Article makes simple errors and could cause unnecessary deaths

EDITOR—The worldwide meta-analysis of antiplatelet trials shows that low dose aspirin (or some other effective antiplatelet regimen) reduces non-fatal myocardial infarction, non-fatal stroke, and vascular death in a wide range of patients who are at high risk of occlusive vascular disease.1 A paper disputing this was published concurrently in the For Debate section of the journal,2 but the arguments in it (some of which the author also published on the same date in an editorial in the Lancet)3 depend strongly on quite simple mistakes about the randomised evidence and could cause unnecessary deaths.

Consider, for example, the ISIS-2 trial of short term antiplatelet therapy, in which 17 187 patients with suspected acute myocardial infarction were randomised, half to active aspirin and half to placebo.4 This trial showed a clear reduction in five week all cause mortality (811/8587 (9.4%) aspirin v 1030/8600 (12.0%) placebo deaths, 2P<0.00001).5 Bizarrely, in a section entitled “Trials do not show that aspirin saves lives,” the For Debate paper attempts to dismiss the ISIS-2 findings by suggesting that “all patients lost to follow up in the active group should be considered to have died and none …