Circulation: STEMI patients benefit from less aspirin

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Researchers at Duke University found no significant association between initial aspirin dose and risk of death, myocardial infarction, or stroke for the acute treatment of ST-elevation myocardial infarction. In addition, a higher dose was associated with a significant increase in the risk of moderate or severe bleeding.

Jeffrey S. Berger, MD, and colleagues analyzed combined data from the GUSTO I and GUSTO III trials (Global Utilization of Streptokinase and Tissue plasminogen activator for Occluded coronary arteries, and Global Use of Strategies To Open occluded coronary arteries, totaling 48,422 STEMI patients.

The results were adjusted for previously identified mortality and bleeding risk factors and appeared in the Jan. 15 issue of Circulation.

Overall, 24.4 percent of patients received an initial aspirin dose of 325 mg, and 75.6 percent received 162 mg. The 24-hour mortality rates were 2.9 percent versus 2.8 percent, respectively.

The respective mortality rates at seven and 30 days were 5.2 percent versus 4.9 percent and 7.1 percent versus 6.5 percent for patients receiving the higher versus the lower doses, respectively. After adjustment, aspirin dose was not associated with 24/7 mortality rates.

“The higher associated bleeding risk reinforces the importance of finding the lowest effective aspirin dose as an important goal in each clinical setting,” the authors concluded.