Evidence map›Paper›PMID 39075484›Full record

Observational studyBMC medicine2024

Short- and long-term impact of aspirin cessation in older adults: a target trial emulation.

Zhen Zhou, Katherine L Webb, Mark R Nelson, Robyn L Woods, Michael E Ernst, Anne M Murray, Andrew T Chan, Andrew Tonkin, Christopher M Reid, Suzanne G Orchard and 5 more

Registry-linked trialAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMC medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01038583 (Aspirin in Reducing Events in the Elderly), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
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.

NCT01038583 unknown statusnot on this map

Aspirin in Reducing Events in the Elderly

TypeobservationalSponsorHennepin Healthcare Research InstituteRan2010 to 2024Enrolled19,114ConditionsFunctional Disability, Dementia, Heart Disease, StrokeArms100 mg enteric-coated aspirin, Placebo
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Trial
  2. Review
  3. Article
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Zhen Zhou *School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Katherine L Webb *School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Mark R NelsonMenzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
Robyn L WoodsSchool of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Michael E ErnstDepartment of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA.
Anne M MurrayDivision of Geriatrics, Department of Medicine Hennepin HealthCare, Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
Andrew T ChanClinical and Translational Epidemiology Unit, Massachusetts General Hospital, Boston, MA, USA.
Andrew TonkinSchool of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Christopher M ReidSchool of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Suzanne G OrchardSchool of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Brenda KirpachDivision of Geriatrics, Department of Medicine Hennepin HealthCare, Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.
Raj C ShahDepartment of Family & Preventive Medicine and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA.
Nigel StocksDiscipline of General Practice, University of Adelaide, Adelaide, SA, Australia.
Jonathan C BroderSchool of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Rory WolfeSchool of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. rory.wolfe@monash.edu.ORCID 0000-0002-2126-1045

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe net benefit of aspirin cessation in older adults remains uncertain. This study aimed to use observational data to emulate a randomized trial of aspirin cessation versus continuation in older adults without cardiovascular disease (CVD).

methodsPost hoc analysis using a target trial emulation framework applied to the immediate post-trial period (2017-2021) of a study of low-dose aspirin initiation in adults aged ≥ 70 years (ASPREE; NCT01038583). Participants from Australia and the USA were included if they were free of CVD at the start of the post-trial intervention period (time zero, T0) and had been taking open-label or randomized aspirin immediately before T0. The two groups in the target trial were as follows: aspirin cessation (participants who were taking randomized aspirin immediately before T0; assumed to have stopped at T0 as instructed) versus aspirin continuation (participants on open-label aspirin at T0 regardless of their randomized treatment; assumed to have continued at T0). The outcomes after T0 were incident CVD, major adverse cardiovascular events (MACE), all-cause mortality, and major bleeding during 3, 6, and 12 months (short-term) and 48 months (long-term) follow-up. Hazard ratios (HRs) comparing aspirin cessation to continuation were estimated from propensity-score (PS) adjusted Cox proportional-hazards regression models.

resultsWe included 6103 CVD-free participants (cessation: 5427, continuation: 676). Over both short- and long-term follow-up, aspirin cessation versus continuation was not associated with elevated risk of CVD, MACE, and all-cause mortality (HRs, at 3 and 48 months respectively, were 1.23 and 0.73 for CVD, 1.11 and 0.84 for MACE, and 0.23 and 0.79 for all-cause mortality, p > 0.05), but cessation had a reduced risk of incident major bleeding events (HRs at 3 and 48 months, 0.16 and 0.63, p < 0.05). Similar findings were seen for all outcomes at 6 and 12 months, except for a lowered risk of all-cause mortality in the cessation group at 12 months.

conclusionsOur findings suggest that deprescribing prophylactic aspirin might be safe in healthy older adults with no known CVD.

Indexed as

AspirinCardiovascular DiseasesAgedAged, 80 and overAustraliaFemaleHemorrhageHumansMalePlatelet Aggregation InhibitorsRandomized Controlled Trials as TopicUnited StatesAspirinPlatelet Aggregation InhibitorsAspirinCardiovascular diseaseCessationElderlyHemorrhageTarget trial

Identifiers

PMID39075484
PMCPMC11287830

What OpenQuestion holds

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Registered trials

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 OpenQuestion graph.