Veronese, Nicola, Demurtas, Jacopo, Thompson, Trevor ORCID: 0000-0001-9880-782X, Solmi, Marco, Pesolillo, Gabriella, Celotto, Stefano, Barnini, Tommaso, Stubbs, Brendon, Maggi, Stefania, Pilotto, Alberto, Onder, Graziano, Theodoratou, Evropi, Vaona, Alberto, Firth, Joseph, Smith, Lee ORCID: 0000-0003-0890-7566, Koyanagi, Ai, Ioannidis, John P.A. and Tzoulaki, Ioanna (2020) Effect of low‐dose aspirin on health outcomes: an umbrella review of systematic reviews and meta‐analyses. British Journal of Clinical Pharmacology, 86 (8). pp. 1465-1475. ISSN 0306-5251 (Print), 1365-2125 (Online) (doi:https://doi.org/10.1111/bcp.14310)

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Abstract

Aims: 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. Methods: Aspirin is associated with several health outcomes, but the overall ben- efit/risk balance related to aspirin use is unclear. We searched three major data- bases 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.
Results: 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 peo- ple 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).
Conclusion: Compared to other active medications, low-dose aspirin had strong evi- dence for lower risk of bleeding, but also lower comparative efficacy. Low-dose aspi- rin significantly lowers CVD risk and increases risk of bleeding. Evidence for multiple other health outcomes is limited.

Item Type:	Article
Uncontrolled Keywords:	aspirin, cancer, cardiovascular disease, meta-analysis, umbrella review
Subjects:	R Medicine > R Medicine (General)
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences
Last Modified:	02 Aug 2020 13:21
URI:	http://gala.gre.ac.uk/id/eprint/28382

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