A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease
Francesco Burzotta, Marzia Lotrionte, Antonio Abbate, Enrica Maria Fusaro, Giuseppe G.L. Biondi-Zoccai, Pierfrancesco Agostoni, Massimiliano Fusaro, Luca Testa, Imad Sheiban, Giuseppe Sangiorgi
552 Citazioni (Scopus)
Aims: The role of aspirin in patients with coronary artery disease (CAD) is well established, yet patients happen to discontinue aspirin according to physician's advice or unsupervised. We thus undertook a systematic review to appraise the hazards inherent to aspirin withdrawal or non-compliance in subjects at risk for or with CAD. Methods and results: Electronic databases were systematically searched (updated January 2006). Study designs, patient characteristics, and outcomes were abstracted. Pooled estimates for odds ratios (OR) were computed according to random-effect methods. From the 612 screened studies, six were selected (50 279 patients). One study (31 750 patients) focused on adherence to aspirin therapy in the secondary prevention of CAD, two studies (2594) on aspirin discontinuation in acute CAD, two studies (13 706) on adherence to aspirin therapy before or shortly after coronary artery bypass grafting, and another (2229) on aspirin discontinuation among patients undergoing drug-eluting stenting. Overall, aspirin non-adherence/withdrawal was associated with three-fold higher risk of major adverse cardiac events (OR=3.14 [1.75-5.61], P=0.0001). This risk was magnified in patients with intracoronary stents, as discontinuation of antiplatelet treatment was associated with an even higher risk of adverse events (OR=89.78 [29.90-269.60]). Conclusion: Non-compliance or withdrawal of aspirin treatment has ominous prognostic implication in subjects with or at moderate-to-high risk for CAD. Aspirin discontinuation in such patients should be advocated only when bleeding risk clearly overwhelms that of atherothrombotic events. © The European Society of Cardiology 2006. All rights reserved.
https://doi.org/10.1093/eurheartj/ehl334
Platelet Aggregation Inhibitors
Treatment Refusal
10.1093/eurheartj/ehl334
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Burzotta, F., Lotrionte, M., Abbate, A., Fusaro, E. M., Biondi-Zoccai, G. G. L., Agostoni, P., Fusaro, M., Testa, L., Sheiban, I., & Sangiorgi, G. (2006). A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease. European Heart Journal, 27, 2667-2674. https://doi.org/10.1093/eurheartj/ehl334
Burzotta, Francesco ; Lotrionte, Marzia ; Abbate, Antonio et al. / A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease. In: European Heart Journal. 2006 ; Vol. 27. pagg. 2667-2674.
@article{bc2071ed7f1e46a2a0496575fb3ed7fd,
title = "A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease",
abstract = "Aims: The role of aspirin in patients with coronary artery disease (CAD) is well established, yet patients happen to discontinue aspirin according to physician's advice or unsupervised. We thus undertook a systematic review to appraise the hazards inherent to aspirin withdrawal or non-compliance in subjects at risk for or with CAD. Methods and results: Electronic databases were systematically searched (updated January 2006). Study designs, patient characteristics, and outcomes were abstracted. Pooled estimates for odds ratios (OR) were computed according to random-effect methods. From the 612 screened studies, six were selected (50 279 patients). One study (31 750 patients) focused on adherence to aspirin therapy in the secondary prevention of CAD, two studies (2594) on aspirin discontinuation in acute CAD, two studies (13 706) on adherence to aspirin therapy before or shortly after coronary artery bypass grafting, and another (2229) on aspirin discontinuation among patients undergoing drug-eluting stenting. Overall, aspirin non-adherence/withdrawal was associated with three-fold higher risk of major adverse cardiac events (OR=3.14 [1.75-5.61], P=0.0001). This risk was magnified in patients with intracoronary stents, as discontinuation of antiplatelet treatment was associated with an even higher risk of adverse events (OR=89.78 [29.90-269.60]). Conclusion: Non-compliance or withdrawal of aspirin treatment has ominous prognostic implication in subjects with or at moderate-to-high risk for CAD. Aspirin discontinuation in such patients should be advocated only when bleeding risk clearly overwhelms that of atherothrombotic events. {\textcopyright} The European Society of Cardiology 2006. All rights reserved.",
keywords = "Aspirin, Coronary Artery Disease, Coronary artery disease, Discontinuation, Humans, Meta-analysis, Platelet Aggregation Inhibitors, Risk Factors, Systematic review, Treatment Refusal, Aspirin, Coronary Artery Disease, Coronary artery disease, Discontinuation, Humans, Meta-analysis, Platelet Aggregation Inhibitors, Risk Factors, Systematic review, Treatment Refusal",
author = "Francesco Burzotta and Marzia Lotrionte and Antonio Abbate and Fusaro, {Enrica Maria} and Biondi-Zoccai, {Giuseppe G.L.} and Pierfrancesco Agostoni and Massimiliano Fusaro and Luca Testa and Imad Sheiban and Giuseppe Sangiorgi",
doi = "10.1093/eurheartj/ehl334",
publisher = "Oxford : Oxford University Press United Kingdom: Harcourt Publishers Limitedinternational.com, Fax: 011 44 20 83085876",
Burzotta, F, Lotrionte, M, Abbate, A, Fusaro, EM, Biondi-Zoccai, GGL, Agostoni, P, Fusaro, M, Testa, L, Sheiban, I & Sangiorgi, G 2006, 'A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease', European Heart Journal, vol. 27, pagg. 2667-2674. https://doi.org/10.1093/eurheartj/ehl334
A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease. / Burzotta, Francesco; Lotrionte, Marzia; Abbate, Antonio et al.
In: European Heart Journal, Vol. 27, 2006, pag. 2667-2674.
T1 - A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease
AU - Burzotta, Francesco
AU - Lotrionte, Marzia
AU - Abbate, Antonio
AU - Fusaro, Enrica Maria
AU - Biondi-Zoccai, Giuseppe G.L.
AU - Agostoni, Pierfrancesco
AU - Fusaro, Massimiliano
AU - Testa, Luca
AU - Sheiban, Imad
AU - Sangiorgi, Giuseppe
N2 - Aims: The role of aspirin in patients with coronary artery disease (CAD) is well established, yet patients happen to discontinue aspirin according to physician's advice or unsupervised. We thus undertook a systematic review to appraise the hazards inherent to aspirin withdrawal or non-compliance in subjects at risk for or with CAD. Methods and results: Electronic databases were systematically searched (updated January 2006). Study designs, patient characteristics, and outcomes were abstracted. Pooled estimates for odds ratios (OR) were computed according to random-effect methods. From the 612 screened studies, six were selected (50 279 patients). One study (31 750 patients) focused on adherence to aspirin therapy in the secondary prevention of CAD, two studies (2594) on aspirin discontinuation in acute CAD, two studies (13 706) on adherence to aspirin therapy before or shortly after coronary artery bypass grafting, and another (2229) on aspirin discontinuation among patients undergoing drug-eluting stenting. Overall, aspirin non-adherence/withdrawal was associated with three-fold higher risk of major adverse cardiac events (OR=3.14 [1.75-5.61], P=0.0001). This risk was magnified in patients with intracoronary stents, as discontinuation of antiplatelet treatment was associated with an even higher risk of adverse events (OR=89.78 [29.90-269.60]). Conclusion: Non-compliance or withdrawal of aspirin treatment has ominous prognostic implication in subjects with or at moderate-to-high risk for CAD. Aspirin discontinuation in such patients should be advocated only when bleeding risk clearly overwhelms that of atherothrombotic events. © The European Society of Cardiology 2006. All rights reserved.
AB - Aims: The role of aspirin in patients with coronary artery disease (CAD) is well established, yet patients happen to discontinue aspirin according to physician's advice or unsupervised. We thus undertook a systematic review to appraise the hazards inherent to aspirin withdrawal or non-compliance in subjects at risk for or with CAD. Methods and results: Electronic databases were systematically searched (updated January 2006). Study designs, patient characteristics, and outcomes were abstracted. Pooled estimates for odds ratios (OR) were computed according to random-effect methods. From the 612 screened studies, six were selected (50 279 patients). One study (31 750 patients) focused on adherence to aspirin therapy in the secondary prevention of CAD, two studies (2594) on aspirin discontinuation in acute CAD, two studies (13 706) on adherence to aspirin therapy before or shortly after coronary artery bypass grafting, and another (2229) on aspirin discontinuation among patients undergoing drug-eluting stenting. Overall, aspirin non-adherence/withdrawal was associated with three-fold higher risk of major adverse cardiac events (OR=3.14 [1.75-5.61], P=0.0001). This risk was magnified in patients with intracoronary stents, as discontinuation of antiplatelet treatment was associated with an even higher risk of adverse events (OR=89.78 [29.90-269.60]). Conclusion: Non-compliance or withdrawal of aspirin treatment has ominous prognostic implication in subjects with or at moderate-to-high risk for CAD. Aspirin discontinuation in such patients should be advocated only when bleeding risk clearly overwhelms that of atherothrombotic events. © The European Society of Cardiology 2006. All rights reserved.
KW - Aspirin
KW - Coronary Artery Disease
KW - Discontinuation
KW - Meta-analysis
KW - Platelet Aggregation Inhibitors
KW - Risk Factors
KW - Treatment Refusal
U2 - 10.1093/eurheartj/ehl334
DO - 10.1093/eurheartj/ehl334
Burzotta F, Lotrionte M, Abbate A, Fusaro EM, Biondi-Zoccai GGL, Agostoni P et al. A systematic review and meta-analysis on the hazards of discontinuing or not adhering to aspirin among 50 279 patients at risk for coronary artery disease. European Heart Journal. 2006;27:2667-2674. doi: 10.1093/eurheartj/ehl334