We know that increasing the dose of ASA increases the risk of major and minor bleeding (abstract), but it is unclear if the efficacy also increases with increasing dose. This was a retrospective analysis of a larger study (BRAVO trial) which enrolled patients with a recent vascular event (MI, USA, TIA, or CVA) or dual bed vascular disease, and randomized them to an oral IIb/IIIa inhibitor or placebo. In this retrospective review, researchers evaluated the ASA dose (<162 or >162mg) in those 4590 patients that recieved a placebo in the inital trial. They found all cause mortality significantly lower in the higher dose ASA group at 1 year (2.9% in those <162mg and 1.6% in those >162mg, p=.003), and also found higher overall bleeding risk (but no significant difference in major bleeding). This suggests that ASA dose >162mg is more efficacious than <162mg in preventing death in those with a recent event or signficant vascular disease, at the expense of minor (but not major) bleeding (citation: Aronow DH et al; Am J Card 2008;102(10):1285)
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November 7, 2008 |
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About the Author: Danielle Scheurer
Danielle Scheurer, MD, MSCR, SFHM is a clinical hospitalist and the Chief Quality Officer at the Medical University of South Carolina in Charleston, South Carolina, where she also serves as Assistant Professor of Medicine. She is a graduate of the University of Tennessee College of Medicine, completed her residency at Duke University, and completed her Masters in Clinical Research at the Medical University of South Carolina. She is also the President of SHM's Board of Directors and previously served as Physician Editor of The Hospitalist, SHM's monthly newsmagazine.
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