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Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials.
JAMA 1998; 280(22):1930-5JAMA

Abstract

CONTEXT

Aspirin has been widely used to prevent myocardial infarction and ischemic stroke but some studies have suggested it increases risk of hemorrhagic stroke.

OBJECTIVE

To estimate the risk of hemorrhagic stroke associated with aspirin treatment.

DATA SOURCES

Studies were retrieved using MEDLINE (search terms, aspirin, cerebrovascular disorders, and stroke), bibliographies of the articles retrieved, and the authors' reference files.

STUDY SELECTION

All trials published in English-language journals before July 1997 in which participants were randomized to aspirin or a control treatment for at least 1 month and in which the incidence of stroke subtype was reported.

DATA EXTRACTION

Information on country of origin, sample size, duration, study design, aspirin dosage, participant characteristics, and outcomes was abstracted independently by 2 authors who used a standardized protocol.

DATA SYNTHESIS

Data from 16 trials with 55462 participants and 108 hemorrhagic stroke cases were analyzed. The mean dosage of aspirin was 273 mg/d and mean duration of treatment was 37 months. Aspirin use was associated with an absolute risk reduction in myocardial infarction of 137 events per 10000 persons (95% confidence interval [CI], 107-167; P<.001) and in ischemic stroke, a reduction of 39 events per 10000 persons (95% CI, 17-61; P<.001). However, aspirin treatment was also associated with an absolute risk increase in hemorrhagic stroke of 12 events per 10000 persons (95% CI, 5-20; P<.001). This risk did not differ by participant or study design characteristics.

CONCLUSIONS

These results indicate that aspirin therapy increases the risk of hemorrhagic stroke. However, the overall benefit of aspirin use on myocardial infarction and ischemic stroke may outweigh its adverse effects on risk of hemorrhagic stroke in most populations.

Authors+Show Affiliations

Department of Biostatistics and Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA 70112, USA. jhe@mailhost.tcs.tulane.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

9851479

Citation

He, J, et al. "Aspirin and Risk of Hemorrhagic Stroke: a Meta-analysis of Randomized Controlled Trials." JAMA, vol. 280, no. 22, 1998, pp. 1930-5.
He J, Whelton PK, Vu B, et al. Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials. JAMA. 1998;280(22):1930-5.
He, J., Whelton, P. K., Vu, B., & Klag, M. J. (1998). Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials. JAMA, 280(22), pp. 1930-5.
He J, et al. Aspirin and Risk of Hemorrhagic Stroke: a Meta-analysis of Randomized Controlled Trials. JAMA. 1998 Dec 9;280(22):1930-5. PubMed PMID: 9851479.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized controlled trials. AU - He,J, AU - Whelton,P K, AU - Vu,B, AU - Klag,M J, PY - 1998/12/16/pubmed PY - 2001/8/14/medline PY - 1998/12/16/entrez SP - 1930 EP - 5 JF - JAMA JO - JAMA VL - 280 IS - 22 N2 - CONTEXT: Aspirin has been widely used to prevent myocardial infarction and ischemic stroke but some studies have suggested it increases risk of hemorrhagic stroke. OBJECTIVE: To estimate the risk of hemorrhagic stroke associated with aspirin treatment. DATA SOURCES: Studies were retrieved using MEDLINE (search terms, aspirin, cerebrovascular disorders, and stroke), bibliographies of the articles retrieved, and the authors' reference files. STUDY SELECTION: All trials published in English-language journals before July 1997 in which participants were randomized to aspirin or a control treatment for at least 1 month and in which the incidence of stroke subtype was reported. DATA EXTRACTION: Information on country of origin, sample size, duration, study design, aspirin dosage, participant characteristics, and outcomes was abstracted independently by 2 authors who used a standardized protocol. DATA SYNTHESIS: Data from 16 trials with 55462 participants and 108 hemorrhagic stroke cases were analyzed. The mean dosage of aspirin was 273 mg/d and mean duration of treatment was 37 months. Aspirin use was associated with an absolute risk reduction in myocardial infarction of 137 events per 10000 persons (95% confidence interval [CI], 107-167; P<.001) and in ischemic stroke, a reduction of 39 events per 10000 persons (95% CI, 17-61; P<.001). However, aspirin treatment was also associated with an absolute risk increase in hemorrhagic stroke of 12 events per 10000 persons (95% CI, 5-20; P<.001). This risk did not differ by participant or study design characteristics. CONCLUSIONS: These results indicate that aspirin therapy increases the risk of hemorrhagic stroke. However, the overall benefit of aspirin use on myocardial infarction and ischemic stroke may outweigh its adverse effects on risk of hemorrhagic stroke in most populations. SN - 0098-7484 UR - https://www.unboundmedicine.com/medline/citation/9851479/Aspirin_and_risk_of_hemorrhagic_stroke:_a_meta_analysis_of_randomized_controlled_trials_ L2 - https://jamanetwork.com/journals/jama/fullarticle/vol/280/pg/1930 DB - PRIME DP - Unbound Medicine ER -