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Clopidogrel plus aspirin versus aspirin alone for preventing cardiovascular disease

Low‐dose aspirin as antiplatelet therapy is still the drug of choice for preventing cardiovascular events, but the protection aspirin gives to people at high risk of cardiovascular events is only relatively modest. This review of 28,165 people in two trials where clopidogrel was given in addition to antiplatelet treatment found that in patients with acute coronary syndromes the benefit ‐ a reduction in cardiovascular events ‐ outweighs the harm of major bleeding. However, clopidogrel plus aspirin has no clear positive risk‐benefit profile in people at high risk of cardiovascular events (multiple atherothrombotic risk factors) or in people with established cardiovascular disease (known coronary disease, ischemic cerebrovascular disease or peripheral arterial disease) but not presenting with an acute coronary syndrome, and the combination should not be prescribed routinely to prevent cardiovascular disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Aspirin with or without an antiemetic for acute migraine headaches in adults

This is an updated version of the original Cochrane review published in Issue 4, 2010 (Kirthi 2010); no new studies were found. A single oral dose of 1000 mg of aspirin reduced pain from moderate or severe to none by two hours in approximately 1 in 4 people (24%) taking aspirin, compared with about 1 in 10 (11%) taking placebo. Pain was reduced from moderate or severe to no worse than mild pain by two hours in roughly 1 in 2 people (52%) taking aspirin compared with approximately 1 in 3 (32%) taking placebo. Of those who experienced effective headache relief at two hours, more had that relief sustained over 24 hours with aspirin than with placebo. Addition of 10 mg of the antiemetic metoclopramide substantially increased relief of nausea and vomiting compared with aspirin alone, but made little difference to pain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Aspirin and/or heparin for women with unexplained recurrent miscarriage with or without inherited thrombophilia

Recurrent miscarriage is associated with inherited blood clotting disorders that could interfere with the placental blood circulation. Recurrent miscarriage can also be unexplained, with no known cause. Anticoagulant drugs such as aspirin or low molecular weight heparin may help women with recurrent miscarriage and such an underlying blood clotting problem. These drugs may also cause bleeding (including nose bleeds and haematomas) in the mother, though not in the baby. Data from nine included randomised controlled trials (involving 1228 women) analysed in this review, provided no evidence to support the use of anticoagulants in women with recurrent miscarriage, regardless of the presence of inherited blood clotting disorders (thrombophilia).

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Non‐steroidal anti‐inflammatory drugs, including aspirin and paracetamol (acetaminophen) in people taking methotrexate for inflammatory arthritis

This summary of a Cochrane review describes what we know from research about any safety issues from using non‐steroidal anti‐inflammatory drugs, or NSAIDs, including aspirin, or paracetamol (acetaminophen), or both, along with methotrexate in people with inflammatory arthritis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Clopidogrel used in combination with aspirin compared with aspirin alone in the treatment of non-ST-segment-elevation acute coronary syndromes: a systematic review and economic evaluation

Most of the mortality and morbidity associated with non-ST-segment elevation acute coronary syndromes (ACS) arises from disruption of atheromatous plaques, followed by platelet aggregation and thrombus formation. Aspirin is the most commonly prescribed antiplatelet agent, which is known to reduce the risk of fatal and non-fatal myocardial infarction in patients with unstable angina. Clopidogrel, a different antiplatelet agent, inhibits platelet aggregation induced by adenosine diphosphate, thereby reducing ischaemic events. Combining clopidogrel with aspirin may therefore have an additive effect as each acts via a different inhibitory pathway.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2004

Evaluation of the Benefits and Harms of Aspirin for Primary Prevention of Cardiovascular Events: A Comparison of Quantitative Approaches [Internet]

Prior work has described various quantitative approaches to the assessment of benefits and harms of medical interventions. Researchers rarely use these approaches in the context of a systematic review.

Methods Research Reports - Agency for Healthcare Research and Quality (US).

Version: November 2013
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Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews

Study finds that there is a fine balance between the benefits and risks of regular aspirin use in the primary prevention of cardiovascular disease.

Health Technology Assessment - NIHR Journals Library.

Version: September 2013
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Aspirin Use in Adults: Cancer, All-Cause Mortality, and Harms: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Cancer is the second leading cause of death in United States. The net benefit for aspirin (ASA) in cardiovascular disease (CVD) primary prevention is controversial due to increased risks from bleeding alongside relatively modest cardiovascular benefits. Consideration of additional cancer prevention effects might clarify whether long-term, low-dose ASA may offer an overall health benefit for the two top causes of mortality in the United States.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: September 2015
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Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010
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Low-Dose Aspirin for the Prevention of Morbidity and Mortality From Preeclampsia: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

We conducted a systematic review of the evidence on the use of low-dose aspirin for the prevention of morbidity and mortality from preeclampsia to support the U.S. Preventive Services Task Force (USPSTF) in updating its previous recommendation. Prior reviews have established that benefits of aspirin prophylaxis are not obtained in populations of healthy or unselected pregnant women not at high risk of preeclampsia. In this review we considered the evidence on benefits and harms of low-dose aspirin for women at elevated risk of developing preeclampsia and consequent maternal and fetal health outcomes. Three key questions (KQs) were systematically reviewed: 1) Is there evidence that aspirin reduces adverse maternal or fetal health outcomes? 2) Is there evidence that aspirin reduces incidence of preeclampsia? and 3) What are the harms of low-dose aspirin use during pregnancy?

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: April 2014
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The prognostic utility of tests of platelet function for the detection of ‘aspirin resistance’ in patients with established cardiovascular or cerebrovascular disease: a systematic review and economic evaluation

People with heart disease are often prescribed aspirin. Testing the function of platelets in the blood may be able to assess if aspirin is working properly. This review assessed all the evidence on the results of platelet function testing linked to the risk of having another cardiovascular event (such as a heart attack or stroke). The review found that people classified as ‘aspirin resistant’ by platelet function testing were, on average, slightly more at risk of having another cardiovascular event. However, the increase in risk was very small and it was not certain which was the most accurate of the platelet function tests available. Therefore, at the moment, the result of platelet function testing on its own is not very informative in determining a person’s future risk of cardiovascular events.

Health Technology Assessment - NIHR Journals Library.

Version: May 2015
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Aspirin Use for the Prevention of Colorectal Cancer: An Updated Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Colorectal cancer (CRC) is the third most commonly diagnosed cancer in both men and women in the United States (U.S.). Aspirin may inhibit CRC development and related mortality.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: September 2015
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Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer: A Decision Analysis: Technical Report [Internet]

Evidence indicates that aspirin is effective for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC), but regular use also increases risk for gastrointestinal (GI) and cerebral hemorrhages.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: September 2015
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Aspirin for the Primary Prevention of Cardiovascular Events: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]

Cardiovascular disease (CVD) is the leading cause of death in the United States, contributing to more than a third of deaths annually.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: September 2015
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Acute Upper Gastrointestinal Bleeding: Management

The incidence of acute upper gastrointestinal haemorrhage in the United Kingdom ranges between 84–172 /100,000/year, equating to 50–70,000 hospital admissions per year. This is therefore a relatively common medical emergency; it is also one that more often affects socially deprived communities.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2012
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Combination of heparin and aspirin is superior to aspirin alone in enhancing live births in patients with recurrent pregnancy loss and positive anti-phospholipid antibodies: a meta-analysis of randomized controlled trials and meta-regression

OBJECTIVE: The combination of heparin and aspirin was regarded as the 'standard therapy' for patients with recurrent pregnancy loss (RPL) and positive aPL antibodies to enhance live births, but it largely stems from expert opinion. We performed a meta-analysis of randomized controlled trials (RCTs) to assess whether this combination works better than aspirin alone.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

Safety and efficacy of warfarin plus aspirin combination therapy for giant coronary artery aneurysm secondary to Kawasaki disease: a meta-analysis

OBJECTIVE: To compare the safety and efficacy of warfarin plus aspirin versus aspirin alone for the treatment of children with giant coronary artery aneurysm (CAA) secondary to Kawasaki disease (KD).

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

The efficacy and safety of aspirin plus dipyridamole versus aspirin in secondary prevention following TIA or stroke: a meta-analysis of randomized controlled trials

OBJECTIVE: Stroke is becoming a common disease worldwide, and has an increased rate of recurrence yearly after a transient ischemic attack (TIA) or stroke. Aspirin, dipyridamole, clopidogrel and aspirin plus dipyridamole combination therapy have been recommended for the secondary prevention of stroke in Americans.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Prevention of recurrent miscarriage for women with antiphospholipid antibody or lupus anticoagulant

Treatments for recurrent miscarriage when there are antibodies in the mothers blood.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Antiplatelet therapy for preventing stroke in patients with non‐valvular atrial fibrillation and no previous history of stroke or transient ischemic attacks

Antiplatelet agents like aspirin are effective for preventing serious vascular events in patients with atrial fibrillation not suitable for oral anticoagulants. Atrial fibrillation is an irregularity of the heartbeat that leads to blood clots forming in the upper chambers of the heart (the atria). These clots can break free and travel through the bloodstream to the brain and cause a stroke. Drugs that slow clotting, such as antiplatelet agents (aspirin and others) and anticoagulants reduce the risk of stroke in patients with atrial fibrillation. In this review the benefits of antiplatelet agents are shown to be modest (nearly 25% decrease in stroke), but they are relatively safe, easy to take, and therefore an important treatment option for many atrial fibrillation patients. Anticoagulation with warfarin and related drugs offers more protection against stroke (nearly two‐thirds reduction), but anticoagulant drugs can cause severe bleeding and require careful regulation with regular blood tests. The choice of antiplatelet drugs versus anticoagulants should be individualized based on the patient's inherent risk of stroke, ability to tolerate anticoagulation without bleeding, access to adequate anticoagulation monitoring, and patient preferences.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

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