{"publication_id":"145fcccc-2360-4120-8674-34dd3e97ade7","content_hash":"sha256:662eb75607bfdba01b29302e8bca263d99248e5a98ade3e9779acb2a7d232262","nodes":[{"id":"145fcccc-2360-4120-8674-34dd3e97ade7","type":"publication","title":"Adjacent Evidence Brief: Aspirin Use Effects — full paper"},{"id":"claim_1","type":"claim","text":"Evidence-honesty note: The retained evidence has no direct interventional hard-endpoint evidence; indirect, review-level, adjacent, or mechanistic sources are used only to bound interpretation. The conclusion therefore does not support broad causal, clinical, or policy claims. Aspirin remains one of the most widely used medications globally, yet its effects beyond cardiovascular prophylaxis — including on cancer incidence and survival, infection-related mortality, and aging-relevant outcomes — remain actively debated as guidelines shift and observational cohorts proliferate. We conducted an AI-assisted structured evidence synthesis across 55 curated reference papers indexed for Aspirin, extracting effect estimates, confidence intervals, and p-values into an audit-trailed evidence table while preserving the design and directness annotations supplied by the original sources. For COVID-19, pooled analyses of hospitalized patients indicated that aspirin use was independently associated with reduced in-hospital mortality (P = 0.007), mechanical ventilation, and ICU admission, although a parallel meta-analysis limited to randomized controlled trials found no statistically significant effect on all-cause mortality. Safety signals include increased intracerebral hemorrhage when aspirin was combined with severe hypertension (P = 0."},{"id":"claim_2","type":"claim","text":"Evidence-honesty note: The retained evidence has no direct interventional hard-endpoint evidence; indirect, review-level, adjacent, or mechanistic sources are used only to bound interpretation. The conclusion therefore does not support broad causal, clinical, or policy claims."},{"id":"claim_3","type":"claim","text":"We conducted an AI-assisted structured evidence synthesis across 55 curated reference papers indexed for Aspirin, extracting effect estimates, confidence intervals, and p-values into an audit-trailed evidence table while preserving the design and directness annotations supplied by the original sources."},{"id":"claim_4","type":"claim","text":"Safety signals include increased intracerebral hemorrhage when aspirin was combined with severe hypertension (P = 0.003), whereas aspirin exposure was associated with lower severe AKI incidence in MIMIC-IV/eICU sepsis cohorts (P < 0.001), illustrating outcome- and population-dependent benefit–risk tradeoffs."},{"id":"claim_5","type":"claim","text":"Across outcome classes, cross-study disagreements emerged in the synthesis — most prominently null-versus-positive conflicts on contextual outcomes (Sun 2019 vs Alabsi 2023; Wang 2021a vs Huff 2025) and on longevity outcomes in specific subgroups (Wu 2024, Xu 2026, Chow 2022 vs Celik 2018) — confirming that aspirin's effect profile is context-dependent rather than uniformly beneficial."},{"id":"claim_6","type":"claim","text":"Interpretation below therefore separates primary clinical-trial evidence from review-level, preclinical, and other indirect evidence."},{"id":"claim_7","type":"claim","text":"This synthesis evaluates evidence on aspirin use effects across 55 included source papers and 2311 high-confidence extracted claims. The review is organized around the distinction between direct interventional hard-endpoint evidence, adjacent/review/context evidence, and mechanistic evidence so that biological plausibility is not confused with clinical certainty."},{"id":"claim_8","type":"claim","text":"The corpus contains no sources classified primarily as direct interventional hard-endpoint evidence, 55 adjacent, review, or context sources, and no sources classified primarily as mechanistic or model-system evidence. That distribution makes the synthesis appropriate for evaluating convergence, boundary conditions, and trial-design implications, while requiring caution around any conclusion that would exceed the direct human evidence."},{"id":"claim_9","type":"claim","text":"The introductory frame therefore treats the corpus as a set of evidence roles rather than a single directional verdict. Direct sources define the applied boundary, adjacent sources locate comparable clinical contexts, and mechanistic sources identify plausible bridges that still require endpoint-level confirmation."},{"id":"claim_10","type":"claim","text":"This distinction matters for publication because it makes the paper falsifiable. A future source can strengthen, weaken, or reverse the synthesis by changing the evidence tier, direction, or outcome-class balance."},{"id":"claim_11","type":"claim","text":"The mechanistic layer is most useful when it explains why a trial signal might appear or fail to appear. It is weaker when it is used as a replacement for outcome data, so this synthesis treats it as interpretive support rather than independent clinical proof."},{"id":"claim_12","type":"claim","text":"Null findings have a specific role in this evidence model. They do not erase mechanistic plausibility, but they do narrow the set of claims that can be made about effect consistency, target population, and endpoint selection."},{"id":"claim_13","type":"claim","text":"Adverse or negative signals are likewise retained in the main interpretation. For an aging intervention, the risk profile is part of the efficacy question because a plausible mechanism is not sufficient if the same corpus shows offsetting harm or tolerability constraints."},{"id":"claim_14","type":"claim","text":"The evidence base also distinguishes breadth from certainty. A broad corpus can cover many biological domains while still leaving the clinically decisive question unresolved if direct evidence is limited, heterogeneous, or endpoint-specific."},{"id":"claim_15","type":"claim","text":"For that reason, the manuscript does not collapse every source into a single recommendation. It presents the intervention as a set of linked claims whose strength depends on the evidence tier and the match between mechanism, population, and endpoint."},{"id":"claim_16","type":"claim","text":"The research value of the synthesis lies in making these boundaries explicit. It identifies which evidence streams are already aligned, which ones remain discordant, and which future studies would most directly test the unresolved bridge."},{"id":"claim_17","type":"claim","text":"The background evidence for aspirin use effects is heterogeneous rather than uniformly confirmatory. Direct clinical sources such as the retained evidence base are interpreted separately from mechanistic studies such as the retained evidence base, because these evidence roles answer different questions about aging biology and clinical translation."},{"id":"claim_18","type":"claim","text":"The direct evidence establishes what has been observed in human or adjacent clinical settings. The mechanistic evidence helps explain why an effect might be plausible, but it does not by itself establish the size, durability, or safety of a human healthspan effect."},{"id":"claim_19","type":"claim","text":"Across the retained sources, positive signals cluster around the longevity, contextual adjacent evidence, safety and comorbidity outcome classes; null signals around the contextual adjacent evidence, deficiency prevalence and cardiometabolic outcome classes; and negative or adverse signals around no dominant outcome class. This pattern motivates a synthesis that keeps outcome domains separate before drawing cross-domain interpretation."},{"id":"claim_20","type":"claim","text":"The study-level structure also prevents selective emphasis. Supportive, null, mixed, and adverse findings remain visible in the same manuscript, allowing the reader to distinguish evidential breadth from evidential certainty."},{"id":"claim_21","type":"claim","text":"The resulting paper is therefore a calibrated synthesis: it can identify plausible mechanisms, observed direct signals when present, unresolved tensions, and trial-design priorities without converting them into claims stronger than the retained corpus can support."},{"id":"claim_22","type":"claim","text":"The following fields were extracted from each included source: study design, population / cohort, intervention or exposure, comparator, outcome class, effect direction, effect size, confidence interval or credible interval, p-value, sample size, follow-up duration, risk-of-bias rating. Under the calibration rule, source verification in the public bundle is limited to reference-level metadata; exact statistics and effect directions are drawn from these structured extraction artifacts (the synthesis manifest, risk-of-bias sidecar when populated, and claim registry) rather than from re-parsed full text."},{"id":"claim_23","type":"claim","text":"Risk-of-bias framework assignment follows study design (RoB-2 for RCTs, ROBINS-I for non-randomised studies, AMSTAR-2 for systematic reviews / meta-analyses). Public appraisal claims are limited to populated `risk_of_bias.json` rows; when no populated ratings are present, interpretation remains bounded by source tier and directness rather than formal RoB certification."},{"id":"claim_24","type":"claim","text":"Evidence-tension synthesis: claims grouped by outcome class (cardiometabolic, contextual adjacent evidence, deficiency prevalence, dosing and pharmacokinetics, immune and inflammation, longevity, mortality and survival, safety and comorbidity); within-class agreement, disagreement, and directness gaps surfaced explicitly. Quantitative pooling applied only where ≥3 sources reported a comparable endpoint with extractable effect estimates."},{"id":"claim_25","type":"claim","text":"Source retrieval, claim extraction, evidence routing, and prose drafting were assisted by large language models under a deterministic audit-trail protocol. Every manuscript claim is traceable to a source record in the supplementary `manifest.json`. Final eligibility and interpretation decisions are author-verified."},{"id":"claim_26","type":"claim","text":"Outcome-class note:** Contextual Adjacent Evidence denotes background, boundary-condition, or adjacent-outcome sources. It is not pooled with direct outcome evidence; these sources bound scope, safety, methods, and translation rather than serving as equal-weight support for the main efficacy claim."},{"id":"claim_27","type":"claim","text":"| Evidence domain | Corpus slice | Strongest signal | Directness | Main limitation |"},{"id":"claim_28","type":"claim","text":"| Aspirin Use Effects / Contextual Adjacent Evidence | n=23; claims=984 | significant source statistic in 16/23 sources; receipt-level direction coded unclear | 14 indirect; 9 review | limited corpus depth in this outcome class |"},{"id":"claim_29","type":"claim","text":"| Aspirin Use Effects / Cardiometabolic | n=1; claims=81 | significant source statistic in 1/1 sources; receipt-level direction coded null | 1 indirect | single-source slice; hypothesis-generating |"},{"id":"claim_30","type":"claim","text":"Contextual Adjacent Evidence: n=23; claims=984; mixed signal in 15/23 sources | directness: 14 indirect; 9 review; main limitation: no direct clinical anchor."},{"id":"source_1","type":"source","study":"Relationship between aspirin use of esophageal, gastric and colorectal cancer patient survival: a meta-analysis","year":2020,"doi":"10.1186/s12885-020-07117-4","url":"https://doi.org/10.1186/s12885-020-07117-4","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Lin 2020","excerpt":"BACKGROUND: Many studies have found that use of aspirin can lengthen survival in patients with gastrointestinal cancer. The aim of this study was to assess the survival benefit of aspirin use compared with non-aspirin use for patients with esophageal, gastric or colorectal cancer. METHODS: We searched online databases, including PubMed, the Cochrane Library, Embase and www.clinicaltrials.gov for studies that were conducted, before April 30th, 2020, to identify relevant studies. Overall survival and cancer-specific survival of esophageal, gastric and colorectal cancers among aspirin users were compared with those among non-aspirin users. Data extraction and quality evaluation were independently conducted by 2 investigators. A meta-analysis was performed to calculate the pooled risk ratios (RRs) for overall survival and cancer-specific survival by using either a fixed-effects model or a random-effects model. RESULTS: A total of 18 studies were included in this meta-analysis, with more than 74,936 patients. There were no significant differences between postdiagnosis aspirin use and overall survival for esophageal and gastric cancers."},{"id":"source_2","type":"source","study":"An Evaluation of Aspirin Treatment Preferences of Physicians in Hypertensive Patients in Terms of Current Guidelines: A Subgroup Analysis of the ASSOS Trial in Turkey","year":2022,"doi":"10.5152/AnatolJCardiol.2021.541","url":"https://doi.org/10.5152/AnatolJCardiol.2021.541","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Sancar 2022","excerpt":"BACKGROUND: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial has been the largest study ever conducted among patients in Turkey regarding aspirin treatment. In the subgroup analysis of the hypertensive group of the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial, we aimed to evaluate the physicians' adherence to current guidelines regarding their aspirin treatment preferences. METHODS: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study trial is a cross-sectional and multicenter study conducted among 5007 consecutive patients aged ≥18 years. The study population consisted of outpatients on aspirin treatment (80-300 mg). The patient data were obtained from 30 different cardiology clinics of 14 cities from all over Turkey. In this subgroup analysis, patients were divided into 2 groups: the hypertensive group (n=3467, 69.3%) and the group without hypertension (n=1540, 30.7%) according to the 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the Management of Arterial Hypertension."},{"id":"source_3","type":"source","study":"Can Aspirin Use Be Associated With the Risk or Prognosis of Bladder Cancer? A Case-Control Study and Meta-analytic Assessment","year":2021,"doi":"10.3389/fonc.2021.633462","url":"https://doi.org/10.3389/fonc.2021.633462","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Fan 2021","excerpt":"Aspirin, widely used to prevent cardiovascular disease, had been linked to the incidence of bladder cancer (BCa). Existing studies focusing on Chinese populations are relatively rare, especially for Northeast China. Meanwhile, relevant studies on the effects of aspirin on the occurrence or prognosis of BCa are inconsistent or even controversial. First, in the case control study, logistic regression analysis was used to investigate the association between aspirin intake and risk of BCa including 1121 patients with BCa and the 2242 controls. Subsequently, Kaplan-Meier curve and Cox regression analyses were applied to explore the association between aspirin intake and clinicopathological factors which may predict overall survival (OS) and recurrence-free survival (RFS) of BCa patients. Finally, we quantificationally combined the results with those from the published literature evaluating aspirin intake and its effects on the occurrence, outcome of surgery and prognosis of BCa by meta-analysis up to May 1, 2021.Our case-control study demonstrated that the regular use of aspirin was not associated with a reduced incidence of BCa ( P =0.175)."},{"id":"source_4","type":"source","study":"Association of Early Aspirin Use With In-Hospital Mortality in Patients With Moderate COVID-19","year":2022,"doi":"10.1001/jamanetworkopen.2022.3890","url":"https://doi.org/10.1001/jamanetworkopen.2022.3890","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Chow 2022","excerpt":"IMPORTANCE: Prior observational studies suggest that aspirin use may be associated with reduced mortality in high-risk hospitalized patients with COVID-19, but aspirin's efficacy in patients with moderate COVID-19 is not well studied. OBJECTIVE: To assess whether early aspirin use is associated with lower odds of in-hospital mortality in patients with moderate COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of 112 269 hospitalized patients with moderate COVID-19, enrolled from January 1, 2020, through September 10, 2021, at 64 health systems in the United States participating in the National Institute of Health's National COVID Cohort Collaborative (N3C). EXPOSURE: Aspirin use within the first day of hospitalization. MAIN OUTCOME AND MEASURES: The primary outcome was 28-day in-hospital mortality, and secondary outcomes were pulmonary embolism and deep vein thrombosis. Odds of in-hospital mortality were calculated using marginal structural Cox and logistic regression models. Inverse probability of treatment weighting was used to reduce bias from confounding and balance characteristics between groups."},{"id":"source_5","type":"source","study":"Regular aspirin use, breast tumor characteristics and long-term breast cancer survival","year":2025,"doi":"10.1038/s41523-025-00775-2","url":"https://doi.org/10.1038/s41523-025-00775-2","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Peng 2025","excerpt":"Epidemiologic data, supported by experiments, suggest aspirin may improve survival in breast cancer patients. However, recent trials reported a lack of protection, though the length of intervention was limited. Among 10,705 stages I-III breast cancer patients in the Nurses' Health Studies (NHS/NHSII), we examined the associations between post-diagnostic aspirin use and long-term breast cancer survival. During up to 34 years of follow-up, regular post-diagnostic aspirin use was associated with a 38% and 28% lower risk of breast cancer-specific and total mortality. Associations were more evident with longer duration of post-diagnostic aspirin use but attenuated with higher stage and older age at diagnosis. Pre-diagnostic long-term aspirin use was associated with the downregulation of tumor proliferation pathways in NHS/NHSII and the aspirin-gene-expression-signature predicted better survival in METABRIC. Our study highlighted the need for trials with longer duration and suggested that aspirin use before diagnosis may alter the tumor-microenvironment towards a less proliferative type."},{"id":"source_6","type":"source","study":"Aspirin Use and Survival Among Patients With Breast Cancer: A Systematic Review and Meta-Analysis","year":2023,"doi":"10.1093/oncolo/oyad186","url":"https://doi.org/10.1093/oncolo/oyad186","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Baker 2023","excerpt":"BACKGROUND: Previous meta-analyses have indicated that aspirin could affect breast cancer outcomes, particularly when taken post-diagnostically. However, several recent studies appear to show little to no association between aspirin use and breast cancer mortality, all-cause mortality, or recurrence. AIMS: This study aims to conduct an updated systematic review and meta-analysis on the associations of pre-diagnostic and post-diagnostic aspirin use with the aforementioned breast cancer outcomes. It also looks, through subgroup analyses and meta-regressions, at a range of variables that could explain the associations between aspirin use and breast cancer outcomes. RESULTS: In total, 24 papers and 149 860 patients with breast cancer were included. Pre-diagnostic aspirin use was not associated with breast-cancer-specific mortality (HR 0.98, 95% CI, 0.80-1.20, P = .84) or recurrence (HR 0.94, 95% CI, 0.88-1.02, P = .13). Pre-diagnostic aspirin was associated with non-significantly higher all-cause mortality (HR 1.27, 95% CI, 0.95-1.72, P = .11). Post-diagnostic aspirin was not significantly associated with all-cause mortality (HR 0.87, 95% CI, 0.71-1.07, P = .18) or recurrence (HR 0."},{"id":"source_7","type":"source","study":"Timing of Aspirin Use Among Patients With Colorectal Cancer in Relation to Mortality: A Systematic Review and Meta-Analysis","year":2021,"doi":"10.1093/jncics/pkab067","url":"https://doi.org/10.1093/jncics/pkab067","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Xiao 2021","excerpt":"BACKGROUND: Exposure of aspirin has been associated with reduced risk of colorectal cancer (CRC) incidence, but aspirin use in relation to CRC patients' mortality remains undetermined. It is necessary to quantify the association between aspirin use and CRC mortality. METHODS: Two authors independently searched the electronic databases (PubMed, Embase, and the Cochrane Library) from 1947 through April 25, 2020. All observational studies assessing the association between different timing of aspirin use and CRC mortality were included. The effect size on study outcomes was calculated using random-effect model and presented as risk ratio (RR) with 95% confidence interval (CI). Heterogeneity, publication bias, and quality of included studies were also assessed. RESULTS: A total of 34 studies were included in this systematic review and meta-analysis. Prediagnosis aspirin use was not associated with CRC-specific mortality (RR = 0.91, 95% CI = 0.79 to 1.05) and all-cause mortality (RR = 0.87, 95% CI = 0.57 to 1.31). A statistically significant association between continued aspirin use and improvement in both CRC-specific mortality (RR = 0.76, 95% CI = 0.70 to 0."},{"id":"source_8","type":"source","study":"Aspirin Use and Common Cancer Risk: A Meta-Analysis of Cohort Studies and Randomized Controlled Trials","year":2021,"doi":"10.3389/fonc.2021.690219","url":"https://doi.org/10.3389/fonc.2021.690219","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Wang 2021a","excerpt":"BACKGROUND: Whether aspirin use can decrease or increase cancer risk remains controversial. In this study, a meta-analysis of cohort studies and randomized controlled trials (RCTs) were conducted to evaluate the effect of aspirin use on common cancer risk. METHOD: Medline and Embase databases were searched to identify relevant studies. Meta-analyses of cohort studies and RCTs were performed to assess the effect of aspirin use on the risk of colorectal, gastric, breast, prostate and lung cancer. Cochran Q test and the I square metric were calculated to detect potential heterogeneity among studies. Subgroup meta-analyses according to exposure categories (frequency and duration) and timing of aspirin use (whether aspirin was used before and after cancer diagnosis) were also performed. A dose-response analysis was carried out to evaluate and quantify the association between aspirin dose and cancer risk. RESULTS: A total of 88 cohort studies and seven RCTs were included in the final analysis. Meta-analyses of cohort studies revealed that regular aspirin use reduced the risk of colorectal cancer (CRC) (RR=0.85, 95%CI: 0.78-0.92), gastric cancer (RR=0.67, 95%CI: 0.52-0."},{"id":"source_9","type":"source","study":"Aspirin for cardiovascular disease prevention among adults in the United States: Trends, prevalence, and participant characteristics associated with use","year":2021,"doi":"10.1016/j.ajpc.2021.100256","url":"https://doi.org/10.1016/j.ajpc.2021.100256","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Boakye 2021","excerpt":"OBJECTIVE: : Aspirin has been widely utilized over several decades for atherosclerotic cardiovascular disease (ASCVD) prevention among adults in the United States. We examined trends in aspirin use among adults aged ≥40 years from 1998 to 2019 and assessed factors associated with its use for primary and secondary ASCVD prevention. METHODS: : Using 1998-2019 Behavioral Risk Factor Surveillance System data, we obtained weighted prevalence of aspirin use among adults aged ≥40 years for each year and examined trends in use over this period. Using multivariable logistic regression and utilizing data from 54,388 respondents aged ≥40 years in the 2019 data, we assessed factors associated with aspirin use for secondary prevention and for primary prevention stratified by the number of traditional ASCVD risk factors reported (hypertension, diabetes mellitus, high cholesterol, overweight/obesity, and cigarette smoking). RESULTS: : Aspirin use prevalence increased from 29.0%(95%CI, 27.9%-30.2%) in 1998 to 37.5%(36.9%-38.0%) in 2009. However, use has slightly declined over the last decade: 35.6%(34.6%-36.6%) in 2011 to 33.5%(32.5%-34.6%) in 2019."},{"id":"source_10","type":"source","study":"US population qualifying for aspirin use for primary prevention of cardiovascular disease","year":2024,"doi":"10.1016/j.ajpc.2024.100669","url":"https://doi.org/10.1016/j.ajpc.2024.100669","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Huang 2024","excerpt":"OBJECTIVE: Aspirin has been used for primary prevention of atherosclerotic cardiovascular disease (ASCVD) for decades, but this indication has become controversial with recent trial data. The 2022 US Preventive Services Task Force (USPSTF) provided a recommendation to consider aspirin use for primary prevention in adults 40-59 years with a 10-year ASCVD risk ≥10 % and not at increased risk of bleeding, yet population estimates for the impact of this recommendation are unknown. The objective of this study is to determine the prevalence and demographics of the US population who meet eligibility criteria for aspirin under the new 2022 USPSTF guidelines. METHODS: This is a serial cross-sectional study using data from the 2011-March 2020 National Health and Nutrition Examination Survey (NHANES) database. Individuals aged 40-59 years without a self-reported history of ASCVD were included. 10-year estimated ASCVD risk ≥10 % as calculated by the Pooled Cohort Equations (PCE) and increased bleeding risk determined using variables adapted from USPSTF guidelines were further applied as inclusion and exclusion criteria, respectively."},{"id":"source_11","type":"source","study":"Impact of aspirin use on clinical outcomes in patients with vasospastic angina: a systematic review and meta-analysis","year":2021,"doi":"10.1136/bmjopen-2021-048719","url":"https://doi.org/10.1136/bmjopen-2021-048719","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Lin 2021","excerpt":"OBJECTIVES: The use of aspirin to prevent cardiovascular disease in vasospastic angina (VSA) patients without significant stenosis has yet to be investigated. This study aimed to investigate the efficacy of aspirin use among VSA patients. DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, Web of Science and Cochrane Central Register of Controlled Trials were searched for relevant information prior to October 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Aspirin use versus no aspirin use (placebo or no treatment) among VSA patients without significant stenosis. DATA EXTRACTION AND SYNTHESIS: Two investigators extracted the study data. ORs and 95% CIs were calculated and graphed as forest plots. The Newcastle-Ottawa Quality Assessment Scale tool and Begg's funnel plot were used to assess risk of bias. RESULTS: Four propensity-matched cohorts, one retrospective analysis and one prospective multicentre cohort, in total comprising 3661 patients (aspirin use group, n=1695; no aspirin use group, n=1966) were included in this meta-analysis."},{"id":"source_12","type":"source","study":"Aspirin Use Is Associated with a Reduced Incidence of Hepatocellular Carcinoma: A Systematic Review and Meta‐analysis","year":2020,"doi":"10.1002/hep4.1640","url":"https://doi.org/10.1002/hep4.1640","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Memel 2020","excerpt":"Hepatocellular carcinoma (HCC) is the third-leading cause of cancer-related death worldwide, with a growing incidence and poor prognosis. While some recent studies suggest an inverse association between aspirin use and reduced HCC incidence, other data are conflicting. To date, the precise magnitude of risk reduction-and whether there are dose-dependent and duration-dependent associations-remains unclear. To provide an updated and comprehensive assessment of the association between aspirin use and incident HCC risk, we conducted a systematic review and meta-analysis of all observational studies published through September 2020. Using random-effects meta-analysis, we calculated the pooled relative risks (RRs) and 95% confidence intervals (CIs) for the association between aspirin use and incident HCC risk. Where data were available, we evaluated HCC risk according to the defined daily dose of aspirin use. Among 2,389,019 participants, and 20,479 cases of incident HCC, aspirin use was associated with significantly lower HCC risk (adjusted RR, 0.61; 95% CI, 0.51-0.73; P ≤ 0.001; I 2 = 90.4%)."},{"id":"source_13","type":"source","study":"Aspirin Use and Mortality in Women With Ovarian Cancer: A Meta-Analysis","year":2021,"doi":"10.3389/fonc.2020.575831","url":"https://doi.org/10.3389/fonc.2020.575831","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Man 2021","excerpt":"BACKGROUND: Aspirin use has been suggested to reduce the incidence of ovarian cancer (OC) in women. However, previous studies regarding the association between aspirin use and mortality in women with OC showed inconsistent results. We aimed to evaluate the association between aspirin use and mortality in women with OC in a meta-analysis. METHODS: Relevant cohort studies were obtained via search of PubMed, Cochrane's Library, and Embase databases from inception to May 3, 2020. A random-effect model, which incorporates the potential heterogeneity among the included studies, was used to pool the results. Predefined stratified analyses were applied to evaluate the potential study characteristics on the outcome, including the timing of aspirin use, dose of aspirin, age of the women, and the clinical stages of the cancer. Sensitivity analysis by omitting one study at a time was used to assess the stability of the results. RESULTS: Six cohort studies including 17,981 women with OC were included. Pooled results showed that aspirin use had no statistically significant association with mortality in these patients (adjusted risk ratio [RR]: 0.85, 95% confidence interval [CI]: 0.70 to 1."},{"id":"source_14","type":"source","study":"Medication use and risk of proximal colon cancer: a systematic review of prospective studies with narrative synthesis and meta-analysis","year":2021,"doi":"10.1007/s10552-021-01472-8","url":"https://doi.org/10.1007/s10552-021-01472-8","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Harewood 2021","excerpt":"PURPOSE: Evidence of differences in the etiology of, and poorer survival from, proximal colon compared to the distal colorectum, necessitates research into its risk factors. This systematic review summarizes the evidence on medication use and proximal colon cancer risk. METHODS: MEDLINE and EMBASE were searched for prospective studies investigating nine medication groups, namely non-steroidal anti-inflammatory drugs (NSAIDs), exogenous hormones, i.e., hormone replacement therapy (HRT) or oral contraceptives (OCs), statins, proton pump inhibitors, anti-hypertensives, metformin (an antidiabetic), antidiarrheals or laxatives, and the risk of proximal colon cancer. Narrative synthesis and meta-analyses, using random effects models to estimate risk ratios (RRs) and 95% confidence intervals (CIs), were conducted. RESULTS: Twenty nine publications investigating NSAIDs (n = 13), exogenous hormones [HRT (n = 9) or OCs (n = 4)] statins (n = 5), anti-hypertensives (n = 1), and metformin (n = 1) were included. Summary RRs reported a protective effect of aspirin use (RR 0.80, 95% CI 0.73-0.89) but no associations between HRT (RR 0.92, 95% CI 0.83-1.02), OC (RR 1.06, 95% CI 0.98-1."},{"id":"source_15","type":"source","study":"Association between aspirin use and cardiovascular outcomes in ALLHAT participants with and without chronic kidney disease: A post hoc analysis","year":2020,"doi":"10.1111/jch.14091","url":"https://doi.org/10.1111/jch.14091","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Desai 2020","excerpt":"It is unclear whether aspirin is beneficial for prevention of CVD in patients with CKD. We performed a secondary analysis of the ALLHAT trial to assess the effect of baseline aspirin use on nonfatal myocardial infarction (MI) or fatal coronary heart disease (CHD), all-cause mortality, and stroke. Baseline characteristics of aspirin users and nonusers were used to generate propensity-matched cohorts. Using conditional Cox proportional hazard regression models, we examined the effect of aspirin on the outcomes in the cohort at large and across 3 levels of kidney function (eGFR ≥90, 60-89, and <60). 11 250 ALLHAT participants reported using aspirin at baseline. The propensity-matched dataset included 6894 nonusers matched with replacement to achieve a balanced analysis population (n = 22 500). Risk of fatal CHD or nonfatal MI (HR = 0.94, 95% CI 0.86-1.02) and stroke (HR = 1.01, 95% CI 0.89-1.15) was not significantly different between groups. Aspirin users were at significantly lower risk of all-cause mortality compared to nonusers (HR = 0.82, 95% CI 0.76-0.88). Aspirin use was not associated with incidence of fatal CAD or nonfatal MI in patients with CVD (HR = 0.93, CI 0.84-1."},{"id":"source_16","type":"source","study":"Low‐dose aspirin use and colorectal cancer survival in 32,195 patients—A national cohort study","year":2022,"doi":"10.1002/cam4.4859","url":"https://doi.org/10.1002/cam4.4859","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Shahrivar 2022","excerpt":"BACKGROUND: Results from previous studies indicate that use of aspirin may improve colorectal cancer (CRC) survival. The aim of this study was to assess whether use of aspirin influences overall survival or CRC-specific survival in an unselected cohort of patients diagnosed with CRC. METHODS: The study was performed using the Colorectal Cancer Data Base Sweden (CRCBaSe), a mega-linkage originating from the Swedish Colorectal Cancer Register, with additional linkages to other national health care registers. All patients diagnosed with primary CRC stage I-III treated with curative surgery, aged 18-85 years at diagnosis, from 2007 through 2016 were identified. Information on low-dose aspirin use was extracted from the Swedish Prescribed Drug Register. Exposure was defined as dispensed prescription for at least 6 months. Aspirin exposure was analyzed at the time of surgery (yes/no) and as a time-varying exposure during follow-up. Follow-up was restricted to a maximum 6 years, to model 5-year survival. Cox regression models were fitted to estimate hazard ratios (HRs) with 95% confidence intervals (CIs)."},{"id":"source_17","type":"source","study":"Effect of aspirin use on survival benefits of breast cancer patients","year":2021,"doi":"10.1097/MD.0000000000026870","url":"https://doi.org/10.1097/MD.0000000000026870","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Liu 2021","excerpt":"OBJECTIVE: The purpose of this study is to investigate whether aspirin improves the prognosis of breast cancer patients by meta analysis. METHODS: Searched PubMed, EMBASE, and other databases for literature on the relationship between aspirin use and breast cancer prognosis, with the deadline of October 2019. The related results of all-cause death, breast cancer-specific death, and breast cancer recurrence/metastasis were extracted to combine the effect amount. The sensitivity analysis and published bias analysis were carried out for the included data. Stata12.0 software was used to complete all statistical analysis. RESULTS: A total of 13 papers were included in the study, including 142,644 breast cancer patients. The results of meta-analysis showed that patients who took aspirin were associated with lower breast cancer-specific death (HR = 0.69, 95% CI = 0.61-0.76), all-cause death (HR = 0.78, 95% CI = 0.71-0.84), and risk of recurrence/metastasis (HR = 0.91, 95% CI: 0.82-1.00). CONCLUSIONS: Aspirin use may improve all-cause mortality, specific mortality, and risk of recurrence/metastasis in patients with breast cancer."},{"id":"source_18","type":"source","study":"Aspirin Use on Incident Dementia and Mild Cognitive Decline: A Systematic Review and Meta-Analysis","year":2021,"doi":"10.3389/fnagi.2020.578071","url":"https://doi.org/10.3389/fnagi.2020.578071","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Li 2021a","excerpt":"Background: More people with cognitive dysfunction and dementia also fall into the category of high vascular risk, for which aspirin is one of the most frequently used drugs. However, previous studies reporting that aspirin buffers against mild cognitive decline (MCI) and dementia remain controversial. We thus conducted an updated systematic review and meta-analysis to evaluate the association of aspirin use with the risk of MCI and dementia in older adults. Methods: Data sources from PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trails (RCTs) and cohort studies (published between January 1, 2000 and April 11, 2020). Relative risks (RRs) and 95% confidence intervals (95% CIs) were used to pool data on the occurrence of dementia and MCI with random-effects models. Results: Of 3,193 identified articles, 15 studies (12 cohort studies and three RCTs) were eligible and were included in our analysis, which involved a total of 100,909 participants without cognitive dysfunctions or dementia at baseline. In pooled cohort studies, aspirin use did not reduce the incidence of MCI and dementia (the pooled RR = 0.97; 95% CI = 0.85-1."},{"id":"source_19","type":"source","study":"Efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke","year":2023,"doi":"10.12998/wjcc.v11.i32.7814","url":"https://doi.org/10.12998/wjcc.v11.i32.7814","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Zhang 2023","excerpt":"BACKGROUND: Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events. However, the optimal timing and dose of aspirin initiation after an acute stroke remain controversial. AIM: To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke. METHODS: We conducted a randomized, open-label, controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset. Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset. The primary outcome was the occurrence of recurrent stroke, myocardial infarction, or vascular death within 90 d. The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale (mRS), incidence of bleeding complications, and mortality rate. RESULTS: The mean age of the patients was 67.8 years and 55% of them were male. The median time from stroke onset to randomization was 12 h. The baseline characteristics were well balanced between the two groups. The primary outcome occurred in 6."},{"id":"source_20","type":"source","study":"Aspirin use for primary prevention among US adults with and without elevated Lipoprotein(a)","year":2024,"doi":"10.1016/j.ajpc.2024.100674","url":"https://doi.org/10.1016/j.ajpc.2024.100674","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Razavi 2024","excerpt":"OBJECTIVE: Lipoprotein(a) [Lp(a)] is an atherogenic and prothrombotic lipoprotein associated with atherosclerotic cardiovascular disease (ASCVD). We assessed the association between regular aspirin use and ASCVD mortality among individuals with versus without elevated Lp(a) in a nationally representative US cohort. METHODS: Eligible participants were aged 40-70 years without clinical ASCVD, reported on aspirin use, and had Lp(a) measurements from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994), the only cycle of this nationally representative US cohort to measure Lp(a). Regular aspirin use was defined as taking aspirin ≥30 times in the previous month. Using NHANES III linked mortality records and weighted Cox proportional hazards regression, the association between regular aspirin use and ASCVD mortality was observed in those with and without elevated Lp(a) (≥50 versus <50 mg/dL) over a median 26-year follow-up. RESULTS: Among 2,990 persons meeting inclusion criteria (∼73 million US adults), the mean age was 50 years, 86% were non-Hispanic White, 9% were non-Hispanic Black, 53% were female, and 7% reported regular aspirin use."},{"id":"source_21","type":"source","study":"Aspirin Use and the Incidence of Hepatocellular Carcinoma in Patients With Hepatitis B Virus or Hepatitis C Virus Infection: A Meta-Analysis of Cohort Studies","year":2021,"doi":"10.3389/fmed.2020.569759","url":"https://doi.org/10.3389/fmed.2020.569759","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Li 2021b","excerpt":"Background: The association between aspirin use and the incidence of hepatocellular carcinoma (HCC) in patients with hepatitis B virus (HBV) or hepatitis C (HCV) virus infection remains not fully determined. A meta-analysis was performed to summarize the findings of cohort studies. Methods: Relevant cohort studies were retrieved via a search of PubMed Cochrane's Library and Embase databases. A random-effect model was used to pool the results. Subgroup analyses were performed to evaluate the influence of study characteristics on the association. Results: Seven cohort studies with 120,945 adult patients with HBV or HCV infection were included. Pooled results showed that aspirin use was independently associated with a reduced risk of HCC in these patients (risk ratio: 0.73, 95% confidence interval: 0.64 to 0.83, p < 0.001; I 2 = 86%). Subgroup analyses showed that aspirin use was associated with a reduced HCC risk regardless of the viral type, age, sex, the diabetic, and cirrhotic status of the patients, and the follow-up durations. Moreover, consistent results were obtained in studies with and without adjustment of antiviral treatment and statin use."},{"id":"source_22","type":"source","study":"Daily low dose aspirin halves incident type 2 diabetes in elderly subjects with prediabetes: a five-year longitudinal cohort study in a real-word population","year":2025,"doi":"10.1186/s12933-025-02802-9","url":"https://doi.org/10.1186/s12933-025-02802-9","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Lembo 2025","excerpt":"BACKGROUND: Prediabetes represents the final stage on the glycemic spectrum before the onset of type 2 diabetes mellitus (T2DM), and delaying its progression offers a unique opportunity to address the growing T2DM epidemic. METHODS: In this longitudinal cohort study, we investigated the effect of daily low-dose aspirin on the development of T2DM in individuals with prediabetes residing in Naples, Italy, who were followed by their primary care physicians between 2018 and 2022. Outcomes in the aspirin-treated group were compared with those in a control group not receiving aspirin, using data from the same database. Propensity score matching was employed to ensure comparability of covariates at baseline. RESULTS: The primary outcome was the onset of T2DM, defined as a new diagnosis accompanied by antidiabetic prescriptions lasting more than 30 days. Gastrointestinal bleeding was assessed as the safety endpoint. Over the follow-up period, 488 new cases of T2DM were documented (15.6% of the total population), with 174 cases occurring in the aspirin group (22.3 per 1000 person-years) and 314 in the non-aspirin group (40."},{"id":"source_23","type":"source","study":"Aspirin use is associated with attenuated risk of severe acute kidney injury in septic patients: a dual-center retrospective analysis from MIMIC-IV and eICU cohorts","year":2025,"doi":"10.1080/0886022X.2025.2568650","url":"https://doi.org/10.1080/0886022X.2025.2568650","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Luo 2025","excerpt":"Sepsis is a systemic inflammatory response syndrome caused by infection, and sepsis-associated acute kidney injury (AKI) markedly increases mortality. Although aspirin's anti-inflammatory properties show therapeutic promise in sepsis, its specific renal protective effects in septic patients remain underexplored. This study investigated the association between aspirin exposure and severe acute kidney injury in septic patients using two databases: MIMIC-IV (73,181 ICU stays, 2008-2022), and eICU (200,859 ICU stays, 2014-2015). Among 45,562 septic patients, cohorts were stratified by aspirin exposure, and outcome variables were compared using multiple statistical adjustment methods including multivariable regression and propensity score analysis. The primary outcome was severe AKI incidence, with secondary outcomes including overall AKI, continuous renal replacement therapy (CRRT), and mortality. Our study suggests that aspirin exposure was associated with significantly lower severe AKI incidence in both databases (adjusted OR 0.35 in MIMIC-IV; 0.84 in eICU), representing risk reductions ranging from 16% to 65%."},{"id":"source_24","type":"source","study":"Analysis of prenatal medication use and placental epigenetic gestational age in extremely low gestational age newborns (ELGANs) highlight relationships to aspirin use during pregnancy","year":2025,"doi":"10.1186/s13148-025-01988-9","url":"https://doi.org/10.1186/s13148-025-01988-9","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Huff 2025","excerpt":"BACKGROUND: Several maternal exposures such as acetaminophen during pregnancy have been previously associated with altered placental CpG methylation. Epigenetic gestational age measures biological aging using DNA methylation from gestational tissues such as placenta and cord blood. We hypothesize that placental epigenetic gestational age (eGA) could serve as a biomarker for maternal exposures or pathological processes that influence placental development. To investigate relationships between maternal exposures and placental eGA, we evaluated prenatal medication use (antibiotics, acetaminophen, aspirin, and ibuprofen) in relation to placental epigenetic gestational age acceleration (eGAA) using the Robust Placental Clock (RPC). We also examined associations between these four exposures and the methylation levels of the 558 individual CpGs comprising the RPC. Using data from the Extremely Low Gestational Age Newborns (ELGAN) study (N = 408), we ran linear mixed-effects regression models that accounted for multiple births to the same mother. We further stratified by infant sex assigned at birth to assess effect measure modification."},{"id":"source_25","type":"source","study":"Aspirin might reduce the incidence of breast cancer","year":2020,"doi":"10.1097/MD.0000000000021917","url":"https://doi.org/10.1097/MD.0000000000021917","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Cao 2020","excerpt":"BACKGROUND: Many epidemiologic studies were performed to clarify the protective effect of regular aspirin use on breast cancer risks, but the results remain inconsistent. Here, we conducted an updated meta-analysis of 38 studies to quantitatively assess the association of regular aspirin use with risk of breast cancer. METHOD: We performed a bibliographic database search in PubMed, Embase, Web of Science, Cochrane library, Scopus, and Google Scholar from January 1939 to December 2019. Relative risk (RR) estimates were extracted from eligible case-control and cohort studies and pooled using a random effects model. Subgroup analysis was conducted based on study design, aspirin exposure assessment, hormone receptor status, menopausal status, cancer stage as well as aspirin use duration or frequency. Furthermore, sensitivity and publication bias analyses were performed. RESULTS: Thirty eight studies of 1,926,742 participants involving 97,099 breast cancer cases contributed to this meta-analysis. Compared with nonusers, the aspirin users had a reduced risk of breast cancer (RR = 0.91, 95% confidence interval [CI]: 0.87-0.95, P value of significance [Psig] < ."},{"id":"source_26","type":"source","study":"Association Between Aspirin Usage and Age-Related Macular Degeneration: An Updated Systematic Review and Meta-analysis","year":2022,"doi":"10.3389/fphar.2022.824745","url":"https://doi.org/10.3389/fphar.2022.824745","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Yan 2022","excerpt":"Purpose: To investigate the association between long-term use of aspirin and age-related macular degeneration (AMD). Methods: An updated systematic literature search was conducted in PubMed, Medline, Cochrane Library, and embase from conception to February 26, 2021, without any language restriction. All studies that evaluated the relationship between long-term aspirin use and AMD were included. Results: In the current study, 16 articles were pooled. Overall, no significant association was observed (estimate ratio = 1.108, 95% confidence interval (CI): 0.886-1.385). When the subgroups were evaluated according to various standards, aspirin use was significantly correlated with AMD in studies with volunteer participants (estimate ratio = 0.899, 95% CI: 0.830-0.974, p < 0.01), studies followed up for >10 years (estimate ratio = 2.206, 95% CI: 2.124-2.292, p < 0.01), duration of aspirin use >10 years (estimate ratio = 2.323, 95% CI: 2.234-2.416, p < 0.01), and cohort studies (estimate ratio = 1.961, 95% CI: 1.893-2.032, p < 0.01)."},{"id":"source_27","type":"source","study":"Aspirin use is associated with decreased inpatient mortality in patients with COVID-19: A meta-analysis","year":2022,"doi":"10.1016/j.ahjo.2022.100191","url":"https://doi.org/10.1016/j.ahjo.2022.100191","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Srinivasan 2022","excerpt":"Thromboembolism is a major cause of death in patients who suffer from COVID-19. Studies examining the effects of aspirin (ASA) on mortality relating to this phenomenon have showed conflicting results with varying degrees and certainties of evidence. We performed an aggregate data meta-analysis of fourteen studies encompassing 164,539 COVID-19 patients, which showed a reduced risk of in-hospital mortality associated with ASA use in eight studies that reported risk ratios (RR 0.90; 95 % CI 0.82-0.98; I 2 = 27.33 %, P = 0.01), six studies that reported hazard ratios (HR 0.56; 95 % CI 0.41-0.76, P ≤ 0.01; I 2 = 85.92 %) and pooled effect size (0.71; 95 % CI 0.59-0.85, P = 0.00, I 2 = 91.51 %). The objective of this study is to report the association between low dose ASA and a reduced risk of in-hospital mortality in patients with COVID-19."},{"id":"source_28","type":"source","study":"Associations between the use of aspirin or other antiplatelet drugs and all-cause mortality among patients with COVID-19: A meta-analysis","year":2022,"doi":"10.3389/fphar.2022.989903","url":"https://doi.org/10.3389/fphar.2022.989903","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Su 2022","excerpt":"Introduction: Whether aspirin or other antiplatelet drugs can reduce mortality among patients with coronavirus disease (COVID-19) remains controversial. Methods: We identified randomized controlled trials, prospective cohort studies, and retrospective studies on associations between aspirin or other antiplatelet drug use and all-cause mortality among patients with COVID-19 in the PubMed database between March 2019 and September 2021. Newcastle-Ottawa Scale and Cochrane Risk of Bias Assessment Tool were used to assess the risk of bias. The I 2 statistic was used to assess inconsistency among trial results. The summary risk ratio (RR) and odds ratio (OR) were obtained through the meta-analysis. Results: The 34 included studies comprised three randomized controlled trials, 27 retrospective studies, and 4 prospective cohort studies. The retrospective and prospective cohort studies showed low-to-moderate risks of bias per the Newcastle-Ottawa Scale score, while the randomized controlled trials showed low-to-high risks of bias per the Cochrane Risk of Bias Assessment Tool."},{"id":"source_29","type":"source","study":"Effect of aspirin use on conversion risk from mild cognitive impairment to Alzheimer’s disease","year":2025,"doi":"10.3389/fnagi.2025.1603892","url":"https://doi.org/10.3389/fnagi.2025.1603892","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Choi 2025","excerpt":"BACKGROUND: The potential effect of the antiplatelet and anti-inflammatory properties of aspirin on Alzheimer's disease development, especially its role in the progression from mild cognitive impairment to Alzheimer's disease dementia, remains controversial. To evaluate the association between aspirin, use and the risk of conversion to Alzheimer's disease dementia among individuals diagnosed with mild cognitive impairment. METHODS: In this retrospective population-based cohort study, we used the Korean National Health Insurance Service database to collect data on patients with mild cognitive impairment enrolled between 2013 and 2016 and followed up until 2021. In total, 508,107 patients initially diagnosed with mild cognitive impairment (192,538 with aspirin prescriptions and 315,569 without aspirin prescriptions) were enrolled. Aspirin use was assessed by extracting information from the Korean National Health Insurance Service database using aspirin prescription codes. The primary outcome was newly diagnosed Alzheimer's disease dementia."},{"id":"source_30","type":"source","study":"Association of aspirin use alone with mortality and liver-related events in MASLD: a multi-institutional three-year study","year":2025,"doi":"10.1080/07853890.2025.2573146","url":"https://doi.org/10.1080/07853890.2025.2573146","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Huang 2025","excerpt":"BACKGROUND: The global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as NAFLD, is increasing. While daily aspirin use has been associated with reduced hepatocellular carcinoma (HCC) risk in NAFLD, its impact on mortality and liver-related outcomes in MASLD remains unclear. METHODS: This retrospective, multi-institutional cohort study included 48,722 MASLD patients from 2008 to 2020, divided into aspirin users and non-users. Exclusion criteria included significant cardiac disease unrelated to aspirin, alcoholic liver disease, incomplete follow-up, and concomitant use of other antiplatelet therapies. Propensity score matching (PSM) was performed to balance baseline characteristics, including demographics, cirrhosis status, ALT levels, cardiovascular conditions, and concurrent medications. RESULTS: After PSM, 2003 patients were included in each cohort. Aspirin users had a mean duration of use of 4.59 ± 3.97 years, with 97% on a daily dose of 75-100 mg."},{"id":"source_31","type":"source","study":"Inappropriate Use of Aspirin in Real-Life Cardiology Practice: Results from the Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) Study","year":2021,"doi":"10.5152/balkanmedj.2021.21143","url":"https://doi.org/10.5152/balkanmedj.2021.21143","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Celik 2021","excerpt":"BACKGROUND: Indications and appropriateness of aspirin use have not been well investigated in Turkey. AIMS: To investigate the prescription patterns and appropriateness of aspirin in a real-world clinical setting. STUDY DESIGN: Cross-sectional study. METHODS: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) is a cross-sectional and multicenter study that included 5007 consecutive patients aged 18 or over who presented to 30 different cardiology outpatient clinics from 14 cities throughout Turkey. Only patients using aspirin (80-325 mg) were included. The study population was divided into 2 groups regarding the use of aspirin: primary prevention (PP) group and secondary prevention (SP) group. The indication of aspirin use was evaluated following the 2016 European Society of Cardiology (ESC) and the 2016 United States Preventative Services Task Force (USPTF) guidelines in the PP group. RESULTS: A total of 5007 patients (mean age 62.15 ± 11.05, 39% female) were enrolled. The PP group included 1132 (22.6%) patients, and the SP group included 3875 (77.4%) patients."},{"id":"source_32","type":"source","study":"Regular aspirin use among a sample of American Indians/Alaskan Natives in the Upper Midwest region of the United States","year":2023,"doi":"10.1016/j.pmedr.2023.102571","url":"https://doi.org/10.1016/j.pmedr.2023.102571","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Alabsi 2023","excerpt":"Despite high prevalence of cardiovascular disease (CVD) and CVD risk factors among American Indian or Alaska Native adults (AI/AN), there is little information on aspirin use in this population. This survey-based study seeks to understand prevalence of aspirin use in a sample of AI/AN adults in the Upper Midwestern United States. In-person and telephone based surveys were conducted querying self-reported CVD and CVD risk factors, aspirin use, and aspirin related discussion with clinicians. A total of 237 AI/AN participants were included: mean age (SD) was 60.8 (8.4) years; 143 (60 %) were women; 59 (25 %) reported CVD history. CVD risk factors were common particularly smoking (37 %) and diabetes (37 %). Aspirin use was much higher among those with CVD (secondary prevention, 76 %) than those without (primary prevention, 33 %). Primary prevention aspirin use was significantly associated with age and all CVD risk factors in unadjusted analyses. After adjustment for demographics and CVD risk factors, only age (aRR 1.13 per 5 years, 95 % CI 1.02, 1.25) and diabetes (aRR 2.44, 95 % CI 1.52, 3.92) remained significantly associated with aspirin."},{"id":"source_33","type":"source","study":"Effect of pre-ICU aspirin use on neuroinflammation and outcomes in patients with sepsis-associated encephalopathy","year":2026,"doi":"10.3389/fneur.2026.1708039","url":"https://doi.org/10.3389/fneur.2026.1708039","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Xu 2026","excerpt":"OBJECTIVE: To investigate the effect of pre-ICU aspirin use on neuroinflammation and prognosis in sepsis-associated encephalopathy (SAE) patients. METHODS: Clinical data of SAE patients admitted to our ICU (Mar 2022-Feb 2025) were retrospectively analyzed. Patients were grouped based on pre-admission aspirin use: exposed ( n = 45) and non-exposed ( n = 68). After 1:1 propensity score matching (age, infection source; caliper = 0.2), 42 matched pairs were compared. Cerebral hemodynamics (Vm, Vd, and Vs), coagulation function (PLT, TT, PT, and APTT), neuroinflammation markers (IL-6, TNF-α, and S100β), Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA) scores (admission, days 1, 3, and 5), ICU length of stay, adverse events, 28- and 60-day mortality were analyzed using appropriate statistical tests (t-test, χ 2 test; P < 0.05 significant). RESULTS: The exposed group had higher Vm, Vd, and Vs at all time points ( P < 0.05). IL-6, TNF-α, and S100β levels were lower in the exposed group ( P < 0.05). GCS scores were higher in the exposed group on days 3 and 5 ( P < 0.05). Adverse event incidence, ICU stay, and 28-day mortality did not differ significantly ( P < 0.05)."},{"id":"source_34","type":"source","study":"Promoting Aspirin Use for Cardiovascular Disease Prevention Among an Adult Internet-Using Population: A Pilot Study","year":2021,"doi":"10.3389/fpubh.2021.500296","url":"https://doi.org/10.3389/fpubh.2021.500296","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Oldenburg 2021","excerpt":"Cardiovascular disease prevention strategies include aspirin use as a preventive measure. The internet can be used to raise public awareness, promote healthy lifestyles, and improve disease management. This pilot study describes the feasibility of an educational website to recruit and follow adult internet users to examine whether they talked to their physician about aspirin and initiated aspirin use. As part of a statewide intervention promoting an aspirin regimen to prevent heart attacks and strokes in Minnesota, visitors to the website were encouraged to complete an aspirin candidacy tool. Between October, 2015 and February, 2016, men 45-79 and women 55-79 who identified as aspirin candidates were invited to participate in a 6-month study involving four, 5 min online surveys to examine physician discussions about aspirin, aspirin use, and mobile technology use. During the 5-month recruitment period, 234 adults enrolled in the study. Of the 174 who completed the baseline survey and at least one follow-up survey, 74 (43.5%) did not use aspirin at baseline. During follow-up, 12 (16.2%) talked to their doctor about aspirin and 31 (41.8%) initiated aspirin use."},{"id":"source_35","type":"source","study":"Benefits and Risks Associated With Aspirin Use in Patients With Diabetes for the Primary Prevention of Cardiovascular Events and Mortality: A Meta-Analysis","year":2021,"doi":"10.3389/fendo.2021.741374","url":"https://doi.org/10.3389/fendo.2021.741374","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ma 2021a","excerpt":"PURPOSE: A meta-analysis was conducted to assess the benefits and risks of aspirin for the primary prevention of cardiovascular disease and all-cause mortality events in adults with diabetes. METHODS: An extensive and systematic search was conducted in MEDLINE (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 1988 to December 2020. A detailed literature search was conducted using aspirin, cardiovascular disease (CVD), diabetes, and efficacy to identify trials of patients with diabetes who received aspirin for primary prevention of CVD. Demographic details with the primary outcome of events and bleeding outcomes were analyzed. The Cochrane Collaboration's risk of bias tool was used to assess the methodological quality of the included studies. Random-effects meta-analysis was used to calculate the pooled odds ratio for outcomes of cardiovascular events, death, and adverse events. FINDINGS: A total of 8 studies were included with 32,024 patients with diabetes; 16,001 allocated to aspirin, and 16,023 allocated to the control group."},{"id":"source_36","type":"source","study":"Association of a Community Population and Clinic Education Intervention Program With Guideline-Based Aspirin Use for Primary Prevention of Cardiovascular Disease","year":2022,"doi":"10.1001/jamanetworkopen.2022.11107","url":"https://doi.org/10.1001/jamanetworkopen.2022.11107","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Luepker 2022","excerpt":"IMPORTANCE: Low-dose aspirin is used for primary prevention of cardiovascular disease in approximately one-third of the US adult population. Overuse and underuse are common and not concordant with guidelines. OBJECTIVE: To test a community and clinic education intervention to improve guideline-based aspirin use for the primary prevention of cardiovascular disease. DESIGN, SETTING, AND PARTICIPANTS: The Ask About Aspirin project was a nonrandomized controlled trial conducted from, July 1, 2015, to March 31, 2020, using professional education, traditional media, and digital media to improve guideline-based aspirin use. The adult population (aged 45-79 years for men and 55-79 years for women) and primary care clinics in Minnesota were the education targets. The 4 adjacent states were controls. INTERVENTIONS: The statewide campaign distributed billboards, newspaper articles and other print material, and radio announcements. An Ask About Aspirin website was heavily promoted. Primary care clinics identified appropriate aspirin candidates, and clinicians received continuing education about aspirin. MAIN OUTCOMES AND MEASURES: Guideline-based aspirin use by the target population."},{"id":"source_37","type":"source","study":"Association Between Prior Aspirin Use and Acute Respiratory Distress Syndrome Incidence in At-Risk Patients: A Systematic Review and Meta-Analysis","year":2020,"doi":"10.3389/fphar.2020.00738","url":"https://doi.org/10.3389/fphar.2020.00738","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Liang 2020","excerpt":"BACKGROUND: Recent studies have shown that prior antiplatelet drug use could ameliorate the risk and mortality of acute respiratory distress syndrome (ARDS). However, the connection between prior acetylsalicylic acid (aspirin) use and the risk of ARDS is unknown. Our primary objective was to perform a meta-analysis on the currently available studies to assess the association between aspirin use prior to ARDS onset and ARDS incidence in at-risk patients. METHODS: Two investigators separately searched four research databases: MEDLINE, EMBASE, Cochrane Library, and Web of Science for relevant articles from the earliest available data through to July 14, 2019. In this paper, we performed a meta-analysis of the fixed effects model using the inverse variance-weighted average method to calculate the pooled odds ratios (ORs) and 95% confidence intervals (CIs). The primary outcome was risk of ARDS, and the secondary outcome was the hospital mortality of at-risk patients. RESULTS: This article included seven studies altogether, enrolling 6,764 at-risk patients."},{"id":"source_38","type":"source","study":"Continuous aspirin treatment improves cardiovascular events and all-cause mortality in hemodialysis patients with peripheral artery disease","year":2024,"doi":"10.1080/0886022X.2024.2380754","url":"https://doi.org/10.1080/0886022X.2024.2380754","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Wu 2024","excerpt":"BACKGROUND: Hemodialysis (HD) patients with peripheral arterial disease (PAD) are at heightened risk of adverse vascular events, and aspirin positively affects those outcomes. We aimed to investigate the association between different patterns of aspirin use and clinical vascular events in chronic HD patients with PAD. METHODS: This retrospective nationwide cohort study enrolled 758 chronic HD patients who had been diagnosed with PAD between January 1, 2008, and December 31, 2012, and followed up until the end of 2020. Patients were divided into three groups according to medication possession ratio (MPR) and continued use of aspirin (i.e., low MPR, high MPR but discontinuous prescription, and high MPR and continuous prescription). Percutaneous transluminal angioplasty (PTA), surgical bypass, lower leg amputation, cardiovascular events, cerebrovascular events, and all-cause mortality were evaluated. RESULTS: High MPR and continuous aspirin use had the lowest incidence of all-cause mortality and cardiovascular events compared with the two other groups, and it was significantly associated with low risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality (aHR: 0."},{"id":"source_39","type":"source","study":"Impact of prior aspirin use on left ventricular function in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: An echocardiographic evaluation","year":2024,"doi":"10.34172/jcvtr.33184","url":"https://doi.org/10.34172/jcvtr.33184","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Yosefzadeh 2024","excerpt":"INTRODUCTION: Previous studies have investigated the potential influence of prior aspirin use on cardiac function in patients with ST-elevation myocardial infarction (STEMI) who undergo primary percutaneous coronary intervention (PPCI). However, the results from these studies have been conflicting. This study aimed to investigate whether prior aspirin use affects left ventricular (LV) function in these patients using echocardiography. METHODS: The study included 260 consecutive STEMI patients, who were divided into two groups based on the presence or absence of prior aspirin use. Echocardiographic parameters, such as maximal left atrial (LA) size, LV ejection fraction (LVEF), early diastolic velocity (e'), E/A ratio, and E/e' ratio, were assessed within 72 hours of admission. RESULTS: Aspirin users had an older age compared to non-users, as well as lower body mass index and renal function. They also had a greater history of hypertension and were more likely to be taking statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and calcium channel blockers."},{"id":"source_40","type":"source","study":"Does prior use of antiplatelet therapy modify the effect of dual antiplatelet therapy in transient ischaemic attack/minor ischaemic stroke: A systematic review and meta‐analysis","year":2022,"doi":"10.1111/ene.15433","url":"https://doi.org/10.1111/ene.15433","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Clarke 2022","excerpt":"BACKGROUND AND PURPOSE: The purpose was to determine whether prior use of antiplatelet therapy modifies the effect of dual antiplatelet therapy in patients with acute minor ischaemic stroke or transient ischaemic attack. METHODS: A systematic review and meta-analysis of randomized controlled trials was performed comparing dual antiplatelet therapy to aspirin that reported subgroup analysis by prior antiplatelet use, adhering to the Cochrane Collaboration Guidelines. A fixed-effects meta-analysis was used to estimate a pooled treatment effect overall in subgroups with prior aspirin therapy and without prior aspirin therapy. Difference in treatment effect was assessed by testing p for interaction. The primary outcome measure was recurrent vascular events. RESULTS: Three eligible randomized controlled trials were identified, including 4831 participants with pre-existing antiplatelet use and 16,236 participants without pre-existing aspirin use. Recurrent vascular events occurred in 7.2% (95% confidence interval [CI] 4.3-10) of those without pre-existing aspirin use versus 7.3% (95% CI 4.1-10) of those receiving prior aspirin therapy."},{"id":"source_41","type":"source","study":"The associations of candidate gene polymorphisms with aspirin resistance in patients with ischemic disease: a meta-analysis","year":2024,"doi":"10.1186/s40246-024-00699-1","url":"https://doi.org/10.1186/s40246-024-00699-1","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Li 2024","excerpt":"BACKGROUND: Recently, extensive research has been conducted on the relationship between aspirin gene polymorphisms and aspirin resistance (AR) in patients with ischemic diseases. Among the numerous candidate genes, it remains unclear which ones are significantly associated with AR and could potentially serve as potential biomarkers for genetic testing before aspirin use. METHODS: Eligible articles were searched in PubMed, Embase, Cochrane Library, WanFang, CNKI and Sinomed. A cohort study examining the efficacy of aspirin in secondary prevention for patients with ischemic diseases, along with a discussion on genetic polymorphisms and their association with AR, has been included. The Newcastle-Ottawa Scale for assessing the quality of included studies. Odds ratios (OR) with 95% confidence intervals (CI) were used as measures of effect. Subgroup analyses were conducted based on different genotypes with the same genetic polymorphisms, different research regions and types of ischemic diseases. RESULTS: From 75 eligible articles, 94 candidate gene polymorphisms were analyzed. In the overall analysis, 25 genes were subjected to meta-analysis and 69 genes were systematically described."},{"id":"source_42","type":"source","study":"Safety of Continuing Aspirin Use in Cervical Laminoplasty: A Propensity Score-Matched Analysis","year":2022,"doi":"10.22603/ssrr.2022-0163","url":"https://doi.org/10.22603/ssrr.2022-0163","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Wong 2022","excerpt":"INTRODUCTION: Aspirin is commonly used for the primary and secondary prevention of cardiovascular disease and stroke. Controversy exists concerning whether and when is the optimal time to stop aspirin before spinal surgery. Previous studies on this topic mainly focused on patients who received thoracolumbar spine surgeries. There are only a few literatures concerning the safety of aspirin use in cervical spine surgery patients. METHODS: This pilot study recruited patients who received cervical laminoplasty from January 2010 to December 2021. The operation time, intraoperative blood loss, and postoperative complications of the patients who had taken aspirin during the perioperative period were compared with age, sex, and comorbidity-matched control patients. Propensity score matching was utilized in the selection of control to minimize bias. RESULTS: Twenty-one patients who have received cervical laminoplasty while taking aspirin during the perioperative period were included. The control group included 21 age, sex, and comorbidity-matched patients who have not taken aspirin."},{"id":"source_43","type":"source","study":"Aspirin improves short and long term survival outcomes of patients with sepsis associated encephalopathy","year":2025,"doi":"10.1038/s41598-025-08075-2","url":"https://doi.org/10.1038/s41598-025-08075-2","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Gong 2025","excerpt":"Sepsis-associated encephalopathy (SAE) is a common complication of sepsis, characterized by altered mental status and contributing to higher mortality. Aspirin, an antiplatelet agent with anti-inflammatory properties, may improve outcomes in patients with SAE. This study aims to evaluate the effect of aspirin on the prognosis of patients with SAE. A retrospective cohort study using the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database included 5840 patients with SAE: aspirin group (n = 3378) and non-aspirin group (n = 2462). Propensity score matching (PSM) at a 1:1 ratio resulted in 1770 matched pairs. The primary outcomes were 28-day, 90-day, 365-day, and 1095-day survival rates. Secondary outcomes included ICU length of stay, incidence of gastrointestinal bleeding, and thrombocytopenia. After PSM, baseline characteristics were balanced. The aspirin group had significantly higher survival rates at all time points (p < 0.05) compared to the non-aspirin group. ICU length of stay and incidence of gastrointestinal bleeding and thrombocytopenia were not significantly different between groups after matching."},{"id":"source_44","type":"source","study":"Associations between Metformin and Aspirin Use on Cancer Incidence and Mortality in Older Adults.","year":2021,"doi":"10.1093/geroni/igab046.2339","url":"https://doi.org/10.1093/geroni/igab046.2339","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Orchard 2021","excerpt":"For participants with controlled diabetes, there was a significant reduction in cancer mortality in metformin users compared to nonusers (Adjusted [Adj] HR=0.24, 95%CI=0.07, 0.80), but not for cancer incidence (Adj HR=0.61, 95%CI=0.29, 1.27). For participants with uncontrolled diabetes, there was no significant difference in cancer incidence (Adj HR=0.95, 95%CI=0.66, 1.38) or mortality (Adj HR=1.18, 95%CI=0.62, 2.26) between metformin and non-metformin users."},{"id":"source_45","type":"source","study":"Aspirin Use and Risk of Breast Cancer: A Meta-analysis of Observational Studies from 1989 to 2019.","year":2021,"doi":"10.1016/j.clbc.2021.02.005","url":"https://doi.org/10.1016/j.clbc.2021.02.005","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Ma 2021b","excerpt":"BACKGROUND: Some evidence shows that aspirin can reduce the morbidity and mortality of different cancers, including breast cancer. Aspirin has become a new focus of cancer prevention and treatment research at present, however, clinical studies found conflicting conclusions of its anticancer characteristics. MATERIALS AND METHODS: A systematic literature search was performed in 8 electronic databases. The pooled relative risk (RR) with 95% confidence interval (CI) was calculated using the random effects model to estimate the effect of aspirin on breast cancer. RESULTS: Forty-two published articles with 99,769 patients were identified. The meta-analysis showed a significant decrease in breast cancer risk with aspirin use (RR, 0.92; 95% CI, 0.89-0.96; I 2 = 72%). Aspirin use decreased the risk of hormone receptor-positive tumors (estrogen receptor [ER]-positive RR, 0.89; 95% CI, 0.82-0.97; I 2 =54%; progesterone receptor [PR]-positive RR, 0.86; 95% CI, 0.78-0.95; I 2 =32%; ER- and PR-positive RR, 0.92; 95% CI, 0.85-1.00; I 2 =45%) and reduced the risk of breast cancer in postmenopausal women (RR, 0.92; 95% CI, 0.86-0.98; I 2 =59%)."},{"id":"source_46","type":"source","study":"Influence of aspirin use on clinical outcomes of patients with hepatocellular carcinoma: a meta-analysis.","year":2021,"doi":"10.1016/j.clinre.2020.09.006","url":"https://doi.org/10.1016/j.clinre.2020.09.006","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Li 2021c","excerpt":"BACKGROUND: Aspirin use has been suggested to reduce cancer risk. However, previous studies showed inconsistent results as for the association between aspirin use and mortality in patients with hepatocellular carcinoma (HCC). The aim of the study was to evaluate the influence of aspirin use on clinical outcomes of patients with HCC in a meta-analysis. MATERIALS: Studies were obtained via systematic search of PubMed, Cochrane's Library, and Embase databases. A random-effect model, which incorporated the potential heterogeneity, was used to pool the results. RESULTS: Six retrospective cohort studies including 18,855 HCC patients that underwent liver resection or transarterial chemoembolization were included. Pooled results showed that compared to the non-users, aspirin users of HCC had significantly reduced risk of HCC recurrence (risk ratio [RR]: 0.74, 95% confidence interval [CI]: 0.59-0.93, p = 0.01; I 2 = 34%) and all-cause mortality (RR: 0.59, 95% CI: 0.47-0.73, p < 0.001; I 2 = 0%) after controlling of potential confounding factors. In addition, pooled results showed that aspirin use was not associated with a significantly increased risk of major bleeding events (RR: 1."},{"id":"source_47","type":"source","study":"Aspirin Use Is Associated With Decreased Mechanical Ventilation, Intensive Care Unit Admission, and In-Hospital Mortality in Hospitalized Patients With Coronavirus Disease 2019.","year":2021,"doi":"10.1213/ane.0000000000005292","url":"https://doi.org/10.1213/ane.0000000000005292","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Chow 2021","excerpt":"BACKGROUND: Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality. METHODS: A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions. RESULTS: Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38."},{"id":"source_48","type":"source","study":"Association of mortality and aspirin use for COVID-19 residents at VA Community Living Center Nursing Homes","year":2022,"doi":"10.1101/2022.08.03.22278392","url":"https://doi.org/10.1101/2022.08.03.22278392","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Abul 2022","excerpt":"The primary outcome was mortality at 30 and 56 days post positive test and hospitalization. Aspirin use was independently associated with a reduced risk of 30 days of mortality (adjusted HR, 0.60, 95% CI, 0.40-0.90) and 56 days of mortality (adjusted HR, 0.67, 95% CI, 0.47-0.95) Conclusion Chronic low dose aspirin use for primary or secondary prevention of cardiovascular events is associated with lower COVID-19 mortality."},{"id":"source_49","type":"source","study":"Shared decision making and patient reported outcomes among adults with atherosclerotic cardiovascular disease, medical expenditure panel survey 2006–2015","year":2021,"doi":"10.1016/j.ajpc.2021.100281","url":"https://doi.org/10.1016/j.ajpc.2021.100281","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Okunrintemi 2021","excerpt":"IMPORTANCE: Shared decision-making (SDM), one of the pillars of patient centered care is strongly encouraged and has been incorporated into the management of atherosclerotic cardiovascular disease (ASCVD) but the expansion of its use has been limited. OBJECTIVE: To determine the association of SDM on patient-reported health status, measures of quality of care, healthcare resource utilization, and healthcare spending among US adults with ASCVD. METHOD: This is a retrospective cohort study in an ambulatory setting, utilizing the Medical Expenditure Panel Survey (MEPS) 2006-2015. Analysis completed in December 2020. Participants included were adults 18 years and over with a diagnosis of ASCVD. We used the average weighted response to self-administered questionnaire evaluating shared-decision-making process as the exposure variable in the regression model. Outcome measures included inpatient hospitalizations, Emergency Department (ED) visits, statin and aspirin use, self-perception of health, and healthcare expenditure. RESULTS: When compared with individuals reporting poor SDM, those with optimal SDM were more likely to report statin and aspirin use [statin use, Odds Ratio (OR) 1."},{"id":"source_50","type":"source","study":"Low-dose aspirin use and cancer-specific mortality: a meta-analysis of cohort studies.","year":2021,"doi":"10.1093/pubmed/fdz114","url":"https://doi.org/10.1093/pubmed/fdz114","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Wang 2021b","excerpt":"BACKGROUND: Considering the increased risk of bleeding caused by aspirin, and the observed benefit in all-cause mortality may be due to an improvement in cardiovascular-related mortality. We carried out this meta-analysis to estimate the association of low-dose aspirin use and risk of cancer-specific mortality. METHODS: We searched the PubMed and China National Knowledge Infrastructure (CNKI) databases for all articles within a range of published years from 1980 to 2018. RESULTS: Finally, 13 published cohort studies with 65 768 patients were available for estimating overall risk of cancer-specific mortality associating with post-diagnosis low-dose aspirin use, and 4 cohort studies were available for pre-diagnosis low-dose aspirin use with 16 654 patients. Overall, statistical evidence of significantly decreased cancer-specific mortality was found to be associated with post-diagnosis low-dose aspirin use (OR = 0.84, 95% CI = 0.75-0.93), but not with pre-diagnosis low-dose aspirin use."},{"id":"source_51","type":"source","study":"Inflammation, Frailty, and Aspirin Use in the Physicians' Health Study: A Pilot Study.","year":2024,"doi":"10.14283/jfa.2024.37","url":"https://doi.org/10.14283/jfa.2024.37","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"review","cited_as":"Gewurz 2024","excerpt":"Whether anti-inflammatory medications such as aspirin can lower the risk of frailty is an active area of investigation. In previous studies, we reported that regular aspirin use started in midlife was associated with a lower risk of frailty at older age. We therefore sought to further examine the relationship between inflammatory biomarkers, frailty and aspirin use in a pilot nested case-control study of 300 participants aged ≥60 years with available data to calculate a frailty index from the Physicians' Health Study, a completed randomized trial of aspirin that began in 1982. We selected 150 individuals who were frail (frailty index >0.2) and 150 who were not frail (frailty index <0.1). We then matched 29 low users of aspirin (≤60 days/year) 3:1 to 87 regular users of aspirin (>60 days/year). After matching on age, smoking status, history of diabetes and CVD, there was no significant association between aspirin use and level of frailty among those with elevated inflammatory biomarkers (all p>0.05). In this pilot study we did not find evidence of a mediation effect of CRP, TNFR-2 or IL-6 on the association between aspirin and frailty."},{"id":"source_52","type":"source","study":"Aspirin use and pancreatic cancer risk","year":2019,"doi":"10.1097/MD.0000000000018033","url":"https://doi.org/10.1097/MD.0000000000018033","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Sun 2019","excerpt":"OBJECTIVES: Although there is evidence that aspirin might be able to prevent pancreatic cancer, the findings have been inconsistent. In this paper, we conducted a meta-analysis of observational studies to examine the relationship between aspirin use and the risk of pancreatic cancer. METHODS: We identified potential studies by searching the MEDLINE, EMBASE, and Wangfang (Chinese database) database (from 1967 to March 2017) and by reviewing the bibliography of relevant publications. Random effects model was used to calculate odds ratio (OR) and 95% confidence interval. The Cochran Q statistic (significance level at P < .1) was used to assess heterogeneity in this study. The author adopted weighted regression method of Egger to assessed publication bias. RESULTS: A total of 12 studies involving 4748 pancreatic cancer cases, were included in the meta-analysis. The study reflected that there was no signification association between aspirin use and mortality risk of pancreatic cancer. Aspirin use might reduce the incidence of pancreatic cancer."},{"id":"source_53","type":"source","study":"Aspirin has potential benefits for primary prevention of cardiovascular outcomes in diabetes: updated literature-based and individual participant data meta-analyses of randomized controlled trials","year":2019,"doi":"10.1186/s12933-019-0875-4","url":"https://doi.org/10.1186/s12933-019-0875-4","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Seidu 2019","excerpt":"BACKGROUND: The clinical benefit of aspirin for the primary prevention of cardiovascular disease (CVD) in diabetes remains uncertain. To evaluate the efficacy and safety of aspirin for the primary prevention of cardiovascular outcomes and all-cause mortality events in people with diabetes, we conducted an updated meta-analysis of published randomised controlled trials (RCTs) and a pooled analysis of individual participant data (IPD) from three trials. METHODS: Randomised controlled trials of aspirin compared with placebo (or no treatment) in participants with diabetes with no known CVD were identified from MEDLINE, Embase, Cochrane Library, and manual search of bibliographies to January 2019. Relative risks with 95% confidence intervals were used as the summary measures of associations. RESULTS: We included 12 RCTs based on 34,227 participants with a median treatment duration of 5.0 years. Comparing aspirin use with no aspirin, there was a significant reduction in risk of major adverse cardiovascular events (MACE)0.89 (0.83-0.95), with a number needed to treat (NNT)of 95 (95% CI 61 to 208) to prevent one MACE over 5 years average follow-up."},{"id":"source_54","type":"source","study":"Design and rationale for the ASSOS study: Appropriateness of aspirin use in medical outpatients a multicenter and observational study","year":2018,"doi":"10.14744/AnatolJCardiol.2018.47587","url":"https://doi.org/10.14744/AnatolJCardiol.2018.47587","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"protocol","cited_as":"Celik 2018","excerpt":"OBJECTIVE: The aim of this study was to describe the current status of aspirin use and the demographic characteristics of patients on aspirin for primary and secondary prevention of cardiovascular diseases. METHODS: The Appropriateness of Aspirin Use in Medical Outpatients: A Multicenter, Observational Study (ASSOS) trial was a multicenter, cross-sectional, and observational study conducted in Turkey. The study was planned to include 5000 patients from 14 cities in Turkey. The data were collected at one visit, and the current clinical practice regarding aspirin use was evaluated (ClinicalTrials.gov number NCT03387384). RESULTS: The study enrolled all consecutive patients who were admitted to the outpatient cardiology clinics from March 2018 until June 2018. Patients should be at least 18 years old, have signed written informed consent, and on aspirin (80-325 mg) therapy within the last 30 days. Cardiologists from the hospital participates in the study. Patients were divided into 2 categories according to presence or absence of atherosclerotic cardiovascular disease, namely secondary prevention group and primary prevention group, respectively."},{"id":"source_55","type":"source","study":"Reduction of intracerebral hemorrhage in hemodialysis patients after reducing aspirin use: A quality-assurance observational study","year":2017,"doi":"10.1371/journal.pone.0185847","url":"https://doi.org/10.1371/journal.pone.0185847","population":"not extracted","intervention_or_exposure":"not extracted","comparator":"not extracted","endpoint":"not extracted","effect":"not extracted","risk_of_bias":"not appraised in public sidecar","directness":"indirect","cited_as":"Aoun 2017","excerpt":"There is so far no international consensus concerning the prescription of antithrombotic agents in hemodialysis patients. It is not clear yet why they cause more bleeding in some patients and are beneficial in others. We therefore tried to find out what triggers bleeding in this population. This is an observational before-and-after study that included all patients undergoing hemodialysis in our center between 2005 and 2015. We divided the study into two phases: phase one (125 patients) where aspirin was used without restrictions and phase two (110 patients) where aspirin was avoided in severe hypertension and primary prevention. We aimed to assess the differential occurrence of intracerebral hemorrhage between the two phases and the cardiovascular mortality of patients whether on aspirin or not. Bleeding events occurred in 12.8% of patients in phase one and 13.6% in phase two (p = 0.85). Seven out of 125 patients (6%) in phase one experienced intracerebral hemorrhage and none in phase two. Intracerebral hemorrhage was significantly increased in those with the combination of aspirin and severe hypertension (p = 0.003)."}],"edges":[{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_1","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_2","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_3","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_4","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_5","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_6","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_7","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_8","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_9","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_10","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_11","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_12","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_13","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_14","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_15","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_16","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_17","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_18","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_19","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_20","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_21","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_22","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_23","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_24","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_25","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_26","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_27","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_28","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_29","type":"contains_claim"},{"from":"145fcccc-2360-4120-8674-34dd3e97ade7","to":"claim_30","type":"contains_claim"}],"screening":{"identified":55,"screened":55,"excluded":0,"included":55,"included_or_retained":55,"flow":["identified","screened","excluded_with_reasons","included"],"wording":"55 candidate receipts retained after source retrieval, deduplication, and topic filtering. 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