Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease

作者：W. Schuyler Jones, Hillary Mulder, Lisa Wruck, Michael Pencina, Sunil Kripalani, Daniel Muñoz, David Crenshaw, Mark B. Effron, Richard N. Ré, Kamal Gupta, R. David Anderson, Carl J. Pepine, Eileen Handberg, Brittney R. Manning, Sandeep Jain, Saket Girotra, Danielle Riley, Darren A. DeWalt, Jeff Whittle, Ythan Goldberg, Véronique L. Roger, Rachel Hess, Catherine P. Benziger, Peter Farrehi, Li Zhou, Daniel E. Ford, Kevin Haynes, Jeffrey J. VanWormer, Kirk U. Knowlton, Jennifer L. Kraschnewski, Tamar S. Polonsky, Dan J. Fintel, Faraz S. Ahmad, James C. McClay, James R. Campbell, Douglas S. Bell, Gregg C. Fonarow, Steven M. Bradley, Anuradha Paranjape, Matthew T. Roe, Holly R. Robertson, Lesley H. Curtis, Amber Sharlow, Lisa G. Berdan, Bradley G. Hammill, Debra F. Harris, Laura G. Qualls, Guillaume Marquis‐Gravel, Madelaine Faulkner Modrow, Gregory M. Marcus, Thomas W. Carton, Elizabeth Nauman, Lemuel R. Waitman, Abel Kho, Elizabeth Shenkman, Kathleen M. McTigue, Rainu Kaushal, Frederick A. Masoudi, Elliott M. Antman, Desiree R. Davidson, Kevin Edgley, J. Greg Merritt, Linda S. Brown, Doris N. Zemon, Thomas E. McCormick, Jacqueline D. Alikhaani, Kenneth C. Gregoire, Russell L. Rothman, Robert A. Harrington, Adrian F. Hernandez · 发表于：New England Journal of Medicine · 年份：2021 · DOI：10.1056/nejmoa2102137 · 被引用次数：310 · 研究领域：Antiplatelet Therapy and Cardiovascular Diseases、Acute Myocardial Infarction Research、Inflammatory mediators and NSAID effects

BACKGROUND: The appropriate dose of aspirin to lower the risk of death, myocardial infarction, and stroke and to minimize major bleeding in patients with established atherosclerotic cardiovascular disease is a subject of controversy. METHODS: Using an open-label, pragmatic design, we randomly assigned patients with established atherosclerotic cardiovascular disease to a strategy of 81 mg or 325 mg of aspirin per day. The primary effectiveness outcome was a composite of death from any cause, hospitalization for myocardial infarction, or hospitalization for stroke, assessed in a time-to-event analysis. The primary safety outcome was hospitalization for major bleeding, also assessed in a time-to-event analysis. RESULTS: A total of 15,076 patients were followed for a median of 26.2 months (interquartile range [IQR], 19.0 to 34.9). Before randomization, 13,537 (96.0% of those with available information on previous aspirin use) were already taking aspirin, and 85.3% of these patients were previously taking 81 mg of daily aspirin. Death, hospitalization for myocardial infarction, or hospitalization for stroke occurred in 590 patients (estimated percentage, 7.28%) in the 81-mg group and 569 patients (estimated percentage, 7.51%) in the 325-mg group (hazard ratio, 1.02; 95% confidence interval [CI], 0.91 to 1.14). Hospitalization for major bleeding occurred in 53 patients (estimated percentage, 0.63%) in the 81-mg group and 44 patients (estimated percentage, 0.60%) in the 325-mg group...