Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease

This large, pragmatic randomized trial (ADAPTABLE) compared the effectiveness and safety of two aspirin dosing strategies 81 mg vs. 325 mg daily in 15,076 patients with established atherosclerotic cardiovascular disease. Over a median follow-up of 26.2 months, the composite outcome of death, myocardial infarction, or stroke occurred in 7.28% of the 81-mg group versus 7.51% of the 325-mg group (hazard ratio 1.02; 95% CI, 0.91–1.14), indicating no significant difference. Major bleeding occurred in 0.63% vs. 0.60% respectively (HR 1.18; 95% CI, 0.79–1.77). Notably, patients assigned to 325 mg had higher rates of dose switching (41.6% vs. 7.1%) and lower adherence. The trial embedded within PCORnet and guided by patient-partners demonstrated that low-dose aspirin offers similar outcomes with better long-term adherence, highlighting real-world dosing patterns and their implications for secondary prevention.

This large, pragmatic randomized trial (ADAPTABLE) compared the effectiveness and safety of two aspirin dosing strategies 81 mg vs. 325 mg daily in 15,076 patients with established atherosclerotic cardiovascular disease. Over a median follow-up of 26.2 months, the composite outcome of death, myocardial infarction, or stroke occurred in 7.28% of the 81-mg group versus 7.51% of the 325-mg group (hazard ratio 1.02; 95% CI, 0.91–1.14), indicating no significant difference. Major bleeding occurred in 0.63% vs. 0.60% respectively (HR 1.18; 95% CI, 0.79–1.77). Notably, patients assigned to 325 mg had higher rates of dose switching (41.6% vs. 7.1%) and lower adherence. The trial embedded within PCORnet and guided by patient-partners demonstrated that low-dose aspirin offers similar outcomes with better long-term adherence, highlighting real-world dosing patterns and their implications for secondary prevention.