Objective: This paper aims to evaluate the safety and efficacy of aspirin in primary stroke prevention by meta-analysis. Methods: By searching PubMed, Cochrane Library, Embase, MEDLINE, Web of Science, CNKI, China Biomedical Literature Database, VIP Database and Wanfang Database, we collected randomized controlled trials on aspirin for primary prevention of stroke. The retrieval time limit is from the establishment of the database to December 2021. Two researchers independently conducted literature search, screening, data extraction and quality evaluation, and Meta-analysis was performed using RevMan 5.3. Results: A total of 19 articles were included, including 220,636 subjects. Meta-analysis results show that long-term preventive use of aspirin can reduce the incidence of stroke [RR = 0.91, 95% CI (0.85, 0.98), P = 0.009], and reduce the incidence of ischemic stroke [RR = 0.84, 95% CI] (0.77, 0.91), P < 0.0001], reduce the incidence of TIA [RR = 0.80, 95% CI (0.72, 0.88), P < 0.0001], reduce the incidence of myocardial infarction [RR = 0.85, 95% CI (0.75, 0.97), P < 0.01], but increased the incidence of hemorrhagic stroke [RR = 1.23, 95% CI (1.04, 1.46), P = 0.01] and gastrointestinal bleeding [RR = 1.62, 95% CI (1.35, 1.93), P < 0.01], no significant effect on mortality [RR = 0.97, 95% CI (0.93, 1.02), P = 0.20]. Conclusion: Long-term prophylactic use of aspirin can reduce the overall incidence of stroke, but there is also a risk of bleeding. The advantages and disadvantages of aspirin should be fully evaluated and strict screening should be carried out before medication, which can minimize adverse reactions and improve the safety and effectiveness of aspirin in the primary prevention of stroke.
References
[1]
Mozaffarian, D., Benjamin, E.J., Go, A.S., et al. (2015) Heart Disease and Stroke Statistics—2015 Update: A Report from the American Heart Association. Circulation, 131, e29-e32.
[2]
Feigin, V.L., Forouzanfar, M.H., Krishnamurthi, R., et al. (2014) Global and Regional Burden of Stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. The Lancet, 383, 245-254. https://doi.org/10.1016/S0140-6736(13)61953-4
[3]
Williams, C.D., Chan, A.T., Elman, M.R., et al. (2015) Aspirin Use among Adults in the US: Results of a National Survey. American Journal of Preventive Medicine, 48, 501-508. https://doi.org/10.1016/j.amepre.2014.11.005
[4]
Li, W., Deng, Y.L., Zhuo, L., et al. (2016) A Systematic Review and Meta-Analysis of the Efficacy and Safety of Aspirin for Primary Prevention of Cardiovascular Disease. Chinese Journal of Multiple Organ Diseases in the Elderly, 15, 896-901.
[5]
Shah, R., Khan, B., Latham, S.B., et al. (2019) A Meta-Analysis of Aspirin for the Primary Prevention of Cardiovascular Diseases in the Context of Contemporary Preventive Strategies. The American Journal of Medicine, 132, 1295-1304.e3. https://doi.org/10.1016/j.amjmed.2019.05.015
[6]
Haykal, T., Barbarawi, M., Zayed, Y., et al. (2019) Safety and Efficacy of Aspirin for Primary Prevention of Cancer: A Meta-Analysis of Randomized Controlled Trials. Journal of Cancer Research and Clinical Oncology, 145, 1795-1809. https://doi.org/10.1007/s00432-019-02932-0
[7]
Higgins, J.P. and Green, S. (2016) Cochrance Handbook for Systematic Reviews of Intervention Version 5.1.0., The Cochrane Collaboration, London. http://handbook.cochrane.org
[8]
Peto, R., Gray, R., Collins, R., et al. (1988) Randomised Trial of Prophylactic Daily Aspirin in British Male Doctors. British Medical Journal (Clinical Research Ed.), 296, 313-316. https://doi.org/10.1136/bmj.296.6618.313
[9]
Steering Committee of the Physicians’ Health Study Research Group (1989) Final Report on the Aspirin Component of the Ongoing Physicians’ Health Study. The New England Journal of Medicine, 321, 129-135. https://doi.org/10.1056/NEJM198907203210301
[10]
Lindblad, B., Persson, N.H., Takolander, R., et al. (1993) Does Low-Dose Acetylsalicylic Acid Prevent Stroke after Carotid Surgery? A Double-Blind, Placebo-Controlled Randomized Trial. Stroke, 24, 1125-1128. https://doi.org/10.1161/01.STR.24.8.1125
[11]
Medical Research Council’s General Practice Research Framework (1998) Thrombosis Prevention Trial: Randomised Trial of Low-Intensity Oral Anticoagulation with Warfarin and Low-Dose Aspirin in the Primary Prevention of Ischaemic Heart Disease in Men at Increased Risk. The Lancet, 351, 233-241. https://doi.org/10.1016/S0140-6736(97)11475-1
[12]
Hansson, L., Zanchetti, A., Carruthers, S.G., et al. (1998) Effects of Intensive Blood-Pressure Lowering and Low-Dose Aspirin in Patients with Hypertension: Principal Results of the Hypertension Optimal Treatment (HOT) Randomised Trial. The Lancet, 351, 1755-1762. https://doi.org/10.1016/S0140-6736(98)04311-6
[13]
Meade, T.W. and Brennan, P.J. (2000) Determination of Who May Derive Most Benefit from Aspirin in Primary Prevention: Subgroup Results from a Randomised Controlled Trial. British Medical Journal, 321, 13-17. https://doi.org/10.1136/bmj.321.7252.13
[14]
Roncaglioni, M.C. (2001) Low-Dose Aspirin and Vitamin E in People at Cardiovascular Risk: A Randomised Trial in General Practice. The Lancet, 357, 89-95. https://doi.org/10.1136/bmj.321.7252.13
[15]
Sacco, M., Pellegrini, F., Roncaglioni, M.C., et al. (2003) Primary Prevention of Cardiovascular Events with Low-Dose Aspirin and Vitamin E in Type 2 Diabetic Patients: Results of the Primary Prevention Project (PPP) Trial. Diabetes Care, 26, 3264-3272. https://doi.org/10.2337/diacare.26.12.3264
[16]
Cleland, J.G., Findlay, I., Jafri, S., et al. (2004) The Warfarin/Aspirin Study in Heart Failure (WASH): A Randomized Trial Comparing Antithrombotic Strategies for Patients with Heart Failure. American Heart Journal, 148, 157-164. https://doi.org/10.1016/j.ahj.2004.03.010
[17]
Ridker, P.M., Cook, N.R., Lee, I.M., et al. (2005) A Randomized Trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women. The New England Journal of Medicine, 352, 1293-1304. https://doi.org/10.1056/NEJMoa050613
[18]
Hunan Province Cardiovascular and Cerebrovascular Disease Prevention and Control Network Collaboration Group (2006) The Role of Low-Dose Aspirin in the Primary Prevention of Cardiovascular and Cerebrovascular Events in 2180 Hypertensive Patients. Chinese Journal of Arteriosclerosis, 14, 233-236.
[19]
Ogawa, H., Nakayama, M., Morimoto, T., et al. (2008) Low-Dose Aspirin for Primary Prevention of Atherosclerotic Events in Patients with Type 2 Diabetes: A Randomized Controlled Trial. Journal of the American Medical Association, 300, 2134-2141. https://doi.org/10.1001/jama.2008.623
[20]
Belch, J., MacCuish, A., Campbell, I., et al. (2008) The Prevention of Progression of Arterial Disease and Diabetes (POPADAD) Trial: Factorial Randomised Placebo Controlled Trial of Aspirin and Antioxidants in Patients with Diabetes and Asymptomatic Peripheral Arterial Disease. British Medical Journal, 337, a1840. https://doi.org/10.1136/bmj.a1840
[21]
Fowkes, F.G., Price, J.F., Stewart, M.C., et al. (2010) Aspirin for Prevention of Cardiovascular Events in a General Population Screened for a Low Ankle Brachial Index: A Randomized Controlled Trial. Journal of the American Medical Association, 303, 841-848. https://doi.org/10.1001/jama.2010.221
[22]
Kurth, T., Diener, H.C. and Buring, J.E. (2011) Migraine and Cardiovascular Disease in Women and the Role of Aspirin: Subgroup Analyses in the Women’s Health Study. Cephalalgia, 31, 1106-1115. https://doi.org/10.1177/0333102411412628
[23]
Ikeda, Y., Shimada, K., Teramoto, T., et al. (2014) Low-Dose Aspirin for Primary Prevention of Cardiovascular Events in Japanese Patients 60 Years or Older with Atherosclerotic Risk Factors: A Randomized Clinical Trial. Journal of the American Medical Association, 312, 2510-2520. https://doi.org/10.1001/jama.2014.15690
[24]
McNeil, J.J., Wolfe, R., Woods, R.L., et al. (2018) Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. The New England Journal of Medicine, 379, 1509-1518. https://doi.org/10.1056/NEJMoa1805819
[25]
Gaziano, J.M., Brotons, C., Coppolecchia, R., et al. (2018) Use of Aspirin to Reduce Risk of Initial Vascular Events in Patients at Moderate Risk of Cardiovascular Disease (ARRIVE): A Randomised, Double-Blind, Placebo-Controlled Trial. The Lancet, 392, 1036-1046. https://doi.org/10.1016/S0140-6736(18)31924-X
[26]
ASCEND Study Collaborative Group, Bowman, L., Mafham, M., et al. (2018) Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. The New England Journal of Medicine, 379, 1529-1539. https://doi.org/10.1056/NEJMoa1804988
[27]
Expert Writing Group of Severe Cerebrovascular Disease Branch of Chinese Stroke Society (2017) Chinese Expert Consensus on Postoperative Monitoring and Management of Acute Ischemic Stroke after Endovascular Treatment. Chinese Medical Journal, 97, 162-172.
[28]
Zhu, X.Y. (2009) Analysis and Nursing Countermeasures of Intracranial Hemorrhage after Craniotomy in Patients Taking Low-Dose Aspirin for a Long Time. Journal of Nursing, 16, 41-43.
[29]
Guirguis-Blake, J.M., Evans, C.V., Senger, C.A., et al. (2016) Aspirin for the Primary Prevention of Cardiovascular Events: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 164, 804-813. https://doi.org/10.7326/M15-2113
[30]
Bibbins-Domingo, K. and U.S. Preventive Services Task Force (2016) Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 164, 836-845. https://doi.org/10.7326/M16-0577
[31]
Yang, D., Gao, M.Y. and Zhang, Q. (2020) Meta-Analysis of Efficacy and Safety Evaluation of Aspirin in the Primary Prevention of Cardiovascular Disease. Journal of Preventive Medicine Information, 36, 126-132.
[32]
Zheng, S.L. and Roddick, A.J. (2019) Association of Aspirin Use for Primary Prevention with Cardiovascular Events and Bleeding Events: A Systematic Review and Meta-Analysis. Journal of the American Medical Association, 321, 277-287. https://doi.org/10.1001/jama.2018.20578
[33]
Gelbenegger, G., Postula, M., Pecen, L., et al. (2019) Aspirin for Primary Prevention of Cardiovascular Disease: A Meta-Analysis with a Particular Focus on Subgroups. BMC Medicine, 17, Article No. 198. https://doi.org/10.1186/s12916-019-1428-0
