Lack of Effect of Aspirin in Asymptomatic Patients with Carotid Bruits and Substantial Carotid Narrowing

Côté, Robert; Battista, Rossano; Abrahamowicz, Michal; Langlois, Yves; Bourque, F; Mackey, Ariane

doi:10.7326/0003-4819-123-9-199511010-00002

Cited by 137 publications

(46 citation statements)

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“…On the basis of just under 2 years of follow-up, the annual rate of ischemic events and death due to any cause was 12.3% in the placebo group and 11.0% in the aspirin group (Pϭ0.61), but the sample size of 372 patients may have been insufficient to detect a clinically meaningful difference. 348 In the Veterans Affairs Cooperative Study Group 76 and ACAS, 74 the stroke rates were approximately 2% per year in groups treated with aspirin alone. 74,76,349 No controlled studies of stroke have shown superior results with antiplatelet agents other than aspirin in patients with asymptomatic ECVD.…”

Section: Brott Et Al Ecvd Guideline: Full Text E487mentioning

confidence: 99%

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

Brott¹,

Halperin²,

Abbara

et al. 2011

Stroke

142

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Section: Brott Et Al Ecvd Guideline: Full Text E487mentioning

confidence: 99%

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

Brott¹,

Halperin²,

Abbara

et al. 2011

Stroke

142

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“…This percentage increases significantly in patients with ischemic heart disease or peripheral artery disease, being 20–30% in the presence of carotid stenosis >50% [44, 45]. Asymptomatic carotid stenosis is associated with an annual risk of 0.7–2.5% for stroke and 10% for mortality/morbidity associated with cardiovascular disease [46,47,48,49,50,51,52,53,54]. The grade of asymptomatic carotid stenosis also correlates with the risk of myocardial infarction and vascular death.…”

Section: Neurovascular Disease Markersmentioning

confidence: 99%

Asymptomatic Cerebrovascular Disease and Systemic Diagnosis in Stroke, Atherothrombosis as a Disease of the Vascular Tree

Gállego¹,

Martínez‐Vila²

2005

Cerebrovasc Dis

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Atherosclerosis is a chronic vascular disease of true epidemic proportions. It is the first cause of death in developed countries and responsible for one quarter of documented deaths worldwide. Arteriosclerotic vascular disease is a systemic process which affects different organs; principally the heart, brain, and peripheral artery system. Despite well-documented differences, all manifestations of the disease share the same risk factors; albeit with varying degrees of impact. The concept of asymptomatic cerebrovascular disease is an important one for clinicians who treat stroke patients. The development of new neuroimaging and vascular evaluation techniques has enabled the presence of apparently silent lesions to be detected and their progress monitored in follow-up. Ultrasonography techniques enable the identification of atheromatous disease. Asymptomatic involvement of the cerebral parenchyma consists of ischemia, leukoaraiosis, and silent hemorrhage and can be detected using the available radiological techniques such as cranial CT, magnetic resonance, or gradient echo magnetic resonance imaging. From the point of view of prevention, it is of considerable importance to identify diagnostic markers for arteriosclerosis in asymptomatic patients in some, if not all, vascular territories. In view of the natural history of this disease and the impact it has on society, there is an increasing need to identify and understand the risk factors or vascular disease risk markers, so that the stratification of risk of an individual patient or in a specific population can be established, appropriate cerebrovascular assessments conducted, and appropriate therapeutic intervention initiated.

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“…[23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] 'Major' bleeding is based on definitions in individual studies or includes GI bleeding episodes that were fatal or required hospitalization or transfusion. The mean or median duration of 12 studies comprising 97.5% of the patients in the 14 studies ranged from 12 to 76 months, while the other 2.5% of the patients were from two studies with 3 months median duration.…”

Section: Gastrointestinal Bleeding With Low-dose Aspirinmentioning

confidence: 99%

Review article: gastrointestinal bleeding with low‐dose aspirin – what's the risk?

Laine

2006

Aliment Pharmacol Ther

118

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SUMMARYThis review examines ulcers and gastrointestinal bleeding with low-dose aspirin, focusing on randomized placebo-controlled trials.The single endoscopic trial assessing ulcers showed no significant difference in 12-week ulcer incidence: 6% of 381 given placebo vs. 7% of 387 given 81 mg enteric-coated aspirin.The relative risk of major gastrointestinal bleeding with low-dose aspirin in a meta-analysis of placebo-controlled trials of vascular protection was 2.07 (95% CI: 1.61-2.66). The absolute rate increase with aspirin above placebo was 0.12% per year (95% CI: 0.07-0.19%) with a number-needed-to-harm of 833 patients (95% CI: 526-1429). A metaanalysis of aspirin 50-1500 mg daily reported an odds ratio for any gastrointestinal bleeding of 1.68 (95% CI: 1.51-1.88) with an numberneeded-to-harm at 1 year of 247. The relative risk of hospitalization for upper gastrointestinal bleeding with low-dose aspirin in a large Danish cohort study was 2.6 (95% CI: 2.2-2.9) with an absolute annual incidence of 0.6%.Factors that may increase the risk of gastrointestinal bleeding include prior history of ulcers or gastrointestinal bleeding, corticosteroid use, anticoagulant therapy and addition of a non-aspirin non-steroidal antiinflammatory drug.When determining whether low-dose aspirin is appropriate for an individual patient, the cardiovascular benefit must be weighed against the potential for clinical events such as gastrointestinal bleeding.

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Lack of Effect of Aspirin in Asymptomatic Patients with Carotid Bruits and Substantial Carotid Narrowing

Abstract: Aspirin did not have a significant long-term protective effect in asymptomatic patients with high-grade (> or = 50%) carotid stenosis.

Cited by 137 publications

References 0 publications

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease

Asymptomatic Cerebrovascular Disease and Systemic Diagnosis in Stroke, Atherothrombosis as a Disease of the Vascular Tree

Review article: gastrointestinal bleeding with low‐dose aspirin – what's the risk?

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