Effect of low-dose aspirin on health outcomes: An umbrella review of systematic reviews and meta-analyses.

Aspirin / administration & dosage Gastrointestinal Hemorrhage / chemically induced Humans Risk Assessment
aspirin cancer cardiovascular disease meta-analysis umbrella review

Journal

British journal of clinical pharmacology
ISSN: 1365-2125
Titre abrégé: Br J Clin Pharmacol
Pays: England
ID NLM: 7503323

Informations de publication

Date de publication:
08 2020
Historique:
received: 30 10 2019
revised: 13 03 2020
accepted: 23 03 2020
pubmed: 4 6 2020
medline: 3 7 2021
entrez: 4 6 2020
Statut: ppublish

Résumé

This study aimed to use an umbrella review methodology to capture the range of outcomes that were associated with low-dose aspirin and to systematically assess the credibility of this evidence. Aspirin is associated with several health outcomes, but the overall benefit/risk balance related to aspirin use is unclear. We searched three major databases up to 15 August 2019 for meta-analyses of observational studies and randomized controlled trials (RCTs) including low-dose aspirin compared to placebo or other treatments. Based on random-effects summary effect sizes, 95% prediction intervals, heterogeneity, small-study effects and excess significance, significant meta-analyses of observational studies were classified from convincing (class I) to weak (class IV). For meta-analyses of RCTs, outcomes with random effects P-value < .005 and a moderate/high GRADE assessment, were classified as strong evidence. From 6802 hits, 67 meta-analyses (156 outcomes) were eligible. Observational data showed highly suggestive evidence for aspirin use and increased risk of upper gastrointestinal bleeding (RR = 2.28, 95% CI: 1.97-2.64). In RCTs of low-dose aspirin, we observed strong evidence for lower risk of CVD in people without CVD (RR = 0.83; 95% CI: 0.79-0.87) and in general population (RR = 0.83; 95% CI: 0.79-0.89), higher risk of major gastrointestinal (RR = 1.47; 95% CI: 1.26-1.72) and intracranial bleeding (RR = 1.34; 95% CI: 1.18-1.53), and of major bleedings in people without CVD (RR = 1.62; 95% CI: 1.26-2.08). Compared to other active medications, low-dose aspirin had strong evidence for lower risk of bleeding, but also lower comparative efficacy. Low-dose aspirin significantly lowers CVD risk and increases risk of bleeding. Evidence for multiple other health outcomes is limited.

Identifiants

DOI: 10.1111/bcp.14310 PMID: 32488906 PMC: PMC7373714
pubmed: 32488906
doi: 10.1111/bcp.14310
pmc: PMC7373714
doi:

Substances chimiques

Aspirin R16CO5Y76E

Types de publication

Journal Article Research Support, Non-U.S. Gov't Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1465-1475

Subventions

Organisme : Cancer Research UK
ID : 22804
Pays : United Kingdom
Organisme : Department of Health
ID : ICA-CL-2017-03-001
Pays : United Kingdom
Organisme : Cancer Research UK
ID : C31250/A22804
Pays : United Kingdom

Informations de copyright

© 2020 The British Pharmacological Society.

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Auteurs

Nicola Veronese (N)

National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy.
Geriatrics Unit, Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genoa, Italy.

Jacopo Demurtas (J)

Primary Care Department, Azienda USL Toscana Sud Est, Grosseto, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.

Trevor Thompson (T)

Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK.

Marco Solmi (M)

Department of Neuroscience, University of Padova, Padua, Italy.

Gabriella Pesolillo (G)

Primary Care Service, ASL 02, Chieti, Italy.

Stefano Celotto (S)

Primary Care Department, Alto Friuli-Collinare-Medio Friuli, Udine, Italy.

Tommaso Barnini (T)

Primary Care Service, AUSL Toscana Centro, Florence, Italy.

Brendon Stubbs (B)

Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.
Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK.

Stefania Maggi (S)

National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy.

Alberto Pilotto (A)

Geriatrics Unit, Department of Geriatric Care, Ortho Geriatrics and Rehabilitation, Frailty Area, E.O. Galliera Hospital, Genoa, Italy.

Graziano Onder (G)

Fondazione Policlinico Universitario A. Gemelli, IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy.

Evropi Theodoratou (E)

Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
Edinburgh Cancer Research Centre, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK.

Alberto Vaona (A)

Primary Care Department, Azienda ULSS20 Verona, Verona, Italy.

Joseph Firth (J)

NICM Health Research Institute, University of Western Sydney, Penrith, Australia.
Division of Psychology and Mental Health, University of Manchester, Manchester, UK.

Lee Smith (L)

The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK.
ORCID: 0000-0003-0890-7566

Ai Koyanagi (A)

Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.

John P A Ioannidis (JPA)

Stanford Prevention Research Center, Department of Medicine, Stanford University Medical School, Stanford, California, USA.
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA.
Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, California, USA.
Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, USA.

Ioanna Tzoulaki (I)

Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
MRC-PHE Centre for Environment, School of Public Health, Imperial College London, UK.

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