Skip to main content

Table 8 Quality, strength and evidence-base of the developed recommendations

From: Effectiveness and patient safety of platelet aggregation inhibitors in the prevention of cardiovascular disease and ischemic stroke in older adults – a systematic review

Indication Recommendations Strength of the recommendation Quality of the evidence Evidence base
Primary prevention CVD (ASA not recommended) It is suggested to discontinue ASA for primary prevention of CVD in adults without diabetes because there is uncertainty about the risk/benefit ratio: The risk of haemorrhagic stroke, major gastrointestinal and extracranial bleeds may be increased, there is less confidence regarding its benefits in decreasing vascular events in adults aged 65 and older. Weak Low [28,29,30,31,32,33,34,35]
ASA in the secondary prevention of CVD No stop recommendation developed    [36]
ASA in the primary prevention of stroke
a) with AF
b) without AF
With AF: It is suggested to discontinue ASA for the primary prevention of stroke in older adults with atrial fibrillation (including adults older than 75 years) and consider the use of oral anticoagulants instead. Oral anticoagulants are more beneficial than ASA in preventing cardiovascular events and these benefits appear to apply to older people, while the risk of bleeding appears to be similar for both treatments. Without AF: No stop recommendation developed Weak Low With AF: [30, 37,38,39,40,41,42,43,44,45,46,47,48,49, 56] Without AF: [50]
ASA in the secondary prevention of stroke
a) with AF
b) without AF
No recommendation developed    With AF: [34, 39, 40] Without AF: [52]
ADP-receptor inhibitors in secondary prevention of cardiovascular disease It is recommended to discontinue ASA in adults at high-risk of vascular events with recent transient ischaemic attack or ischaemic stroke who are also taking clopidogrel and who do not have another indication for dual therapy (e.g. first year after acute coronary syndrome, first year after elective drug eluting coronary stenting, aortic valve replacement, carotid stenting or complications of severe lower limb ischaemia despite ASA therapy) because the combination of ASA and clopidogrel compared with clopidogrel alone increases the risk of bleeding complications and may not be beneficial in reducing vascular events, especially in the subgroup of adults aged 65 years or older. Strong Moderate [51, 52]
ADP- receptor inhibitors in the secondary prevention of stroke and/or transient ischemic attack No recommendation developed    [52,53,54]
Dipyridamol in the secondary prevention of stroke No recommendation developed    [55, 56]
  1. Note: MA meta-analysis, RCT randomised controlled trial, SR systematic review