Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients

doi:10.1136/bmj.324.7329.71

BMJ 2002;324:71-86 ( 12 January )

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Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients

Antithrombotic Trialists' Collaboration.

Correspondence to: Antithrombotic Trialists' Secretariat, Clinical Trial Service Unit, Radcliffe Infirmary, Oxford OX2 6HE www.ctsu.ox.ac.uk

Objective: To determine the effects of antiplatelet therapyamong patients at high risk of occlusive vascularevents.
Design: Collaborative meta-analyses (systematicoverviews).
Inclusion criteria: Randomised trials of an antiplatelet regimenversus control or of one antiplatelet regimen versus another inhigh risk patients (with acute or previous vascular disease orsome other predisposing condition) from which results were availablebefore September 1997. Trials had to use a method of randomisationthat precluded prior knowledge of the next treatment to be allocatedand comparisons had to be unconfounded $---$ that is, have study groupsthat differed only in terms of antiplateletregimen.
Studies reviewed: 287 studies involving 135 000 patients incomparisons of antiplatelet therapy versus control and 77 000in comparisons of different antiplateletregimens.
Main outcome measure: "Serious vascular event": non-fatal myocardialinfarction, non-fatal stroke, or vasculardeath.
Results: Overall, among these high risk patients, allocationto antiplatelet therapy reduced the combined outcome of any seriousvascular event by about one quarter; non-fatal myocardial infarctionwas reduced by one third, non-fatal stroke by one quarter, andvascular mortality by one sixth (with no apparent adverse effecton other deaths). Absolute reductions in the risk of having aserious vascular event were 36 (SE 5) per 1000 treated for twoyears among patients with previous myocardial infarction; 38 (5)per 1000 patients treated for one month among patients with acutemyocardial infarction; 36 (6) per 1000 treated for two years amongthose with previous stroke or transient ischaemic attack; 9 (3)per 1000 treated for three weeks among those with acute stroke;and 22 (3) per 1000 treated for two years among other high riskpatients (with separately significant results for those with stableangina (P=0.0005), peripheral arterial disease (P=0.004), andatrial fibrillation (P=0.01)). In each of these high risk categories,the absolute benefits substantially outweighed the absolute risksof major extracranial bleeding. Aspirin was the most widely studiedantiplatelet drug, with doses of 75-150 mg daily at least as effectiveas higher daily doses. The effects of doses lower than 75 mg dailywere less certain. Clopidogrel reduced serious vascular eventsby 10% (4%) compared with aspirin, which was similar to the 12%(7%) reduction observed with its analogue ticlopidine. Additionof dipyridamole to aspirin produced no significant further reductionin vascular events compared with aspirin alone. Among patientsat high risk of immediate coronary occlusion, short term additionof an intravenous glycoprotein IIb/IIIa antagonist to aspirinprevented a further 20 (4) vascular events per 1000 (P<0.0001)but caused 23 major (but rarely fatal) extracranial bleeds per1000.
Conclusions: Aspirin (or another oral antiplatelet drug)is protective in most types of patient at increased risk of occlusivevascular events, including those with an acute myocardial infarctionor ischaemic stroke, unstable or stable angina, previous myocardialinfarction, stroke or cerebral ischaemia, peripheral arterialdisease, or atrial fibrillation. Low dose aspirin (75-150 mg daily)is an effective antiplatelet regimen for long term use, but inacute settings an initial loading dose of at least 150 mg aspirinmay be required. Adding a second antiplatelet drug to aspirinmay produce additional benefits in some clinical circumstances,but more research into this strategy isneeded.

What is already known on this topic
Antiplatelet therapy is effective for short term treatment of patients with suspected acute myocardial infarction and unstable angina

Long term treatment is beneficial for patients who have had a myocardial infarction, stroke, or transient ischaemic attack

Daily aspirin doses of 75-325 mg are effective

What this study adds
Antiplatelet therapy protects against vascular events among patients with stable angina, intermittent claudication, and (if oral anticoagulants are unsuitable) atrial fibrillation

Antiplatelet therapy can be started promptly during acute presumed ischaemic stroke and continued long term

Daily aspirin doses of 75-150 mg seem to be as effective as higher doses for long term treatments (and clopidrogel is an appropriate alternative for patients with a contraindication to aspirin)

Short term addition of a glycoprotein IIb/IIIa antagonist to aspirin prevents vascular events in patients having percutaneous coronary intervention and those with unstable angina but causes increased bleeding

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APPRAISE Steering Committee and Investigators, (2009). Apixaban, an Oral, Direct, Selective Factor Xa Inhibitor, in Combination With Antiplatelet Therapy After Acute Coronary Syndrome: Results of the Apixaban for Prevention of Acute Ischemic and Safety Events (APPRAISE) Trial. Circulation 119: 2877-2885 [Abstract] [Full text]
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Ivandic, B. T., Sausemuth, M., Ibrahim, H., Giannitsis, E., Gawaz, M., Katus, H. A. (2009). Dual Antiplatelet Drug Resistance Is a Risk Factor for Cardiovascular Events after Percutaneous Coronary Intervention. Clin. Chem. 55: 1171-1176 [Abstract] [Full text]
Bath, P. M.W. (2009). Antiplatelet Activity Should Be Measured Routinely: No. Stroke 40: 2273-2274 [Full text]
Berger, J. S., Krantz, M. J., Kittelson, J. M., Hiatt, W. R. (2009). Aspirin for the Prevention of Cardiovascular Events in Patients With Peripheral Artery Disease: A Meta-analysis of Randomized Trials. JAMA 301: 1909-1919 [Abstract] [Full text]
McDermott, M. M., Criqui, M. H. (2009). Aspirin and Secondary Prevention in Peripheral Artery Disease: A Perspective for the Early 21st Century. JAMA 301: 1927-1928 [Full text]
Pulcinelli, F. M., Biasucci, L. M., Riondino, S., Giubilato, S., Leo, A., Di Renzo, L., Trifiro, E., Mattiello, T., Pitocco, D., Liuzzo, G., Ghirlanda, G., Crea, F. (2009). COX-1 sensitivity and thromboxane A2 production in type 1 and type 2 diabetic patients under chronic aspirin treatment. Eur Heart J 30: 1279-1286 [Abstract] [Full text]
Smout, J., Stansby, G. (2009). Surgery and antiplatelet agents: what are the risks?. Clin Risk 15: 101-105 [Full text]
Parving, H.-H., Brenner, B. M., McMurray, John. J. V., de Zeeuw, D., Haffner, S. M., Solomon, S. D., Chaturvedi, N., Ghadanfar, M., Weissbach, N., Xiang, Z., Armbrecht, J., Pfeffer, M. A. (2009). Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE): rationale and study design. Nephrol Dial Transplant 24: 1663-1671 [Abstract] [Full text]
Tousoulis, D., Briasoulis, A., Dhamrait, S. S, Antoniades, C., Stefanadis, C. (2009). Effective platelet inhibition by aspirin and clopidogrel: where are we now?. Heart 95: 850-858 [Full text]
Raine, R., Wong, W., Ambler, G., Hardoon, S., Petersen, I., Morris, R., Bartley, M., Blane, D. (2009). Sociodemographic variations in the contribution of secondary drug prevention to stroke survival at middle and older ages: cohort study. BMJ 338: b1279-b1279 [Abstract] [Full text]
Joshi, R., Chow, C. K., Raju, P. K., Raju, R., Reddy, K. S., MacMahon, S., Lopez, A. D., Neal, B. (2009). Fatal and Nonfatal Cardiovascular Disease and the Use of Therapies for Secondary Prevention in a Rural Region of India. Circulation 119: 1950-1955 [Abstract] [Full text]
Jolly, S. S., Pogue, J., Haladyn, K., Peters, R. J.G., Fox, K. A.A., Avezum, A., Gersh, B. J., Rupprecht, H. J., Yusuf, S., Mehta, S. R. (2009). Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study. Eur Heart J 30: 900-907 [Abstract] [Full text]
Angiolillo, D. J. (2009). Antiplatelet Therapy in Diabetes: Efficacy and Limitations of Current Treatment Strategies and Future Directions. Diabetes Care 32: 531-540 [Full text]
Seddighzadeh, A., Wolf, A. T., Parasuraman, S., Shetty, R., Vallurupalli, N., Reddy, S., Goldhaber, S. Z. (2009). Gastrointestinal Complications After 3 Months of Dual Antiplatelet Therapy for Drug-eluting Stents as Assessed by Wireless Capsule Endoscopy. CLIN APPL THROMB HEMOST 15: 171-176 [Abstract]
ALEXANDER, J. H. (2009). The current state of antiplatelet therapy in acute coronary syndromes: The data and the real world. Cleveland Clinic Journal of Medicine 76: S16-S23 [Abstract] [Full text]
Smyth, S. S., Woulfe, D. S., Weitz, J. I., Gachet, C., Conley, P. B., Goodman, S. G., Roe, M. T., Kuliopulos, A., Moliterno, D. J., French, P. A., Steinhubl, S. R., Becker, R. C., for the 2008 Platelet Colloquium Participants, (2009). G-Protein-Coupled Receptors as Signaling Targets for Antiplatelet Therapy. Arterioscler. Thromb. Vasc. Bio. 29: 449-457 [Abstract] [Full text]
Collyer, T. C., Gray, D. J., Sandhu, R., Berridge, J., Lyons, G. (2009). Assessment of platelet inhibition secondary to clopidogrel and aspirin therapy in preoperative acute surgical patients measured by Thrombelastography(R) Platelet MappingTM. Br J Anaesth 102: 492-498 [Abstract] [Full text]
Palnum, K. D., Andersen, G., Ingeman, A., Krog, B. R., Bartels, P., Johnsen, S. P. (2009). Sex-Related Differences in Quality of Care and Short-Term Mortality Among Patients With Acute Stroke in Denmark: A Nationwide Follow-Up Study. Stroke 40: 1134-1139 [Abstract] [Full text]
Kurth, T., Bousser, M.-G. (2009). Stroke in Women: An Evolving Topic. Stroke 40: 1027-1028 [Full text]
Steinhubl, S. R., Bhatt, D. L., Brennan, D. M., Montalescot, G., Hankey, G. J., Eikelboom, J. W., Berger, P. B., Topol, E. J., on behalf of the CHARISMA Investigators, (2009). Aspirin to Prevent Cardiovascular Disease: The Association of Aspirin Dose and Clopidogrel With Thrombosis and Bleeding. ANN INTERN MED 150: 379-386 [Abstract] [Full text]
Mehta, S. R. (2009). Aspirin for Prevention and Treatment of Cardiovascular Disease. ANN INTERN MED 150: 414-416 [Full text]
Budaj, A., Eikelboom, J. W., Mehta, S. R., Afzal, R., Chrolavicius, S., Bassand, J.-P., Fox, K. A.A., Wallentin, L., Peters, R. J.G., Granger, C. B., Joyner, C. D., Yusuf, S., on behalf of OASIS 5 Investigators, (2009). Improving clinical outcomes by reducing bleeding in patients with non-ST-elevation acute coronary syndromes. Eur Heart J 30: 655-661 [Abstract] [Full text]
Mora, S. (2009). Aspirin Therapy in Women: Back to the ABCs. Circ Cardiovasc Qual Outcomes 2: 63-64 [Full text]
Hopkins, J., Limacher, M. (2009). The Role of Aspirin in Cardiovascular Disease Prevention in Women. AMERICAN JOURNAL OF LIFESTYLE MEDICINE 3: 123-134 [Abstract]
Fletcher, E. H., Newton, J. L., Gray, C. S. (2009). Commencing antiplatelet therapy in older people after an acute ischaemic stroke. Age Ageing 38: 142-144 [Full text]
Tay, K. H., Lane, D. A., Lip, G. Y. H. (2009). Challenges facing anticoagulation among the elderly and frail. Age Ageing 38: 140-142 [Full text]
Berger, J. S., Brown, D. L., Burke, G. L., Oberman, A., Kostis, J. B., Langer, R. D., Wong, N. D., Wassertheil-Smoller, S. (2009). Aspirin Use, Dose, and Clinical Outcomes in Postmenopausal Women With Stable Cardiovascular Disease: The Women's Health Initiative Observational Study. Circ Cardiovasc Qual Outcomes 2: 78-87 [Abstract] [Full text]
Ovbiagele, B. (2009). Medications Impair Kidney Function in Stroke Population--Reply. Arch Neurol 66: 416-416 [Full text]
Bailey, A. L., Scantlebury, D. C., Smyth, S. S. (2009). Thrombosis and Antithrombotic Therapy in Women. Arterioscler. Thromb. Vasc. Bio. 29: 284-288 [Abstract] [Full text]
Josephson, C. B, Salman, R. A.-S., Phillips, S. J (2009). An episode of transient neurological symptoms. BMJ 338: b616-b616 [Full text]
Santilli, F., Rocca, B., De Cristofaro, R., Lattanzio, S., Pietrangelo, L., Habib, A., Pettinella, C., Recchiuti, A., Ferrante, E., Ciabattoni, G., Davi, G., Patrono, C. (2009). Platelet cyclooxygenase inhibition by low-dose aspirin is not reflected consistently by platelet function assays implications for aspirin "resistance".. J Am Coll Cardiol 53: 667-677 [Abstract] [Full text]
Ross, J. S., Gross, C. P. (2009). Policy Research: Using Evidence to Improve Healthcare Delivery Systems. Circulation 119: 891-898 [Full text]
Kuliczkowski, W., Witkowski, A., Polonski, L., Watala, C., Filipiak, K., Budaj, A., Golanski, J., Sitkiewicz, D., Pregowski, J., Gorski, J., Zembala, M., Opolski, G., Huber, K., Arnesen, H., Kristensen, S. D., De Caterina, R. (2009). Interindividual variability in the response to oral antiplatelet drugs: a position paper of the Working Group on antiplatelet drugs resistance appointed by the Section of Cardiovascular Interventions of the Polish Cardiac Society, endorsed by the Working Group on Thrombosis of the European Society of Cardiology. Eur Heart J 30: 426-435 [Abstract] [Full text]
Patrono, C., Baigent, C. (2009). Low-Dose Aspirin, Coxibs, and other NSAIDS: A Clinical Mosaic Emerges. Mol. Interv. 9: 31-39 [Abstract] [Full text]
Akay, O. M., Canturk, Z., Akin, E., Bal, C., Gulbas, Z. (2009). Aspirin-Resistance Frequency: A Prospective Study in 280 Healthy Turkish Volunteers. CLIN APPL THROMB HEMOST 15: 98-102 [Abstract]
Cohen, M. (2009). Expanding the Recognition and Assessment of Bleeding Events Associated With Antiplatelet Therapy in Primary Care. Mayo Clin Proc. 84: 149-160 [Abstract] [Full text]
Cacoub, P. P., Bhatt, D. L., Steg, P.G., Topol, E. J., Creager, M. A., for the CHARISMA Investigators, (2009). Patients with peripheral arterial disease in the CHARISMA trial. Eur Heart J 0: ehn534v1-10 [Abstract] [Full text]
Gresele, P., Migliacci, R. (2009). The peripheral arterial disease subgroup in the CHARISMA trial: does it tell us anything new?. Eur Heart J 0: ehn565v1-2 [Full text]
Bhattacharyya, O. K., Estey, E. A., Cheng, A. Y.Y. (2009). Update on the Canadian Diabetes Association 2008 clinical practice guidelines. cfp 55: 39-43 [Full text]
O'Riordan, J. M., Margey, R. J., Blake, G., O'Connell, P. R. (2009). Antiplatelet Agents in the Perioperative Period. Arch Surg 144: 69-76 [Abstract] [Full text]
Adams, H. P. Jr (2009). Secondary Prevention of Atherothrombotic Events After Ischemic Stroke. Mayo Clin Proc. 84: 43-51 [Abstract] [Full text]
Scott, D. M., Norwood, R. M, Parra, D. (2009). P2Y12 Inhibitors in Cardiovascular Disease: Focus on Prasugrel. The Annals of Pharmacotherapy 43: 64-76 [Abstract] [Full text]
American Diabetes Association, (2009). Standards of Medical Care in Diabetes--2009. Diabetes Care 32: S13-S61 [Full text]
Lordkipanidze, M., Pharand, C., Nguyen, T. A., Schampaert, E., Palisaitis, D. A., Diodati, J. G. (2008). Comparison of four tests to assess inhibition of platelet function by clopidogrel in stable coronary artery disease patients. Eur Heart J 29: 2877-2885 [Abstract] [Full text]
Authors/Task Force Members, , Van de Werf, F., Bax, J., Betriu, A., Blomstrom-Lundqvist, C., Crea, F., Falk, V., Filippatos, G., Fox, K., Huber, K., Kastrati, A., Rosengren, A., Steg, P. G., Tubaro, M., Verheugt, F., Weidinger, F., Weis, M., ESC Committee for Practice Guidelines (CPG), , Vahanian, A., Camm, J., De Caterina, R., Dean, V., Dickstein, K., Filippatos, G., Funck-Brentano, C., Hellemans, I., Kristensen, S. D., McGregor, K., Sechtem, U., Silber, S., Tendera, M., Widimsky, P., Zamorano, J. L., Document Reviewers, , Silber, S., Aguirre, F. V., Al-Attar, N., Alegria, E., Andreotti, F., Benzer, W., Breithardt, O., Danchin, N., Mario, C. D., Dudek, D., Gulba, D., Halvorsen, S., Kaufmann, P., Kornowski, R., Lip, G. Y. H., Rutten, F. (2008). Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology:. Eur Heart J 29: 2909-2945 [Full text]
Wang, T. Y., Xiao, L., Alexander, K. P., Rao, S. V., Kosiborod, M. N., Rumsfeld, J. S., Spertus, J. A., Peterson, E. D. (2008). Antiplatelet Therapy Use After Discharge Among Acute Myocardial Infarction Patients With In-Hospital Bleeding. Circulation 118: 2139-2145 [Abstract] [Full text]
Ogawa, H., Nakayama, M., Morimoto, T., Uemura, S., Kanauchi, M., Doi, N., Jinnouchi, H., Sugiyama, S., Saito, Y., for the Japanese Primary Prevention of Atheroscler, (2008). Low-Dose Aspirin for Primary Prevention of Atherosclerotic Events in Patients With Type 2 Diabetes: A Randomized Controlled Trial. JAMA 300: 2134-2141 [Abstract] [Full text]
Nicolucci, A. (2008). Aspirin for Primary Prevention of Cardiovascular Events in Diabetes: Still an Open Question. JAMA 300: 2180-2181 [Full text]
Halkes, P H A, Gray, L J, Bath, P M W, Diener, H-C, Guiraud-Chaumeil, B, Yatsu, F M, Algra, A (2008). Dipyridamole plus aspirin versus aspirin alone in secondary prevention after TIA or stroke: a meta-analysis by risk. J. Neurol. Neurosurg. Psychiatry 79: 1218-1223 [Abstract] [Full text]
Bulugahapitiya, U, Siyambalapitiya, S, Sithole, J, Fernando, D J, Idris, I (2008). Age threshold for vascular prophylaxis by aspirin in patients without diabetes. Heart 94: 1429-1432 [Abstract] [Full text]
Zimarino, M., De Caterina, R. (2008). Long-term treatment strategies for atherothrombotic disease: do platelets define the course?. Eur Heart J Suppl 10: I8-I13 [Abstract] [Full text]
Husted, S. (2008). Benefits and risks with antiplatelet therapy: how great a problem is bleeding?. Eur Heart J Suppl 10: I19-I24 [Abstract] [Full text]
Sanz-Ruiz, R., Fernandez-Aviles, F. (2008). European perspective on the use of antiplatelet agents in atherothrombotic disease. Eur Heart J Suppl 10: I14-I18 [Abstract] [Full text]
Bhatt, D. L., Scheiman, J., Abraham, N. S., Antman, E. M., Chan, F. K.L., Furberg, C. D., Johnson, D. A., Mahaffey, K. W., Quigley, E. M., Harrington, R. A., Bates, E. R., Bridges, C. R., Eisenberg, M. J., Ferrari, V. A., Hlatky, M. A., Kaul, S., Lindner, J. R., Moliterno, D. J., Mukherjee, D., Schofield, R. S., Rosenson, R. S., Stein, J. H., Weitz, H. H., Wesley, D. J. (2008). ACCF/ACG/AHA 2008 Expert Consensus Document on Reducing the Gastrointestinal Risks of Antiplatelet Therapy and NSAID Use: A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 52: 1502-1517 [Full text]
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Austin, P. C. PhD, Tu, J. V. MD PhD, Ko, D. T. MD MSc, Alter, D. A. MD PhD (2008). Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction. CMAJ 179: 895-900 [Abstract] [Full text]
Bhattacharyya, O. K. MD PhD, Shah, B. R. MD PhD, Booth, G. L. MD MSc (2008). Management of cardiovascular disease in patients with diabetes: the 2008 Canadian Diabetes Association guidelines. CMAJ 179: 920-926 [Full text]
Eikelboom, J. W., Hankey, G. J., Thom, J., Bhatt, D. L., Steg, P. G., Montalescot, G., Johnston, S. C., Steinhubl, S. R., Mak, K.-H., Easton, J. D., Hamm, C., Hu, T., Fox, K. A.A., Topol, E. J., on behalf of the Clopidogrel for High Atherothromb, (2008). Incomplete Inhibition of Thromboxane Biosynthesis by Acetylsalicylic Acid: Determinants and Effect on Cardiovascular Risk. Circulation 118: 1705-1712 [Abstract] [Full text]
Walsh, M., Spurling, G. (2008). Aspirin in type 2 diabetes: is there any evidence base?. BMJ 337: a1902-a1902 [Full text]
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Belch, J., MacCuish, A., Campbell, I., Cobbe, S., Taylor, R., Prescott, R., Lee, R., Bancroft, J., MacEwan, S., Shepherd, J., Macfarlane, P., Morris, A., Jung, R., Kelly, C., Connacher, A., Peden, N., Jamieson, A., Matthews, D., Leese, G., McKnight, J., O'Brien, I., Semple, C., Petrie, J., Gordon, D., Pringle, S., MacWalter, R., Prevention of Progression of Arterial Disease and, (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. BMJ 337: a1840-a1840 [Abstract] [Full text]
Talelli, P., Greenwood, R. J. (2008). Review: Recurrent stroke: where do we stand with the secondary prevention of noncardioembolic ischaemic strokes?. Ther Adv Cardiovasc Dis 2: 387-405 [Abstract]
Paraskevas, K. I., Papas, T. T., Pavlidis, P., Bessias, N., Andrikopoulos, V. (2008). The Importance of Conservative Measures in Peripheral Arterial Disease: An Update. ANGIOLOGY 59: 529-533
Rosenzweig, J. L., Ferrannini, E., Grundy, S. M., Haffner, S. M., Heine, R. J., Horton, E. S., Kawamori, R. (2008). Primary Prevention of Cardiovascular Disease and Type 2 Diabetes in Patients at Metabolic Risk: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 93: 3671-3689 [Abstract] [Full text]
Bath, P. M.W., Geeganage, C., Gray, L. J., Collier, T., Pocock, S. (2008). Use of Ordinal Outcomes in Vascular Prevention Trials: Comparison With Binary Outcomes in Published Trials * Supplemental Appendix I: Statistical Tests Compared * Supplemental Appendix II: Supplementary Analyses * Supplemental Appendix III: Results. Stroke 39: 2817-2823 [Abstract] [Full text]
Singh, S., Loke, Y. K., Furberg, C. D. (2008). Inhaled Anticholinergics and Risk of Major Adverse Cardiovascular Events in Patients With Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-analysis. JAMA 300: 1439-1450 [Abstract] [Full text]
Sacco, R. L., Diener, H.-C., Yusuf, S., Cotton, D., Ounpuu, S., Lawton, W. A., Palesch, Y., Martin, R. H., Albers, G. W., Bath, P., Bornstein, N., Chan, B. P.L., Chen, S.-T., Cunha, L., Dahlof, B., De Keyser, J., Donnan, G. A., Estol, C., Gorelick, P., Gu, V., Hermansson, K., Hilbrich, L., Kaste, M., Lu, C., Machnig, T., Pais, P., Roberts, R., Skvortsova, V., Teal, P., Toni, D., VanderMaelen, C., Voigt, T., Weber, M., Yoon, B.-W., the PRoFESS Study Group, (2008). Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent Stroke. NEJM 359: 1238-1251 [Abstract] [Full text]
Reynolds, T. M., Mardani, A., Twomey, P. J., Wierzbicki, A. S. (2008). Targeted versus global approaches to the management of hypercholesterolaemia. The Journal of the Royal Society for the Promotion of Health 128: 248-254 [Abstract]
Hasegawa, T., Elder, S. J., Bragg-Gresham, J. L., Pisoni, R. L, Yamazaki, S., Akizawa, T., Jadoul, M., Hugh, R. C., Port, F. K, Fukuhara, S. (2008). Consistent Aspirin Use Associated with Improved Arteriovenous Fistula Survival among Incident Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study. CJASN 3: 1373-1378 [Abstract] [Full text]
Price, J. F, Stewart, M. C, Deary, I. J, Murray, G. D, Sandercock, P., Butcher, I., Fowkes, F G. R, on behalf of the AAA Trialists, (2008). Low dose aspirin and cognitive function in middle aged to elderly adults: randomised controlled trial. BMJ 337: a1198-a1198 [Abstract] [Full text]
Wei, L, Lang, C C, Sullivan, F M, Boyle, P, Wang, J, Pringle, S D, MacDonald, T M (2008). Impact on mortality following first acute myocardial infarction of distance between home and hospital: cohort study. Heart 94: 1141-1146 [Abstract] [Full text]
Bath, P. M.W., Geeganage, C. M., Gray, L. J. (2008). Ordinal Reanalysis of the SHEP Trial. Stroke 39: e145-e145 [Full text]

Rapid Responses:

Read all Rapid Responses

Limit journal space for bloated meta-analyses: Niall A Herity
bmj.com, 12 Jan 2002 [Full text]
Clinical audit of aspirin use in diabetes: Stephanie E. Baldeweg, et al.
bmj.com, 15 Jan 2002 [Full text]
ASPIRIN FOR CHD PREVENTION IN LOWER RISK ADULTS: Michael Pignone, et al.
bmj.com, 15 Jan 2002 [Full text]
Not even 4th place for the risk of antiplatelet drugs?: Peter N Trewby, et al.
bmj.com, 25 Jan 2002 [Full text]
Antithrombotic trialists - Have they shortchanged aspirin with extended-release dipyridamole for str: Louis R Caplan, et al.
bmj.com, 6 Feb 2002 [Full text]
ANTIPLATELET THERAPY IN PREVENTION OF PLATELET AGGREGABILITY, BUT WHEN?: Sergio Sensi, et al.
bmj.com, 7 Feb 2002 [Full text]
Antiplatelet therapy and atrial fibrillation: some caution needed: Gregory YH Lip, et al.
bmj.com, 8 Feb 2002 [Full text]
Is the addition of dipyridamole to aspirin really of no value?: James M Gebel
bmj.com, 25 Feb 2002 [Full text]
A lot of outcomes without anwering the main question: Jes�s A. Gallego, et al.
bmj.com, 2 Mar 2002 [Full text]
Gender difference in the results of thrombolytic therapy in acute myocardial infarction: manzar hussain akbar
bmj.com, 6 Dec 2005 [Full text]