ACC: Low Dose Aspirin Effective and Safe After Stenting

March 24, 2007

NEW ORLEANS -- Low-dose aspirin reduced myocardial infarction and death following coronary stenting and other percutaneous coronary interventions, and it was significantly less toxic than high dose aspirin, researchers reported here.

NEW ORLEANS, March 24 -- Low-dose aspirin reduced myocardial infarction and death following coronary artery stenting and other percutaneous coronary interventions, and it was significantly less toxic than high dose aspirin, researchers reported here today.

Analysis of data from the PCI-CURE (Clopidogrel in Unstable Angina to Prevent Recurrent Ischemic Events) found that the risk of a major bleeding event was halved when patients used low-dose (100 mg) rather than high dose (325 mg) regimens (P=0.006), said Sanjit Jolly, M.D., of McMaster University in Hamilton, Ontario.

The occurrence of major bleeding was not significantly different between the groups at 30 days, Dr. Jolly said at the American College of Cardiology meeting. But the rate of major bleeding was noticeably reduced with low-dose aspirin after eight months.

"In Canada, we are now using a low dose of aspirin after PCI," Dr. Jolly said at a press conference. He noted that the current guidelines of the American Heart Association and ACC suggest take 325 mg aspirin daily. as part of dual platelet therapy.

As a sub-analysis of the PCI-CURE study, researchers compared the safety and efficacy of varying doses of aspirin: low (100 mg), intermediate (101-199 mg) and high (200 mg).

A total of 2,658 patients with acute coronary syndromes undergoing PCI were divided according to the most commonly used dose, and each dose group was evaluated for event rates relating to cardiovascular death, myocardial infarction or stroke, as well as major bleeding.

The researchers found similar rates of cardiovascular death, heart attacks or stroke in all of the aspirin dose groups at 30 days and eight months.

"In this large observational analysis, low-dose aspirin appeared to be just as effective as high-dose aspirin in preventing recurrent cardiac events in acute coronary syndrome patients after PCI, while reducing the long-term risk of major bleeding," said Dr. Jolly.

"Doctors do worry about the possibility of bleeding in patients," said Elliott Antman, M.D., of Harvard Medical School, Boston, and a spokesperson for the American Heart Association, "especially when those patients are going to be on medication such as aspirin probably for a lifetime.