Abstract
Background: Although aspirin is effective in the secondary prevention of stroke among men and women, its use in primary prevention remains controversial. We conducted a meta-analysis of randomized trials to evaluate the benefit and safety of aspirin for the primary prevention of ischemic stroke.Methods: We searched three electronic databases (Medline, the Cochrane Central Register of Controlled Trials, and Embase) for articles published before August 1st, 2016. Randomized trials reporting the effect of aspirin on the primary prevention of ischemic stroke and its side effects (hemorrhagic stroke and severe gastrointestinal bleeding) were included. We used a fixed-effect model to quantify the effect of aspirin on the primary prevention of stroke when the heterogeneity was low, or else applied the random-effect model.Results: Fourteen randomized trials were included. Overall, aspirin use was associated with a decreased risk of ischemic stroke compared with non-aspirin use (OR: 0.83, 95% CI: 0.74–0.93, P = 0.45). In subgroup analyses, the effect of aspirin on ischemic stroke in apparently healthy adults remained significant (OR: 0.83, 95% confidence interval: 0.74–0.94, I2 = 22%, P = 0.28); while in patients with cardiovascular diseases there was no difference in the risk of ischemic stroke between aspirin and non-aspirin groups (OR: 0.75, 95% confidence interval: 0.44–1.29, P = 0.46). As for adverse effects, the prophylactic use of aspirin potentially increased the risk of serious bleeding events in a population of apparently healthy individuals and in patients with previous cardiovascular diseases.Conclusion: This meta-analysis of randomized trials indicated that both the apparently healthy adults and patients with cardiovascular diseases will derive little protective benefit from aspirin considering the increased risk of severe bleeding events.
Highlights
The use of aspirin for the prevention of stroke is already fairly widely spread in many communities
Randomization occurred in all 14 studies, but only 5 studies described the process of random sequence generation (Peto et al, 1988; The Medical Research Council’s General Practice Research Framework, 1998; de Gaetano, 2001; Sacco et al, 2003; Ogawa et al, 2008)
None of the trials appeared to have substantial baseline differences between patients allocated to aspirin therapy vs. the comparator-arm
Summary
The use of aspirin for the prevention of stroke is already fairly widely spread in many communities. The most recent AHA (American Heart Association) guideline for the primary prevention of cardiovascular disease and stroke recommends the use of aspirin in persons whose 10-year risk for coronary heart disease is 6–10% to improve the likelihood of a positive balance of coronary risk reduction over bleeding and hemorrhagic stroke caused by aspirin. It suggests aspirin is not useful for preventing a first stroke in person at low risk (Goldstein et al, 2011). We conducted a meta-analysis of randomized trials to evaluate the benefit and safety of aspirin for the primary prevention of ischemic stroke
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