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Low-Dose Aspirin Is Preferred Maintenance Dose After Acute MI | Journal Scan
Study Questions:
What are current patterns of aspirin dosing among myocardial infarction (MI) patients following percutaneous coronary intervention (PCI) with stenting in contemporary US clinical practice, and what is the association of aspirin dosing with major adverse cardiovascular events (MACE) and bleeding?
Methods:
This was a post hoc analysis of the TRANSLATE-ACS study (Treatment with ADP Receptor Inhibitors: Longitudinal Assessment of Treatment Patterns and Events After Acute Coronary Syndrome). TRANSLATE-ACS was a multicenter, prospective, longitudinal, observational study of more than 12,000 MI patients managed with PCI. Discharge aspirin dose was abstracted from the medical record of the index hospitalization. Patients were divided into groups according to aspirin dose at discharge: high dose (325 mg/day) versus low dose (81 mg/day). Clinical outcomes were major adverse cardiovascular events (MACE) and Bleeding Academic Research Consortium (BARC)-defined bleeding events from discharge to 6 months.
Results:
The analytic sample consisted of 10,213 patients discharged from 228 US hospitals. A total of 6,387 (62.6%) patients received high-dose aspirin. MACE risk was not significantly different between groups (high vs. low: unadjusted 8.2% vs. 9.2%; adjusted hazard ratio, 0.99; 95% confidence interval [CI], 0.85-1.17). In adjusted analyses, patients prescribed high-dose aspirin were more likely to report any BARC-defined bleeding events (adjusted odds ratio, 1.19; 95% CI, 1.06-1.33). This was driven mainly by increased risk of minor BARC type 1 or 2 bleeding events not requiring hospitalization (21.4% vs. 19.5%; adjusted OR, 1.19; 95% CI, 1.05-1.34). In subgroup analyses, there were no significant differences in MACE between high- and low-dose aspirin groups when stratified by age, sex, baseline aspirin use, and discharge ADP receptor inhibitor type.
Conclusions:
Although prescribed at discharge in nearly two-thirds of patients, high maintenance dose aspirin was not associated with lower risk of MACE, but was associated with an increased risk of minor bleeding events.
Perspective:
This was a large analysis of contemporary MI patients treated with PCI and dual antiplatelet therapy in the United States. The findings are valuable and corroborate current guidelines for recommending low-dose aspirin as the preferred maintenance dose following MI. Future efforts should attempt to limit the use of high maintenance dose aspirin therapy (which was prescribed in nearly two-thirds of patients).
Keywords: Acute Coronary Syndrome, Aspirin, Hemorrhage, Medical Records, Myocardial Infarction, Patient Discharge, Percutaneous Coronary Intervention, Prospective Studies, Receptors, Purinergic P2, Risk
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