Low and high dose Aspirin equally effective for preventing major CV events, ADAPTABLE study

During a median of 26.2 months of follow-up, there were no significant differences between the two aspirin doses, either in the risk of death from any cause, hospitalization for myocardial infarction, or hospitalization for stroke (estimated percentage, 7.28% in the 81-mg group and 7.51% in the 325-mg group) or in the risk of hospitalization for major bleeding (estimated percentage, 0.63% in the 81-mg group and 0.60% in the 325-mg group).

The rates of major bleeding requiring blood-product transfusion were 0.63% and 0.60% with the 81-mg and 325-mg doses, respectively.

Still, there are some question marks around the reliability of these new findings, particularly given the high rate of crossover from the high- to low-dose aspirin groups.

"The results showed there was no difference between the 81-mg and 325-mg doses," lead investigator W. Schuyler Jones, MD (Duke University Medical Center, Durham, NC), told TCTMD. "There was some dose-switching in the 325-mg group which does make it a little bit tough to figure out the absolute correct answer, but we think, in general, that this answers the question, especially for the majority of patients. For those on the 81-mg dose, they should continue with 81 mg of daily aspirin."

Lessons that were learned from this pivotal demonstration trial include the feasibility of identifying a large cohort of eligible patients; engaging, recruiting, and randomly assigning these patients to take daily aspirin doses; and performing follow-up with new methods alongside strong engagement of patient-partners.

Source: NEJM: DOI: 10.1056/NEJMoa2102137