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An updated meta-analysis by Abdelaziz et al., analyzed 15 RCTs comparing aspirin to control for primary prevention. The analysis included 165,502 patients with weighted mean follow-up of 6.4 years. It found no difference in the rate of death or CV death between the aspirin and control groups. Rates of MI (2.07% v 2.35%) and ischemic strokes (1.29% v 1.49%) differed significantly in favor of aspirin for reducing risks (NNT 357 and 500, respectively). Aspirin, however, had a statistically significant higher risk of major bleeding (1.47% v 1.02%).

Does aspirin have a role for the primary prevention of CVD? If so, how do you decide which patients may benefit?