High-Dose Aspirin Provides No Extra Ischemic Protection

A new study shows that patients with ST-segment-elevation MI (STEMI) discharged on high-dose aspirin fails to provide any additional protection against ischemic events.

Researchers at Mount Sinai School of Medicine (New York, NY, USA) compared three-year outcomes among 2,289 patients discharged after a primary percutaneous intervention (PCI) on low-dose aspirin (less than 200 mg/day) and 562 patients treated with high-dose aspirin (over 200 mg/day), to examine the relationship between the aspirin dose prescribed at hospital discharge and long-term outcomes after STEMI in patients treated with PCI. All patients participated in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial.

The results showed that patients discharged on high-dose aspirin had higher 3-year rates of major adverse cardiovascular events, reinfarction, ischemic target vessel revascularization, major bleeding, and stent thrombosis. After multivariable analysis, discharge on high-dose aspirin was an independent predictor of major bleeding, which occurred within the first two months, but continued to increase over the entire three-year follow-up period. High-dose aspirin was not associated with a reduction in any ischemic events. The study was published in the December 2012 issue of JACC: Cardiovascular Interventions.

“In the clinical guidelines, the recommended dose of aspirin ranges anywhere from 82 mg to 325 mg because we don't really have any prospective, randomized study showing which dose is actually best for these patients, which is kind of interesting given that we are now putting so much of our attention on the bleeding complications,” said lead author Roxana Mehran, MD. “I think it's important that agents not only protect you against ischemia but also don't expose you to the harm of bleeding complications.”

The researchers noted that clinically, the patients discharged on high-dose aspirin were more likely to undergo femoral PCI (versus radial) and had longer stents implanted, longer fluoroscopy times, and more contrast volume, as well as shorter symptom onset and door-to-balloon inflation times.

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