Summary of 3 large trials on daily aspirin therapy for primary prevention

ASCEND415,480 patients with diabetes and no prior CVD historyTherapy resulted in a 12% reduction in myocardial infarction and ischemic stroke
Therapy resulted in a 30% increased risk for a major bleeding event, especially prominent in patients age 60 or older
ARRIVE512,546 patients with mean 17% 10-year CVD riskNo significant benefit in CVD prevention with therapy compared with placebo
Twofold increase in gastrointestinal bleeding seen in aspirin therapy group
ASPREE6,719,114 patients, average age 74Therapy provided no benefit in preventing first nonfatal cardiovascular event or death
Therapy showed a 30% increased risk of major nonfatal hemorrhage, particularly in upper-gastrointestinal bleeds and intracranial hemorrhage
  • ARRIVE = Aspirin to Reduce Risk of Initial Vascular Events; ASCEND = A Study of Cardiovascular Events in Diabetes; ASPREE = Aspirin in Reducing Events in the Elderly; CVD = cardiovascular disease