{"id":32692,"date":"2012-11-04T18:30:04","date_gmt":"2012-11-04T23:30:04","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=32692"},"modified":"2012-11-04T18:41:18","modified_gmt":"2012-11-04T23:41:18","slug":"aspire-aspirin-an-attractive-alternative-after-first-vte","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/11\/04\/aspire-aspirin-an-attractive-alternative-after-first-vte\/","title":{"rendered":"ASPIRE: Aspirin an Attractive Alternative After First VTE"},"content":{"rendered":"<p>It is unclear what the best approach is for the long-term treatment of people who have had a first unprovoked episode of venous thromboembolism (VTE). Although warfarin is effective at preventing a recurrence, it is inconvenient and raises the risk for bleeding. Newer anticoagulants have not been tested or approved for this population.<\/p>\n<p>The ASPIRE (Aspirin to Prevent Recurrent Venous Thromboembolism) trial\u00a0randomized 822 patients who had finished an initial course of anticoagulant therapy after a first unprovoked case of VTE to either aspirin (100 mg daily) or placebo for 4 years.\u00a0Although the reduction in the rate for recurrent VTE with aspirin did not reach statistical significance, there were significant reductions in secondary outcomes of clinical events:<\/p>\n<p>26% reduction in the yearly rate of VTE recurrence (primary endpoint):<\/p>\n<ul>\n<li>6.5% for placebo and 4.8% for aspirin (HR 0.74, CI 0.52-1.05, p=0.09)<\/li>\n<\/ul>\n<p>34% reduction in the yearly rate of major vascular events (VTE, MI, stroke, or CV death):<\/p>\n<ul>\n<li>8.0% versus 5.2% (HR 0.66, CI 0.48-0.92, p=0.01)<\/li>\n<\/ul>\n<p>33% reduction in the yearly rate of VTE, MI, stroke, major bleeding, or all-cause mortality (net clinical benefit):<\/p>\n<ul>\n<li>9.0% versus 6.0% (HR 0.67, CI 0.49-0.91, p=0.01)<\/li>\n<\/ul>\n<p>The ASPIRE investigators calculated that for every 1000 patients treated for 1 year, aspirin would prevent 17 episodes of VTE and 28 major thrombotic events, at a cost of 5 nonfatal bleeding episodes.<\/p>\n<p><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1210384\">Reporting in the <em>New England Journal of Medicine<\/em><\/a>, the investigators write that although aspirin is &#8220;substantially less effective than warfarin,&#8221; it is &#8220;an attractive alternative because it is simple and inexpensive and its safety profile is well documented.&#8221;<\/p>\n<p>In <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMe1211480\">an accompanying editorial<\/a>, Theodore Warkentin combined the ASPIRE results with findings from <a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa1114238\">the recent WARFASA trial<\/a>\u00a0and calculated that aspirin results in a 32% reduction in the rate of recurrent VTE and a 34% reduction in the rate of major vascular events. He concludes that aspirin is &#8220;a reasonable option&#8221; for patients who wish to stop anticoagulation:<\/p>\n<blockquote><p>Aspirin is inexpensive, does not require monitoring (in contrast to warfarin), and does not accumulate in patients with renal insufficiency (in contrast to dabigatran and rivaroxaban); in addition, if major bleeding occurs or the patient requires urgent surgery, the antiplatelet effects of aspirin can be reversed&#8230;&#8221;<\/p><\/blockquote>\n","protected":false},"excerpt":{"rendered":"<p>It is unclear what the best approach is for the long-term treatment of people who have had a first unprovoked episode of venous thromboembolism (VTE). Although warfarin is effective at preventing a recurrence, it is inconvenient and raises the risk for bleeding. Newer anticoagulants have not been tested or approved for this population. The ASPIRE [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[495,7],"tags":[364,747,748,368],"class_list":["post-32692","post","type-post","status-publish","format-standard","hentry","category-anticoagulation-2","category-prevention","tag-aspirin","tag-venous-thromboembolism","tag-vte","tag-warfarin"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/32692","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=32692"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/32692\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=32692"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=32692"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=32692"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}