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Aspirin's Benefits Unclear in PAD Patients

Analysis Fails to Clarify Role of Aspirin Therapy in Patients With Peripheral Artery Disease
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Aspirin for PAD: More Study Needed

In the newly published analysis, Hiatt and colleagues combined data from trials comparing outcomes among patients with PAD who took aspirin therapy to those of patients who did not.

They found that:

  • Aspirin therapy was associated with a 12% reduction in cardiovascular events, which was not statistically significant.
  • A statistically significant (34%) reduction in nonfatal strokes was seen in the aspirin group.
  • Most of the studies did not assess the incidence of major bleeding, which is the biggest risk associated with aspirin therapy.

The study authors were careful to point out that the current evidence was insufficient to rule out small but important benefits of aspirin (as suggested by the point estimate of a 12% risk reduction).

Cardiologist and study co-author Mori J. Krantz, MD, of the Colorado Prevention Center, tells WebMD that a large, randomized study is needed to fully understand the risks versus benefits of aspirin therapy in patients with PAD.

“The benefits of aspirin therapy in coronary artery disease are unequivocal, but we can’t say the same for patients with peripheral artery disease,” he says. “In this era of evidence-based medicine, we owe it to ourselves to adequately study this drug regimen in this population.”

Internist and PAD researcher Mary McGrae McDermott, MD, of Northwestern University’s Feinberg School of Medicine, agrees.

“This analysis gives a more complete picture of the benefits of aspirin in patients with peripheral artery disease, but we need more data,” McDermott tells WebMD.

She points out that of the 18 studies included in the analysis, 15 were published more than a decade ago. In addition, some of the studies involved small numbers of patients and were of short duration, potentially skewing the results.

“To best inform evidence-based clinical practice guidelines, more high-quality clinical trials are needed,” she writes in an editorial published with the study. But McDermott concludes that “based on the limitations of data available, the findings [of the present study] should not alter recommendations for aspirin as an important therapeutic tool for secondary prevention in patients with PAD.”

Hiatt tells WebMD that a trial now under way in the United Kingdom could help clarify the role of aspirin in patients with peripheral artery disease.

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