10 days overall. After PCI, most patients (>80%) in both groups received open-label thienopyridine for about 4 weeks, after which study drug was restarted for a mean
2001LancetControlled trial quality: predicted high
by an abnormal uterine artery Doppler examination in the second trimester. Searching MEDLINE, EMBASE, and the Cochrane Controlled Trials Register were searched for trials published between 1966 and November 2000. A combination of search terms were used to generate two subsets of citations: one including studies of 'aspirin' ('aspirin', 'antiplatelet', 'salicyl', 'acetylsalicyl', and 'platelet aggregation inhibitors') and the other including studies of 'Doppler ultrasonography' ('ultrasonography', 'ultraso (...) Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis Aspirin for the prevention of preeclampsia in women with abnormal uterine artery Doppler: a meta-analysis Coomarasamy A, Papaioannou S, Gee H, Khan K S Authors' objectives To assess the effect of aspirin in preventing pre-eclampsia in women identified as being at high risk
Analysis of trials evaluating combinations of acetylsalicylicacid and dipyridamole in the secondary prevention of stroke Analysis of trials evaluating combinations of acetylsalicylicacid and dipyridamole in the secondary prevention of stroke Analysis of trials evaluating combinations of acetylsalicylicacid and dipyridamole in the secondary prevention of stroke Redman A R, Ryan G J Authors' objectives To investigate whether the addition of dipyridamole to aspirin further reduces the risk (...) of stroke recurrence. Searching MEDLINE, International Pharmaceutical Abstracts, EMBASE and BIOSIS Previews were searched from 1966 to May 2001 for articles in the English language. The search terms used were 'dipyridamole', 'aspirin', 'acetylsalicylicacid', 'ischaemic stroke' and 'cerebrovascular disorders'. Study selection Study designs of evaluations included in the review The authors aimed to identify clinical trials. Four of the identified studies were reported to be randomised double-blind trials
Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies Association between aspirin and upper gastrointestinal complications: systematic review of epidemiologic studies Garcia Rodriguez L A, Hernandez-Diaz S, de Abajo F J Authors' objectives To systematically review the literature on serious upper gastrointestinal complications (...) (UGIC) associated with aspirin use, and to evaluate the influence of dose and formulation of aspirin as well as the effect of study design. Searching MEDLINE was searched from 1990 to February 2001. The search terms used were 'anti-inflammatory nonsteroidal agents' (both overall and aspirin), 'adverse effects', and 'toxicity' combined with 'peptic ulcer', 'stomach ulcer', 'duodenal ulcer', or 'gastrointestinal diseases' (including haemorrhage and perforation). The references of previous reviews were
. Source of effectiveness data The effectiveness evidence was derived from a review of published studies. Modelling A Markov model was used to estimate the clinical and economic consequences of six strategies in the general US population. The strategies were natural history (no screening and no aspirin), FS-FOBT, COLO, aspirin alone (ASA), FS-FOBT with aspirin (FS-FOBT-ASA), and COLO with aspirin (COLO-ASA). Patients aged 50 years progressed through the model for 30 cycles of one year. The principal (...) persons with no intervention, 1,895 per 100,000 persons with FS-FOBT, and 1,693 per 100,000 persons with COLO. The addition of aspirin further reduced cancer incidence. There were 1,258 cases per 100,000 persons with FS-FOBT-ASA, and 1,109 cases per 100,000 persons with COLO-ASA. When 25% of the population was screened, the total number of deaths was 48,064 with FS-FOBT, 48,080 with COLO, 47,994 with FS-FOBT-ASA, and 47,951 with COLO-ASA. There were 129 aspirin-related deaths. The mean (3%) discounted
Aspirin for vascular dementia. For patients with a diagnosis of vascular dementia there is evidence that aspirin is widely prescribed - in one study, completed by geriatricians and psychiatrists in the UK, 80% of patients with cognitive impairment (with vascular risk factors) were prescribed aspirin. However, a number of queries remain unanswered: Is there convincing evidence that aspirin benefits patients with vascular dementia? Does aspirin affect cognition or improve prognosis? In addition (...) , does the risk of cerebral or gastric haemorrhage outweigh any benefit? The aim of this review is to assess the evidence of effectiveness of aspirin in those with a diagnosis of vascular dementia.To assess the evidence of effectiveness of the use of aspirin for vascular dementia.Computerised databases were searched independently by two reviewers. In addition, relevant websites were searched and some journals were handsearched. Specialists in the field were approached for unpublished material
Antihistamines versus aspirin for itching in late pregnancy. While not common, itching in pregnancy (not due to liver disease) can be distressing.The objective of this review was to assess the effects of treatment for itching in late pregnancy.We searched the Cochrane Pregnancy and Childbirth Group trials register. In addition, the Cochrane Controlled Trials Register (CENTRAL/CCTR) was searched. Date of last search: April 1999.Randomised trials of treatments for itching in women in late (...) pregnancy with normal liver function.Trial quality was assessed and data were extracted independently by two reviewers.One study of 38 women was included. This was a small crossover trial, using alternate allocation. The trial compared a histamine, chlorpheniramine, with aspirin. Aspirin was more effective than chlorpheniramine in relieving itching (odds ratio 2. 39, 95% confidence interval 1.25 to 4.57). However chlorpheniramine was more effective than aspirin when a rash was present.Aspirin appears
Single dose oral aspirin for acute pain. Aspirin has been known to be an effective analgesic for many years and is commonly used throughout the world for many different pain conditions. It is important for both prescribers and patients to have the best possible information about the efficacy and safety of analgesics, and this need is reflected in patient surveys which show that postoperative pain is often poorly managed. We also need to benchmark relative efficacy and safety of current (...) analgesics so that we can compare them with new analgesics.To quantitatively assess the analgesic efficacy and adverse effects of a single-dose of aspirin in acute pain of moderate to severe intensity.Randomised trials were identified by searching Medline (1966 to March 1998), Embase (1980 to January 1998), the Cochrane Library (Issue 1,1998) and the Oxford Pain Relief Database (1950 to 1994).The inclusion criteria used were: full journal publication, postoperative pain or a mixture of postoperative
Non-aspirin, non-steroidal anti-inflammatory drugs for osteoarthritis of the knee. To determine whether there is a difference in the relative efficacy of individual non-steroidal anti-inflammatory drugs (NSAIDs) when used in the management of osteoarthritis (OA) of the knee.We searched Medline (1966-1995) and Bids Embase (Jan-Dec, 1980-1995). The searches were limited to publications in the English language, and were last perfomed in November 1996. We used modified Cochrane Collaboration search (...) strategy to identify all randomised controlled trials. The MeSH heading osteoarthritis was combined with the generic names of the 17 non-aspirin NSAIDs licensed in the UK for the management of OA in general practice. The search of Embase used the term "osteoarthritis" if present in the abstract, title or keywords, and was combined with the generic names of the 17 non-aspirin NSAIDs, only if they were mentioned in the title, abstract or keywords.All double blind, randomised controlled trials
Thienopyridine derivatives (ticlopidine, clopidogrel) versus aspirin for preventing stroke and other serious vascular events in high vascular risk patients. The most widely studied and prescribed antiplatelet agent for the prevention of stroke and other serious vascular events among high vascular risk patients is aspirin. Aspirin inhibits platelet activation by inhibiting platelet cyclooxygenase and thromboxane production, and reduces the odds of a serious vascular event by about a quarter (...) . The thienopyridines (ticlopidine and clopidogrel) inhibit platelet activation by a different mechanism to aspirin (blocking the ADP receptor on platelets), and so may be more effective than aspirin.The objective of this review was to determine the effectiveness and safety of thienopyridine derivatives (ticlopidine and clopidogrel) versus aspirin for the prevention of serious vascular events (stroke, myocardial infarction (MI) or vascular death) in patients at high risk of such events, and specifically in patients
Analgesia and non-aspirin, non-steroidal anti-inflammatory drugs for osteoarthritis of the hip. To review all randomized trials of analgesics and anti-inflammatory therapy in osteoarthritis (OA) of the hip. To determine which non-steroidal, anti-inflammatory drug (NSAID) is the most effective, and which NSAID is the most toxic.We searched the Cochrane Musculoskeletal Group's trials register, the Cochrane Controlled Trials Register and Medline up to August 1994. Reference lists of all trials
Risk of gastrointestinal haemorrhage with long term use of aspirin: meta-analysis. To assess the incidence of gastrointestinal haemorrhage associated with long term aspirin therapy and to determine the effect of dose reduction and formulation on the incidence of such haemorrhage.Meta-analysis of 24 randomised controlled trials (almost 66 000 participants).Aspirin compared with placebo or no treatment, for a minimum of one year.Incidence of gastrointestinal haemorrhage.Gastrointestinal (...) haemorrhage occurred in 2.47% of patients taking aspirin compared with 1.42% taking placebo (odds ratio 1.68; 95% confidence interval 1.51 to 1.88); the number needed to harm was 106 (82 to 140) based on an average of 28 months' therapy. At doses below 163 mg/day, gastrointestinal haemorrhage occurred in 2.30% of patients taking aspirin compared with 1.45% taking placebo (1.59; 1.40 to 1.81). Meta-regression showed no relation between gastrointestinal haemorrhage and dose. For modified release
Comparison of sibrafiban with aspirin for prevention of cardiovascular events after acute coronary syndromes: a randomised trial. The SYMPHONY Investigators. Sibrafiban versus Aspirin to Yield Maximum Protection from Ischemic Heart Events Post-acute Coron Aspirin lowers risks of death and myocardial infarction in patients with acute coronary syndromes. Intravenous glycoprotein IIb/IIIa receptor antagonists further reduce the rates of ischaemic events in these patients, but the efficacy of long (...) -term oral glycoprotein IIb/IIIa receptor blockade has not been established. We tested whether the oral glycoprotein IIb/IIIa receptor antagonist sibrafiban would prevent more cardiovascular events than aspirin, when given within 7 days of, and sustained for 90 days after, an acute coronary syndrome event.9233 patients who had stabilised after an acute coronary syndrome event were randomly assigned aspirin (80 mg orally twice daily) or low-dose or high-dose sibrafiban. Sibrafiban doses (3.0 mg, 4.5
2000LancetControlled trial quality: predicted high
Efficacy of oral anticoagulants compared with aspirin after infrainguinal bypass surgery (The Dutch Bypass Oral Anticoagulants or Aspirin Study): a randomised trial. Oral anticoagulants and aspirin are antithrombotic drugs that are commonly used in patients with vascular disease. We investigated whether either of these treatments prevented more effectively than the other bypass complications after infrainguinal bypass surgery.We did a multicentre, randomised, open trial. 2690 patients who had (...) undergone infrainguinal grafting were randomly assigned oral anticoagulants (target international normalised ratio 3.0-4.5, n=1339) or aspirin (80 mg daily, n=1351). We followed up patients for a mean of 21 months. The primary outcome was graft occlusion.308 graft occlusions occurred in the oral-anticoagulants group compared with 322 in the aspirin group (hazard ratio 0.95 [95% CI 0.82-1.11]), which suggested no overall advantage for either treatment. Oral anticoagulants were beneficial in patients
2000LancetControlled trial quality: predicted high
Determination of who may derive most benefit from aspirin in primary prevention: subgroup results from a randomised controlled trial. To determine which groups of patients may derive particular benefit or experience harm from the use of low dose aspirin for the primary prevention of coronary heart disease.Randomised controlled trial.108 group practices in the Medical Research Council's general practice research framework who were taking part in the thrombosis prevention trial.5499 men aged (...) between 45 and 69 years at entry who were at increased risk of coronary heart disease.Myocardial infarction, coronary death, and stroke.Aspirin reduced coronary events by 20%. This benefit, mainly for non-fatal events, was significantly greater the lower the systolic blood pressure at entry (interaction P=0.0015), the relative risk at pressures 130 mm Hg being 0.55 compared with 0.94 at pressures >145 mm Hg. Aspirin also reduced strokes at low but not high pressures, the relative risks being 0.41
Low molecular-weight heparin versus aspirin in patients with acute ischaemic stroke and atrial fibrillation: a double-blind randomised study. HAEST Study Group. Heparin in Acute Embolic Stroke Trial. Patients with acute ischaemic stroke and atrial fibrillation have an increased risk of early stroke recurrence, and anticoagulant treatment with heparins has been widely advocated, despite missing data on the balance of risk and benefit.Heparin in Acute Embolic Stroke Trial (HAEST (...) ) was a multicentre, randomised, double-blind, and double-dummy trial on the effect of low-molecular-weight heparin (LMWH, dalteparin 100 IU/kg subcutaneously twice a day) or aspirin (160 mg every day) for the treatment of 449 patients with acute ischaemic stroke and atrial fibrillation. The primary aim was to test whether treatment with LMWH, started within 30 h of stroke onset, is superior to aspirin for the prevention of recurrent stroke during the first 14 days.The frequency of recurrent ischaemic stroke
2000LancetControlled trial quality: predicted high