Imperial College London (Royal Brompton & Harefield Hospitals), London, UK and Department of Cardiology, Castle Hill Hospital, Hull and York Medical School, University of Hull, Kingston-upon-Hull HU6 5JQ, UK.
Eur Heart J. 2013 Nov;34(44):3412-8. doi: 10.1093/eurheartj/eht287. Epub 2013 Aug 1.
There is no evidence that aspirin is effective for the primary prevention of cardiovascular events, although it may change the way that they present. Indeed, there is no evidence that long-term aspirin should be given to patients even with known cardiovascular disease. Theoretical arguments that aspirin can prevent cardiovascular events by reducing the propagation of thrombus are countered by evidence that plaque haemorrhage from vasa vasorum may also cause plaque growth and instability. There is evidence that aspirin causes serious bleeding into the brain and the gut. Aspirin may also detract from the benefits of drugs that have definite cardiovascular benefits, such as angiotensin-converting enzyme inhibitors. Meta-analysis is prone to multiple biases in favour of aspirin, including publication bias, bias due to trial and endpoint selection and bias due to interpretation. Meta-analysis should not be relied on in preference to adequately powered clinical trials. Unfortunately, the benefits of aspirin, if they exist, may be so small that a very large study indeed would be required to demonstrate that its benefits outweigh its risks. The evidence that aspirin might reduce cancer is intriguing but relies on data from trials conducted many decades ago using a wide range of aspirin doses. There is no reliable evidence that aspirin used in the current fashionable doses of 50-100 mg/day is of any benefit in any common clinical setting.
没有证据表明阿司匹林对心血管事件的一级预防有效，尽管它可能改变心血管事件的表现方式。事实上，即使患者有已知的心血管疾病，也没有证据表明应长期给予阿司匹林。阿司匹林可以通过减少血栓的传播来预防心血管事件的理论论点，与血管腔出血也可能导致斑块生长和不稳定的证据相矛盾。有证据表明阿司匹林会导致大脑和肠道严重出血。阿司匹林也可能削弱具有明确心血管益处的药物的益处，例如血管紧张素转换酶抑制剂。荟萃分析容易受到多种有利于阿司匹林的偏倚的影响，包括发表偏倚、试验和终点选择偏倚以及解释偏倚。荟萃分析不应优先于充分有力的临床试验。不幸的是，如果阿司匹林确实有任何益处，那么其益处可能非常小，确实需要进行一项非常大型的研究才能证明其益处超过风险。阿司匹林可能降低癌症风险的证据很有趣，但依赖于几十年前使用各种剂量的阿司匹林进行的试验数据。目前流行的 50-100mg/天剂量的阿司匹林在任何常见临床环境中都没有任何益处，这方面没有可靠的证据。
