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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article reviews evidence from the past 20 years on the benefits and risks of antiplatelet therapy for primary and secondary prevention of vascular events.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ELouise Bowman, MBBS, MRCP, University of Oxford, Oxford, United Kingdom, reviewed evidence from the past 20 years on the benefits and risks of antiplatelet therapy for primary and secondary prevention of vascular events. The landmark ISIS-2 trial [ISIS-2 Collaborative Group. \u003Cem\u003ELancet\u003C\/em\u003E 1988] compared vascular mortality rates in patients after suspected acute myocardial infarction. Investigators reported vascular mortality rates of 13% in patients who received routine hospital care alone, 11% in those treated with aspirin only, 10% in those treated with streptokinase only, and 8% in those who received routine care plus aspirin and streptokinase.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EAn analysis of 25 secondary prevention trials (25,000 patients) found that antiplatelet therapy reduced the incidence of serious vascular events by about 25% among patients at risk for occlusive vascular disease [Antiplatelet Trialists\u0027 Collaboration. \u003Cem\u003EBr Med J\u003C\/em\u003E (Clin Res Ed) 1988]. However, researchers noted that the balance of risks and benefits might be different for primary prevention in low-risk individuals. A 1994 meta-analysis [Antiplatelet Trialists\u0027 (ATT) Collaboration. \u003Cem\u003EBMJ\u003C\/em\u003E 1994] of 145 trials of 70,000 high-risk and 30,000 low-risk subjects receiving antiplatelet therapy versus control and 10,000 high-risk subjects receiving different antiplatelet regimens found a significant benefit from antiplatelet therapy. The study provided no clear evidence on the balance of risks and benefits for primary prevention in low-risk subjects.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe ATT Collaboration evaluated the effects of antiplatelet therapy on vascular events in 212,000 high-risk patients from 287 trials [\u003Cem\u003EBMJ\u003C\/em\u003E 2002]. The investigators found a significant odds reduction in most subgroups of individuals treated with antiplatelet therapy versus control, except diabetes patients, in whom the benefit was not clear. Despite this uncertainty, most guidelines recommend antiplatelet therapy for diabetes patients.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe absolute risk of bleeding with aspirin is increased in the elderly, men, diabetes patients, and smokers. Aspirin is associated with a 30% increased risk of intracranial bleeding and a 50% increase in extracranial bleeding. The ATT Collaboration analyzed 6 primary prevention trials of aspirin versus control involving 95,456 patients [\u003Cem\u003ELancet\u003C\/em\u003E 2009]. The meta-analysis showed that aspirin reduced the odds for major coronary events and any serious vascular event but showed no clear benefit in stroke reduction (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Patients at higher risk of vascular events (the elderly, men, diabetes patients, and smokers) also had a 1.6- to 2.2-fold higher risk of bleeding with aspirin. Several ongoing clinical trials are evaluating aspirin therapy in patients with diabetes, cardiovascular disease risk, and the elderly.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/18\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Proportional Effects of Aspirin on Serious Vascular Events in Primary Prevention Trials.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1839746417\u0022 data-figure-caption=\u0022Proportional Effects of Aspirin on Serious Vascular Events in Primary Prevention Trials.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/18\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/18\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/3\/18\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13987\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EProportional Effects of Aspirin on Serious Vascular Events in Primary Prevention Trials.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECHD=coronary heart disease; MI=myocardial infarction.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from Elsevier. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Antithrombotic Trialists\u0027 Collaboration. \u003Cem\u003EThe Lancet\u003C\/em\u003E 2009;373(9678): 1849\u20131860.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EDr. Bowman concluded that the benefits of using antiplatelet therapy for secondary prevention outweigh the risks. Questions remain about the suitability of antiplatelet therapy for primary prevention. Ongoing trials will help to answer some of these questions in the next few years.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/3\/18.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzneqp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzneqp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}