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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.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\u003EVenous thrombosis, which manifests mainly as deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and serious disorder; it occurs in 1 per 1000 individuals per year worldwide, and patients who suffer from DVT or PE are at risk of recurrent events [Rosendaal FR. \u003Cem\u003EPLoS Med\u003C\/em\u003E 2012]. There is limited information on safe and effective long-term preventive strategies. This article discusses results from the Aspirin to Prevent Recurrent Venous Thromboembolism [ASPIRE; ACTRN12605000004662] trial.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EVenous thrombosis, which manifests mainly as deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and serious disorder; it occurs in 1 per 1000 individuals per year worldwide, and patients who suffer from DVT or PE are at risk of recurrent events [Rosendaal FR. \u003Cem\u003EPLoS Med\u003C\/em\u003E 2012]. There is limited information on safe and effective long-term preventive strategies. Timothy Brighton, MBBS, South Eastern Area Lab Services, Prince of Wales Hospital, Sydney, Australia, presented results from the Aspirin to Prevent Recurrent Venous Thromboembolism [ASPIRE; ACTRN12605000004662] trial.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EASPIRE was a double-blind, randomized, placebo-controlled study that evaluated the efficacy of low-dose aspirin versus placebo in preventing a recurrence of venous thromboembolism (VTE) [Brighton TA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012]. The primary endpoint was the composite of recurrent symptomatic objectively confirmed DVT, nonfatal PE, or fatal recurrence of VTE.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EA total of 822 patients aged \u226518 years were randomized to receive 100 mg\/day of aspirin or placebo for up to 4 years following initial anticoagulation therapy. Inclusion criteria were completion of initial anticoagulation therapy after a first unprovoked proximal DVT and\/or PE, and commencement of study medication within 6 weeks (and as soon as possible) after the end of initial anticoagulant therapy.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EDuring a median follow-up period of 37.2 months, VTE recurred in 73 of 411 (18%) patients assigned to placebo and in 57 of 411 (14%) assigned to aspirin (6.5% per year vs 4.8% per year; HR aspirin, 0.74; 95% CI, 0.52 to 1.05; p=0.09).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EAlthough there was no significant reduction in the primary endpoint of recurrent VTE, treatment with aspirin was associated with a lower rate of the prespecified secondary broad composite outcomes combing venous and arterial thrombotic events as well as bleeding, including the rate of VTE, myocardial infarction (MI), stroke, or cardiovascular death (HR aspirin, 0.66; 95% CI, 0.48 to 0.92); The rate of VTE, MI, stroke, major bleeding, or death from any cause was reduced by 33% (HR, 0.67; 95% CI, 0.49 to 0.91; p=0.01). There was no significant difference in the rates of major or clinically relevant nonmajor bleeding episodes (0.6%\/year with placebo vs 1.1%\/year with aspirin; p=0.22) or serious adverse events.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAlthough the primary hypothesis that aspirin would significantly reduce the rate of recurrent VTE was not demonstrated, the presenter speculated that this may have been due to a lack of sufficient statistical power limitation. When combined with earlier data [WARFASA; Becattini CN et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012], Dr. Brighton suggested that the ASPIRE study adds to evidence that long-term, low-dose aspirin reduces the risk of recurrent VTE and major vascular events in patients with a first unprovoked VTE compared with placebo (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Brighton TA et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13049\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13049\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13049\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\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EMeta-analysis ASPIRE and WARFASA.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EDr. Brighton said that aspirin is an effective option for patients who are unable or do not wish to continue anticoagulation beyond their initial therapy. Unlike warfarin therapy aspirin is simple, widely available, low cost, and well tolerated, with low risks of bleeding and benefits that extend beyond the prevention of recurrent VTE.\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EScience Advisors\u0027 Statement\u003C\/h2\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EThe clinical impact of these two trials should be interpreted carefully. While administration of aspirin may result in a modest reduction in VTE, trials of prolonged anticoagulant therapy\u2014including those at reduced intensity\u2014have shown benefit of greater magnitude [Ridker PM et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2003; Schulman S et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1997; Kearon C et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1999; Kearon C et al. \u003Cem\u003EChest\u003C\/em\u003E 2012]. Clinicians should carefully consider treatment guidelines, prior data, and individual patient risks when advising patients with regard to appropriate antithrombotic therapy after VTE, and should not consider aspirin an alternative therapy with equivalent efficacy in patients with a clear indication for anticoagulation for VTE.\u003C\/p\u003E\n      \u003C\/div\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\/18\/13.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_openurl.js?nzn681\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_tables.js?nzn681\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}