Evidence map›Paper›PMID 30017552›Full record

ArticleLancet (London, England)2018

Effects of aspirin on risks of vascular events and cancer according to bodyweight and dose: analysis of individual patient data from randomised trials.

Peter M Rothwell, Nancy R Cook, J Michael Gaziano, Jacqueline F Price, Jill F F Belch, Maria Carla Roncaglioni, Takeshi Morimoto, Ziyah Mehta

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Lancet (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 147 papers, 12 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
147citing papers in PubMed, 12 pooled it
36.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

147 citing papers in PubMed, 12 syntheses or guidelines pooled it, 348 citations in OpenAlex.

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  10. Canadian Stroke Best Practice Recommendations, seventh edition: acetylsalicylic acid for prevention of vascular events.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2020
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  14. Eradication ofHealth technology assessment (Winchester, England) · 2025
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87 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 7 institutions in 4 countries.

Peter M RothwellCentre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK. Electronic address: peter.rothwell@clneuro.ox.ac.uk.
Nancy R CookDivision of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
J Michael GazianoHarvard Medical School, Boston, MA, USA.
Jacqueline F PriceUsher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
Jill F F BelchInstitute of Cardiovascular Research, Vascular and Inflammatory Diseases Research Unit, University Division of Medicine and Therapeutics, Ninewells Hospital and Medical School, Dundee, UK.
Maria Carla RoncaglioniIstituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Takeshi MorimotoDepartment of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan.
Ziyah MehtaCentre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.
University of Oxford · GBBrigham and Women's Hospital · USHarvard University · USHyogo Medical University · JPMario Negri Institute for Pharmacological Research · ITNinewells Hospital · GBUniversity of Edinburgh · GB

Funding

Wellcome Trust
6 · The paper itself

Abstract

backgroundA one-dose-fits-all approach to use of aspirin has yielded only modest benefits in long-term prevention of cardiovascular events, possibly due to underdosing in patients of large body size and excess dosing in patients of small body size, which might also affect other outcomes.

methodsUsing individual patient data, we analysed the modifying effects of bodyweight (10 kg bands) and height (10 cm bands) on the effects of low doses (≤100 mg) and higher doses (300-325 mg or ≥500 mg) of aspirin in randomised trials of aspirin in primary prevention of cardiovascular events. We stratified the findings by age, sex, and vascular risk factors, and validated them in trials of aspirin in secondary prevention of stroke. Additionally, we assessed whether any weight or height dependence was evident for the effect of aspirin on 20-year risk of colorectal cancer or any in-trial cancer.

resultsAmong ten eligible trials of aspirin in primary prevention (including 117 279 participants), bodyweight varied four-fold and trial median weight ranged from 60·0 kg to 81·2 kg (p<0·0001). The ability of 75-100 mg aspirin to reduce cardiovascular events decreased with increasing weight (p

interpretationLow doses of aspirin (75-100 mg) were only effective in preventing vascular events in patients weighing less than 70 kg, and had no benefit in the 80% of men and nearly 50% of all women weighing 70 kg or more. By contrast, higher doses of aspirin were only effective in patients weighing 70 kg or more. Given that aspirin's effects on other outcomes, including cancer, also showed interactions with body size, a one-dose-fits-all approach to aspirin is unlikely to be optimal, and a more tailored strategy is required.

fundingWellcome Trust and National Institute for Health Research Oxford Biomedical Research Centre.

Indexed as

Body WeightAgedAge FactorsAspirinBody HeightCardiovascular DiseasesColorectal NeoplasmsDeath, SuddenFemaleHumansKaplan-Meier EstimateMalePlatelet Aggregation InhibitorsProportional Hazards ModelsRandomized Controlled Trials as TopicRisk FactorsAspirinPlatelet Aggregation Inhibitors

Identifiers

PMID30017552
PMCPMC6083400
OpenAlexW2884727639

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.