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Circulation. 2017 Sep 26;136(13):1183-1192. doi: 10.1161/CIRCULATIONAHA.117.028321.

Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort Study.

Author information

1
From Department of Medical Sciences (J.S., J.O.), Uppsala Clinical Research Center (J.S., J.O.), and Department of Surgical Sciences (J.H), Uppsala University, Sweden; Statisticon AB, Uppsala, Sweden (M.T.); AstraZeneca Nordic Baltic, Södertälje, Sweden (P.A.); and Linköping University, Sweden (K.M.J.). Johan.Sundstrom@medsci.uu.se.
2
From Department of Medical Sciences (J.S., J.O.), Uppsala Clinical Research Center (J.S., J.O.), and Department of Surgical Sciences (J.H), Uppsala University, Sweden; Statisticon AB, Uppsala, Sweden (M.T.); AstraZeneca Nordic Baltic, Södertälje, Sweden (P.A.); and Linköping University, Sweden (K.M.J.).

Abstract

BACKGROUND:

There are increasing concerns about risks associated with aspirin discontinuation in the absence of major surgery or bleeding. We investigated whether long-term low-dose aspirin discontinuation and treatment gaps increase the risk of cardiovascular events.

METHODS:

We performed a cohort study of 601 527 users of low-dose aspirin for primary or secondary prevention in the Swedish prescription register between 2005 and 2009 who were >40 years of age, were free from previous cancer, and had ≥80% adherence during the first observed year of treatment. Cardiovascular events were identified with the Swedish inpatient and cause-of-death registers. The first 3 months after a major bleeding or surgical procedure were excluded from the time at risk.

RESULTS:

During a median of 3.0 years of follow-up, 62 690 cardiovascular events occurred. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37; 95% confidence interval, 1.34-1.41), corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin. The risk increased shortly after discontinuation and did not appear to diminish over time.

CONCLUSIONS:

In long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding was associated with a >30% increased risk of cardiovascular events. Adherence to low-dose aspirin treatment in the absence of major surgery or bleeding is likely an important treatment goal.

KEYWORDS:

aspirin; cohort studies; primary prevention; secondary prevention

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