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Sanjit S. Jolly, Janice Pogue, Kimberly Haladyn, Ron J.G. Peters, Keith A.A. Fox, Alvaro Avezum, Bernard J. Gersh, Hans Jurgen Rupprecht, Salim Yusuf, Shamir R. Mehta, Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study, European Heart Journal, Volume 30, Issue 8, April 2009, Pages 900–907, https://doi.org/10.1093/eurheartj/ehn417
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Abstract
In the setting of percutaneous coronary intervention (PCI), due to a paucity of data, the optimal dose of aspirin is uncertain. We evaluated the safety of different doses of aspirin after PCI.
In the PCI-CURE study, 2658 patients with acute coronary syndromes undergoing PCI were stratified into three aspirin dose groups ≥200 mg (high, n = 1064), 101–199 mg (moderate, n = 538), and ≤100 mg (low, n = 1056). For efficacy, the moderate- (7.4%) and high-dose groups (8.6%) had similar rates of cardiovascular death, myocardial infarction, or stroke compared with the low-dose group (7.1%). For safety, major bleeding was increased with high-dose aspirin [3.9, 1.5, and 1.9% in the high-, moderate-, and low-dose groups; hazard ratio (HR) of high vs. low dose 2.05 (95% CI 1.20–3.50, P = 0.009]. The net adverse clinical events (death, MI, stroke, major bleeding) favoured low-over high-dose aspirin (8.4 vs. 11.0%, HR 1.31, 95% CI 1.00–1.73 P = 0.056).
In this large observational analysis of patients undergoing PCI, low-dose aspirin appeared to be as effective as higher doses in preventing ischaemic events but was also associated with a lower rate of major bleeding and an improved net efficacy to safety balance.
