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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
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
Acetylsalicylicacid (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. Acetylsalicylicacid (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 acetylsalicylicacid (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
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
Efficacy between low and high dose aspirin for the initial treatment of Kawasaki disease: Current evidence based on a meta-analysis. Kawasaki disease (KD) is now the leading cause of acquired heart disease in children in developed countries. Intravenous immunoglobulin (IVIG) and aspirin were considered as the standard initial treatment of KD for decades. However, the optimal dose of aspirin has remained controversial. In recent years, many studies compared the efficacy of low-dose with high (...) -dose aspirin in the acute phase of KD, but the results have not always been consistent. Therefore, we performed this meta-analysis to evaluate the efficacy of low-dose aspirin compared with high-dose for the initial treatment of KD.Studies related to aspirin therapy for KD were selected from PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, and Google scholar through Mar 25th, 2019. Data were analyzed using STATA Version 15.1. Additionally
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
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
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
Optimal aspirin dosing for preeclampsia prevention. 29588190 2019 07 01 2019 07 01 1097-6868 219 1 2018 07 American journal of obstetrics and gynecology Am. J. Obstet. Gynecol. Optimal aspirin dosing for preeclampsia prevention. 117-118 S0002-9378(18)30232-1 10.1016/j.ajog.2018.03.018 Seidler Anna Lene AL NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia. Electronic address: email@example.com. Askie Lisa L NHMRC Clinical Trials Centre, University of Sydney, NSW (...) , Australia. Ray Joel G JG Departments of Medicine and Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. eng Journal Article Meta-Analysis 2018 03 26 United States Am J Obstet Gynecol 0370476 0002-9378 0 Platelet Aggregation Inhibitors R16CO5Y76E Aspirin AIM IM Aspirin administration & dosage Dose-Response Relationship, Drug Female Humans Platelet Aggregation Inhibitors administration & dosage Pre-Eclampsia prevention & control Pregnancy 2018 02 01 2018
Meta-analysis of Aspirin for Primary Prevention of Cardiovascular Events. 31184732 2019 06 19 2019 06 19 1538-3598 321 22 2019 06 11 JAMA JAMA Meta-analysis of Aspirin for Primary Prevention of Cardiovascular Events. 2243-2244 10.1001/jama.2019.4005 Syn Nicholas L NL Yong Loo Lin School of Medicine, National University of Singapore, Singapore. Wee Ian J Y IJY Yong Loo Lin School of Medicine, National University of Singapore, Singapore. eng Journal Article Comment United States JAMA 7501160 0098 (...) -7484 R16CO5Y76E Aspirin AIM IM JAMA. 2019 Jan 22;321(3):277-287 30667501 JAMA. 2019 Jun 11;321(22):2244-2245 31184736 Aspirin Cardiovascular Diseases Hemorrhage Humans Primary Prevention 2019 6 12 6 0 2019 6 12 6 0 2019 6 20 6 0 ppublish 31184732 2735492 10.1001/jama.2019.4005
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
Enoxaparin (or plus aspirin) for the prevention of recurrent miscarriage: A meta-analysis of randomized controlled studies. Enoxaparin treatment has emerged as an important approach to prevent recurrent miscarriage, but the use of enoxaparin for the prevention of recurrent miscarriage has not been well established. We conduct a systematic review and meta-analysis to evaluate the efficacy of enoxaparin to prevent recurrent miscarriage. PubMed, Embase, and the Cochrane Central Register (...) of Controlled Trials are searched. Randomized controlled trials (RCTs) assessing the influence of enoxaparin (or plus aspirin) treatment versus placebo on prevention of recurrent miscarriage are included. Three RCTs are included in the meta-analysis. Compared with control intervention for recurrent miscarriage, enoxaparin treatment has no substantial influence on live births (RR = 1.07; 95% CI = 0.77-1.47; P = 0.69), miscarriage rate (RR = 0.82; 95% CI = 0.31-2.17; P = 0.68), gestational age (Std. MD=-0.13
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
Primary Prevention of Cardiovascular Events with Aspirin: Toward More Harm than Benefit-A Systematic Review and Meta-Analysis. Primary prevention of cardiovascular events with aspirin remains controversial, as the risk of bleeding might outweigh the benefits. Recently, new evidence has emerged from the ARRIVE (Aspirin to Reduce Risk of Initial Vascular Events), ASCEND (A Study of Cardiovascular Events in Diabetes), and ASPREE (Effect of Aspirin on Cardiovascular Events and Bleeding (...) in the Healthy Elderly) trials. The aim of this study was to perform a systematic review and meta-analysis of aspirin's efficacy and safety in the primary prevention of cardiovascular events in healthy individuals and in individuals with cardiovascular risk factors, and separately in those with diabetes. The Medline database was searched, without time restrictions, for relevant human trials published in English up to December 10, 2018, and additional trials were identified from reference lists. Data
Frequency of Intracranial Hemorrhage With Low-Dose Aspirin in Individuals Without Symptomatic Cardiovascular Disease: A Systematic Review and Meta-analysis. Use of low-dose aspirin for the primary prevention of cardiovascular events remains controversial because increased risk of bleeding may offset the overall benefit. Among major bleeding events, intracranial hemorrhage is associated with high mortality rates and functional dependency.To assess the risk of intracranial hemorrhage associated (...) with low-dose aspirin among individuals without symptomatic cardiovascular disease.PubMed, Embase, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov were searched from January 1966 to October 30, 2018.Randomized clinical trials that compared low-dose aspirin (daily dose ≤100 mg) vs control and recorded the end points of intracranial hemorrhage separately for active treatment and control groups were included.A random-effect estimate was computed based on the Mantel-Haenszel
Effect of a Single Aspirin Dose Prior to Fecal Immunochemical Testing on Test Sensitivity for Detecting Advanced Colorectal Neoplasms: A Randomized Clinical Trial. Fecal immunochemical tests for hemoglobin are widely used for colorectal cancer (CRC) screening. Observational studies suggested that sensitivity of fecal immunochemical tests for detecting advanced neoplasms could be increased by acetylsalicylicacid (aspirin), especially among men.To evaluate the potential to increase sensitivity (...) of fecal immunochemical tests by administering a single 300-mg oral aspirin dose 2 days before stool sampling.A randomized, placebo-controlled, double-blind trial was conducted in 14 gastroenterology practices and 4 hospitals in Germany, and included 2422 men and women aged 40 to 80 years scheduled for colonoscopy, with no recent use of aspirin or other drugs with antithrombotic effects (enrollment from June 2013 to November 2016, and final follow-up January 27, 2017).Administration of a single tablet
Optimal Duration of Aspirin Plus Clopidogrel After Ischemic Stroke or Transient Ischemic Attack Background and Purpose- The role of aspirin plus clopidogrel (A+C) therapy compared with aspirin monotherapy in patients presenting with acute ischemic stroke (IS) or transient ischemic attack remains uncertain. We conducted this study to determine the optimal period of efficacy and safety of A+C compared with aspirin monotherapy. Methods- Ten randomized controlled trials (15 434 patients) were (...) selected using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) (inception June 2018) comparing A+C with aspirin monotherapy in patients with transient ischemic attack or IS. The primary efficacy outcome was recurrent IS, and the primary safety outcome was major bleeding. The secondary outcomes were major adverse cardiovascular events (composite of stroke, myocardial infarction, and cardiovascular mortality) and all-cause mortality. We stratified analysis based
Meta-Analysis of AcetylsalicylicAcid Desensitization in Patients With Acute Coronary Syndrome. Acetylsalicylicacid (ASA) hypersensitivity represents a clinical challenge in acute coronary syndrome (ACS) patients urgently requiring ASA for antiplatelet therapy. ASA desensitization has been reported with successful outcomes in cardiac patients. The aim of this review is to determine the safety and efficacy of ASA desensitization therapy in ACS patients. A PubMed database search was conducted (...) for articles containing combinations of keywords, "aspirin desensitization" or "aspirin hypersensitivity" and "acute coronary syndrome" between January 1, 1990 and August 1, 2018. The primary end point was desensitization protocol success. Secondary end points included hypersensitivity adverse events and ASA discontinuation due to hypersensitivity adverse events at follow-up. Fifteen reports consisting of 480 ACS patients with previous hypersensitivity to ASA were included. The pooled desensitization
Does an ASA a day really keep the doctor away? March 18, 2019 Does an ASA a day really keep the doctor away? Clinical Question: Is ASA effective for reducing cardiovascular events in patients without pre- existing cardiovascular disease? Bottom Line: Three recent large, randomized, controlled trials (RCTs) of moderate risk, elderly, and diabetic patients do not support use of ASA for primary prevention. The potential absolute benefit of ~1% (only found in one study) is offset by similar (...) increase in major bleeding. All-cause and cancer mortality was either unchanged or increased with ASA. Routine use of ASA for primary cardiovascular prevention should be discouraged. Evidence: • Three large, high quality, placebo controlled RCTs of ASA 100 mg/day. o ARRIVE: RCT of 12,546 patients at moderate cardiovascular risk [10-year risk 10-20% (mean 17%)]. 1 Predominantly males (70.5%), mean age 64 years. After 5 years: ? No difference in: ? Composite cardiovascular events: 4.3% versus 4.5
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 a comprehensive