Once- versus twice-daily aspirin in patients at high risk of thrombotic events : systematic review and meta-analysis

• Autor(es): Mainoli, Beatrice ; Duarte, Gonçalo S. ; Costa, João ; Ferreira, Joaquim J. ; Caldeira, Daniel
• Data: 2020
• Identificador Persistente: http://hdl.handle.net/10451/43605
• Origem: Repositório da Universidade de Lisboa
• Tipo de Documento: Artigo científico
• Idioma: Inglês
• Contribuidor(es): Repositório Científico de Acesso Aberto da ULisboa

Descrição

Background: Acetylsalicylic acid (ASA) is a frequently used antiplatelet agent, although some individuals have reduced antiplatelet responses on ASA, with recurrent ischemic events. It has been proposed that shortening the ASA dosing interval may overcome the time-dependent renewal of the drug target, leading to a greater antiplatelet efect. We conducted a systematic review of randomized controlled trials (RCTs) to determine the efcacy of once- versus twice-daily ASA in conditions with increased platelet turnover. Methods: We conducted a systematic review and meta-analysis by searching the CENTRAL, MEDLINE, and Embase databases for RCTs assessing once- versus twice-daily ASA. Data were screened, extracted, and appraised by two independent reviewers, and were pooled using a random-efects model. The primary outcomes were major adverse cardiovascular events (MACEs) and serum thromboxane B2 (TxB2). Other pharmacodynamic measures were retrieved as secondary outcomes. Results were reported as mean diferences with corresponding 95% confdence intervals (CIs). We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Seven RCTs were included, enrolling 379 participants overall. None of the studies reported clinical outcomes. Pooled results showed that compared with once-daily ASA, twice-daily ASA was associated with a decrease in mean TxB2 of 1.42 ng/mL (95% CI−2.71 to−0.13; I 2 = 66%). We found no diferences in subgroup analyses based on disease subtype, trial blinding, or trial design. A greater antiplatelet activity of the twice-daily regimen was also found when using PFA-100- ADP methods, although not when using the VerifyNow, LTA-AA, and multiplate methods. Conclusions: Twice-daily ASA was associated with a greater antiplatelet efect compared with standard once-daily ASA.