Journal article
Aspirin for the prevention of recurrent venous thromboembolism: The INSPIRE Collaboration
Circulation, Vol.130(13), pp.1062-1071
2014
Abstract
Background—In patients with a first unprovoked venous thromboembolism (VTE) the risk of recurrent VTE remains high after anticoagulant treatment is discontinued. The Aspirin for the Prevention of Recurrent Venous Thromboembolism (the Warfarin and Aspirin [WARFASA]) and the Aspirin to Prevent Recurrent Venous Thromboembolism (ASPIRE) trials showed that aspirin reduces this risk, but they were not individually powered to detect treatment effects for particular outcomes or subgroups.
Methods and Results—An individual patient data analysis of these trials was planned, before their results were known, to assess the effect of aspirin versus placebo on recurrent VTE, major vascular events (recurrent VTE, myocardial infarction, stroke, and cardiovascular disease death) and bleeding, overall and within predefined subgroups. The primary analysis, for VTE, was by intention to treat using time-to-event data. Of 1224 patients, 193 had recurrent VTE over 30.4 months’ median follow-up. Aspirin reduced recurrent VTE (7.5%/yr versus 5.1%/yr; hazard ratio [HR], 0.68; 95% confidence interval [CI], 0.51–0.90; P=0.008), including both deep-vein thrombosis (HR, 0.66; 95% CI, 0.47–0.92; P=0.01) and pulmonary embolism (HR, 0.66; 95% CI, 0.41–1.06; P=0.08). Aspirin reduced major vascular events (8.7%/yr versus 5.7%/yr; HR, 0.66; 95% CI, 0.50–0.86; P=0.002). The major bleeding rate was low (0.4%/yr for placebo and 0.5%/yr for aspirin). After adjustment for treatment adherence, recurrent VTE was reduced by 42% (HR, 0.58; 95% CI, 0.40–0.85; P=0.005). Prespecified subgroup analyses indicate similar relative, but larger absolute, risk reductions in men and older patients.
Conclusions—Aspirin after anticoagulant treatment reduces the overall risk of recurrence by more than a third in a broad cross-section of patients with a first unprovoked VTE, without significantly increasing the risk of bleeding.
Details
- Title
- Aspirin for the prevention of recurrent venous thromboembolism: The INSPIRE Collaboration
- Authors/Creators
- John Simes (Author/Creator) - National Health and Medical Research CouncilCecilia Becattini (Author/Creator) - University of PerugiaGiancarlo Agnelli (Author/Creator) - University of PerugiaJohn W. Eikelboom (Author/Creator) - Population Health Research InstituteAdrienne C. Kirby (Author/Creator) - National Health and Medical Research CouncilRebecca Mister (Author/Creator) - National Health and Medical Research CouncilPaolo Prandoni (Author/Creator) - University of PaduaTimothy A. Brighton (Author/Creator) - Prince of Wales HospitalR.I. Baker (Author/Creator)
- Publication Details
- Circulation, Vol.130(13), pp.1062-1071
- Publisher
- American Heart Foundation
- Identifiers
- 991005542592507891
- Copyright
- © 2014 American Heart Association, Inc.
- Murdoch Affiliation
- Institute for Immunology and Infectious Diseases
- Language
- English
- Resource Type
- Journal article
- Additional Information
- Ross baker appears courtesy of the INSPIRE study Investigators
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Source: InCites
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- Collaboration types
- Domestic collaboration
- International collaboration
- Citation topics
- 1 Clinical & Life Sciences
- 1.75 Blood Clotting
- 1.75.271 Venous Thromboembolism
- Web Of Science research areas
- Cardiac & Cardiovascular Systems
- Peripheral Vascular Disease
- ESI research areas
- Clinical Medicine