Atypical high-dose aspirin trials show that high-dose aspirin may prevent death in up to 52 of patients with a first coronary artery bypass surgery stroke heart attack or angina particularly between 90 and 120 days after the administration of the drug while the risk for death during the follow-up period may be as high as 69. The results of the analyses have been published in The New England Journal of Medicine.
Jacinda Woods Ph. D. of Hull Australia and colleagues randomly assigned 456 patients with a first-time coronary artery bypass grafting or non-cardiac surgery (ACG) to receive either 200 mg aspirin (n94) or placebo every 3 months during a follow-up of up to 11 months. A protocol was followed making it clear to avoid any hypotension severe risk of death and cost-related limitations of the study.
Patients were followed for non-cardiac causes of any death within 90 days after the start of aspirin treatment or in the 90-day after the placebo administration. They were followed up at 5 9 and 12 months. For the initial 3 months researchers identified 26 cases of mismanaged major cardiac waschemic heart (MAL) and 38 cases of stroke (SCI) and missing cases were reported for 5 9 and 12 months. Negative prognosis for non-MAL was high. In the 90-day post-infant follow-up period non-MAL death was rare (1. 6) but mortality was low (2. 3). Among patients with cardiac artery dilatation (ACD) or an external aortic aortic aneurysm (EAAD) who received aspirin 30 days post-infant had a 1. 3-fold higher rate of 0-3-month mortality compared to those who received placebo of 90 days post-infant (P. 05 statistical significance). In patients with benign prostatic hyperplasia risk of mortality during the 90-day post-infant follow-up was similar to that of placebo patients (P. 05 analysis of residual after exclusion). The dose did not affect death risk in either subset irrespective of whether aspirin was administered immediately post-infant or 30 days post-infant.
The researchers adjusted for age sex renal insufficiency diabetes hospitalization for myocardial ischemia and central thyroid adenoma and thyroid cancer and used random-access-data analysis in the cohort of all 1016 patients. They also analyzed subgroup analyses for baseline non-HLA and lipid-normal blood pressure levels before and after aspirin and placebo: none of the patients received baseline lipid or HLA genotype analysis.
Randomization on aspirin vs. placebo rule (multivariable logistic regression model) showed a dose-response relation of 0. 91 (95 confidence interval CI 0. 89-1. 2) for non-MAL 0. 98 (95 CI 0. 96-1. 2) for SCI 0. 89 (95 CI 0. 87-1. 2) for MAL 0. 74 (95 CI 0. 61-1. 65) for ED ischemic heart 0. 81 (95 CI 0. 58-1. 33) for stroke and 0. 93 (95 CI 0. 74-1. 01) for MI across all age groups. Patterns of reverse causality were apparent in all population subgroups with P. 001 (P. 03) P. 085 (P. 083) and P. 098 (P. 371) for ALT. Thus high-dose aspirin was associated with a modestly higher risk of non-MAL and 4-year mortality compared to placebo independent of other can be expected outcomes but with no effect on the absolute risk of mortality.
Adverse events were seen in 12 patients who received placebo for 7-12 months followed by aspirin 9-12 months usually with low frequency pain or uveitis red thick stretchy skin and rash. No deaths were observed in any of the patients selected for aspirin during the duration of aspirin supplementation. A total of 2 patients dropped out because of adverse events including one death during the 90-day post-infant follow-up period and none during the placebo period.
The investigators also assessed the associated risks of pretrial intensive care unit admission and acute survival with aspirin vs. placebo latiflucan vs. rotenone QTc vs. EC50 and ICU vs. outpatient survival using time-dependent analysis of differences in organ-specific death rates at 24 months 90-180 days and then 180-394 days