Skip to main content
NCBI home page
British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1988 Jan 30;296(6618):320–331.

Secondary prevention of vascular disease by prolonged antiplatelet treatment

Antiplatelet Trialists' Collaboration
PMCID: PMC2544833  PMID: 3125883

Abstract

Thirty one randomised trials of antiplatelet treatment for patients with a history of transient ischaemic attack, occlusive stroke, unstable angina, or myocardial infarction were identified. Six were still in progress, and the results of the remaining 25 were reviewed. They included a total of some 29 000 patients, 3000 of whom had died. Overall, allocation to antiplatelet treatment had no apparent effect on non-vascular mortality but reduced vascular mortality by 15% (SD 4%) and non-fatal vascular events (stroke or myocardial infarction) by 30% (4%). This suggested that with good compliance these treatments might reduce vascular mortality by about one sixth, other vascular events by about a third, and total vascular events by about a quarter. There was no significant difference between the effects of the different types of antiplatelet treatment tested (300-325 mg aspirin daily, higher aspirin doses, sulphinpyrazone, or high dose aspirin with dipyridamole), nor between the effects in patients with histories of cerebral or cardiac disease. Thus antiplatelet treatment can reduce the incidence of serious vascular events by about a quarter among a wide range of patients at particular risk of occlusive vascular disease. The balance of risk and benefit, however, might be different for “primary” prevention among people at low absolute risk of occlusive disease if antiplatelet treatment produced even a small increase in the incidence of cerebral haemorrhage.

Full text

PDF
320

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acheson J., Danta G., Hutchinson E. C. Controlled trial of dipyridamole in cerebral vascular disease. Br Med J. 1969 Mar 8;1(5644):614–615. doi: 10.1136/bmj.1.5644.614. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Amery A., Birkenhäger W., Brixko P., Bulpitt C., Clement D., Deruyttere M., De Schaepdryver A., Dollery C., Fagard R., Forette F. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet. 1985 Jun 15;1(8442):1349–1354. doi: 10.1016/s0140-6736(85)91783-0. [DOI] [PubMed] [Google Scholar]
  3. Boss A. H., Boysen G., Olseen J. S. Effect of incremental doses of aspirin on bleeding time, platelet aggregation and thromboxane production in patients with cerebrovascular disease. Eur J Clin Invest. 1985 Dec;15(6):412–414. doi: 10.1111/j.1365-2362.1985.tb00294.x. [DOI] [PubMed] [Google Scholar]
  4. Bousser M. G., Eschwege E., Haguenau M., Lefaucconnier J. M., Thibult N., Touboul D., Touboul P. J. "AICLA" controlled trial of aspirin and dipyridamole in the secondary prevention of athero-thrombotic cerebral ischemia. Stroke. 1983 Jan-Feb;14(1):5–14. doi: 10.1161/01.str.14.1.5. [DOI] [PubMed] [Google Scholar]
  5. Bousser M. G., Eschwege E., Haguenau M., Lefauconnier J. M., Touboul D., Touboul P. J. Essai coopératif contrôlé "A.I.C.L.A." Prévention secondaire des accidents ischémiques cérébraux liés à l'athérosclérose par l'aspirine et le dipyridamole. 1re Partie: Protocole. Rev Neurol (Paris) 1981;137(5):333–341. [PubMed] [Google Scholar]
  6. Boysen G., Boss A. H., Odum N., Olsen J. S. Prolongation of bleeding time and inhibition of platelet aggregation by low-dose acetylsalicylic acid in patients with cerebrovascular disease. Stroke. 1984 Mar-Apr;15(2):241–243. doi: 10.1161/01.str.15.2.241. [DOI] [PubMed] [Google Scholar]
  7. Breddin K., Loew D., Lechner K., Uberla K., Walter E. Secondary prevention of myocardial infarction: a comparison of acetylsalicylic acid, placebo and phenprocoumon. Haemostasis. 1980;9(6):325–344. doi: 10.1159/000214375. [DOI] [PubMed] [Google Scholar]
  8. Cairns J. A., Gent M., Singer J., Finnie K. J., Froggatt G. M., Holder D. A., Jablonsky G., Kostuk W. J., Melendez L. J., Myers M. G. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med. 1985 Nov 28;313(22):1369–1375. doi: 10.1056/NEJM198511283132201. [DOI] [PubMed] [Google Scholar]
  9. Candelise L., Landi G., Perrone P., Bracchi M., Brambilla G. A randomized trial of aspirin and sulfinpyrazone in patients with TIA. Stroke. 1982 Mar-Apr;13(2):175–179. doi: 10.1161/01.str.13.2.175. [DOI] [PubMed] [Google Scholar]
  10. Canner P. L. Aspirin in coronary heart disease. Comparison of six clinical trials. Isr J Med Sci. 1983 May;19(5):413–423. [PubMed] [Google Scholar]
  11. Elwood P. C. Aspirin in the prevention of myocardial infarction. Current status. Drugs. 1984 Jul;28(1):1–5. doi: 10.2165/00003495-198428010-00001. [DOI] [PubMed] [Google Scholar]
  12. Elwood P. C., Cochrane A. L., Burr M. L., Sweetnam P. M., Williams G., Welsby E., Hughes S. J., Renton R. A randomized controlled trial of acetyl salicylic acid in the secondary prevention of mortality from myocardial infarction. Br Med J. 1974 Mar 9;1(5905):436–440. doi: 10.1136/bmj.1.5905.436. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Elwood P. C., Sweetnam P. M. Aspirin and secondary mortality after myocardial infarction. Lancet. 1979 Dec 22;2(8156-8157):1313–1315. doi: 10.1016/s0140-6736(79)92808-3. [DOI] [PubMed] [Google Scholar]
  14. Fields W. S., Lemak N. A., Frankowski R. F., Hardy R. J. Controlled trial of aspirin in cerebral ischemia. Part II: surgical group. Stroke. 1978 Jul-Aug;9(4):309–319. doi: 10.1161/01.str.9.4.309. [DOI] [PubMed] [Google Scholar]
  15. Fields W. S., Lemak N. A., Frankowski R. F., Hardy R. J. Controlled trial of aspirin in cerebral ischemia. Stroke. 1977 May-Jun;8(3):301–314. doi: 10.1161/01.str.8.3.301. [DOI] [PubMed] [Google Scholar]
  16. FitzGerald G. A. Dipyridamole. N Engl J Med. 1987 May 14;316(20):1247–1257. doi: 10.1056/NEJM198705143162005. [DOI] [PubMed] [Google Scholar]
  17. Gent M., Blakely J. A., Hachinski V., Roberts R. S., Barnett H. J., Bayer N. H., Carruthers S. G., Collins S. M., Gawel M. G., Giroux-Klimek M. A secondary prevention, randomized trial of suloctidil in patients with a recent history of thromboembolic stroke. Stroke. 1985 May-Jun;16(3):416–424. doi: 10.1161/01.str.16.3.416. [DOI] [PubMed] [Google Scholar]
  18. Gent M., Ellis D. Canadian American ticlopidine study (cats) in thromboembolic stroke. Agents Actions Suppl. 1984;15:283–296. [PubMed] [Google Scholar]
  19. Grotta J. C. Current medical and surgical therapy for cerebrovascular disease. N Engl J Med. 1987 Dec 10;317(24):1505–1516. doi: 10.1056/NEJM198712103172405. [DOI] [PubMed] [Google Scholar]
  20. Guiraud-Chaumeil B., Rascol A., David J., Boneu B., Clanet M., Bierme R. Prévention des récidives des accidents vasculaires cérébraux ischémiques par les anti-agrégants plaquettaires. Résultats d'un essai thérapeutique contrôlé de 3 ans. Rev Neurol (Paris) 1982;138(5):367–385. [PubMed] [Google Scholar]
  21. Hass W. K., Kamm B. The North American ticlopidine aspirin stroke study: structure, stratification variables, and patient characteristics. Agents Actions Suppl. 1984;15:273–278. [PubMed] [Google Scholar]
  22. Hennekens C. H., Eberlein K. A randomized trial of aspirin and beta-carotene among U.S. physicians. Prev Med. 1985 Mar;14(2):165–168. doi: 10.1016/0091-7435(85)90031-3. [DOI] [PubMed] [Google Scholar]
  23. High-dose acetylsalicylic acid after cerebral infarction. A Swedish Cooperative Study. Stroke. 1987 Mar-Apr;18(2):325–334. doi: 10.1161/01.str.18.2.325. [DOI] [PubMed] [Google Scholar]
  24. Jakubowski J. A., Stampfer M. J., Vaillancourt R., Deykin D. Cumulative antiplatelet effect of low-dose enteric coated aspirin. Br J Haematol. 1985 Aug;60(4):635–642. doi: 10.1111/j.1365-2141.1985.tb07467.x. [DOI] [PubMed] [Google Scholar]
  25. Klimt C. R., Knatterud G. L., Stamler J., Meier P. Persantine-Aspirin Reinfarction Study. Part II. Secondary coronary prevention with persantine and aspirin. J Am Coll Cardiol. 1986 Feb;7(2):251–269. doi: 10.1016/s0735-1097(86)80489-2. [DOI] [PubMed] [Google Scholar]
  26. Lorenz R. L., Schacky C. V., Weber M., Meister W., Kotzur J., Reichardt B., Theisen K., Weber P. C. Improved aortocoronary bypass patency by low-dose aspirin (100 mg daily). Effects on platelet aggregation and thromboxane formation. Lancet. 1984 Jun 9;1(8389):1261–1264. doi: 10.1016/s0140-6736(84)92446-2. [DOI] [PubMed] [Google Scholar]
  27. MacMahon S. W., Cutler J. A., Furberg C. D., Payne G. H. The effects of drug treatment for hypertension on morbidity and mortality from cardiovascular disease: a review of randomized controlled trials. Prog Cardiovasc Dis. 1986 Nov-Dec;29(3 Suppl 1):99–118. doi: 10.1016/0033-0620(86)90038-1. [DOI] [PubMed] [Google Scholar]
  28. Patrono C. Aspirin for the prevention of coronary thrombosis: current facts and perspectives. Eur Heart J. 1986 Jun;7(6):454–459. doi: 10.1093/oxfordjournals.eurheartj.a062091. [DOI] [PubMed] [Google Scholar]
  29. Patrono C., Ciabattoni G., Patrignani P., Pugliese F., Filabozzi P., Catella F., Davì G., Forni L. Clinical pharmacology of platelet cyclooxygenase inhibition. Circulation. 1985 Dec;72(6):1177–1184. doi: 10.1161/01.cir.72.6.1177. [DOI] [PubMed] [Google Scholar]
  30. Robertson J. T., Dugdale M., Salky N., Robinson H. Proceedings: The effect of a platelet inhibiting drug (sulfinpyrazone) in the therapy of patients with transient ischemic attacks (Tia's) and minor strokes. Thromb Diath Haemorrh. 1975 Nov 15;34(2):598–598. [PubMed] [Google Scholar]
  31. Sorensen P. S., Pedersen H., Marquardsen J., Petersson H., Heltberg A., Simonsen N., Munck O., Andersen L. A. Acetylsalicylic acid in the prevention of stroke in patients with reversible cerebral ischemic attacks. A Danish cooperative study. Stroke. 1983 Jan-Feb;14(1):15–22. [PubMed] [Google Scholar]
  32. Yusuf S., Peto R., Lewis J., Collins R., Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985 Mar-Apr;27(5):335–371. doi: 10.1016/s0033-0620(85)80003-7. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal (Clinical research ed.) are provided here courtesy of BMJ Publishing Group

RESOURCES