Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetesA scoping review

  1. A. Ruiz-García 1
  2. V. Pallarés-Carratalá 2
  3. A. Serrano-Cumplido 3
  4. C. Escobar-Cervantes 4
  5. A. Barquilla-García 5
  6. J.A. Divisón-Garrote 6
  7. M. Turégano-Yedro 7
  8. M.A. Prieto-Díaz 8
  9. S. Cinza-Sanjurjo 9
  10. F.J. Alonso-Moreno 10
  11. P. Beato-Fernández 11
  12. L. García-Matarín 12
  13. D. Rey-Aldana 13
  14. E. Martín-Rioboó 14
  15. A. Moyá-Amengual 15
  16. R. Crespo-Sabarís 16
  17. A. Piera-Carbonell 17
  18. J.C. Romero-Vigara 18
  19. V. Barrios 19
  20. SEMERGEN Working Group on Hypertension, Cardiovascular Disease
  1. 1 European University of Madrid, Villaviciosa de Odón, Madrid, Spain
  2. 2 Medicine Department, Jaume I University, Castellón, Spain
  3. 3 Family Medicine, Getxo, Bizkaia, Spain
  4. 4 Cardiology Service, La Paz University Hospital, Madrid, Spain
  5. 5 Trujillo Primary Care Team, Clinics of Herguijuela and Conquista de la Sierra), Cáceres, Spain
  6. 6 Casas Ibáñez Health Center, Fuentealbilla Clinic, Albacete, Spain
  7. 7 Aldea Moret Health Center, Cáceres, Spain
  8. 8 Vallobín – La Florida Health Center, Oviedo, Spain
  9. 9 Porto do Son Health Center, Santiago de Compostela Health Area, Santiago de Compostela, Spain
  10. 10 Sillería Health Center, Toledo, Spain
  11. 11 Premia de Mar Primary Care Center, Catalan Institute of Health, Barcelona, Spain
  12. 12 Aguadulce Sur Health Center, Roquetas de Mar, Almería, Spain
  13. 13 Estrada Health Center, Pontevedra, Spain
  14. 14 Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), Reina Sofía Hospital, Poniente clinical management unit, Córdoba, Spain
  15. 15 Occupational Medicine, Santa Catalina Health Center, Palma de Mallorca, Islas Baleares, Spain
  16. 16 Primary Care Management of La Rioja Health Service, Logroño, La Rioja, Spain
  17. 17 Luanco Health Center, Gozón, Asturias, Spain
  18. 18 Corella Health Center, Corella, Navarra, Spain
  19. 19 Cardiology Service, Ramón y Cajal University Hospital, Madrid, Spain
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Journal:
Semergen: revista española de medicina de familia

ISSN: 1138-3593

Year of publication: 2022

Issue: 4

Pages: 275-292

Type: Article

DOI: 10.1016/J.SEMERG.2021.12.002 DIALNET GOOGLE SCHOLAR

More publications in: Semergen: revista española de medicina de familia

Sustainable development goals

Abstract

Antecedentes La eficacia y la seguridad de la profilaxis con ácido acetilsalicílico (AAS) para la prevención primaria de la enfermedad cardiovascular arteriosclerótica (ECVA) siguen siendo controvertidas en personas con diabetes (DM) sin ECVA, ya que el posible aumento del riesgo de hemorragias graves podría superar la posible disminución del riesgo de mortalidad y de los principales episodios adversos cardiovasculares (MACE) considerados individualmente o en conjunto. Objetivo Evaluar el riesgo-beneficio de la profilaxis con AAS en prevención primaria en personas con DM y comparar las recomendaciones de las guías de práctica clínica con los resultados de los metaanálisis (MA) y revisiones sistemáticas (RS). Material y métodos Se realizaron búsquedas en Medline, Google Scholar, Embase y Biblioteca Cochrane de RS y MA publicados desde 2009 hasta 2020 que compararan los efectos de AAS versus placebo o control en seguimiento durante al menos un año en personas con DM sin ECVA. Se valoraron la heterogeneidad entre los ensayos clínicos aleatorizados (ECA) incluidos en las RS y MA. Se mostraron los resultados cardiovasculares de eficacia (muerte por cualquier causa [MCC], muerte cardiovascular [MCV], infarto de miocardio [IM], ictus y MACE) y de seguridad (episodios hemorrágicos importantes [EHI], episodios hemorrágicos gastrointestinales importantes [EHGI], hemorragias intracraneales y extracraneales). Resultados Se valoraron las recomendaciones de 12 guías de práctica clínica. Se evaluaron los resultados de 25 RS y MA que incluyeron un total de 20 ECA. Ningún MA ni RS mostró que la profilaxis con AAS disminuyera el riesgo de MCC, MCV o IM. Solo dos de los 19 SR y MA que evaluaron el ictus isquémico mostraron una disminución en el riesgo de ictus (media 20,0% [DE ± 5,7]), rozando la significación estadística. Casi la mitad de los MA y SR mostraron una reducción del riesgo del criterio de valoración compuesto MACE (media 10,5% [DE ± 3,3]) al borde de la significación estadística. Los aumentos significativos en el riesgo de EHGI oscilaron entre el 35 y el 55%. Los aumentos significativos en el riesgo de EHI y hemorragia extracraneal fueron del 33,4% (DE ± 14,9) y del 54,5% (DE ± 0,7), respectivamente. Conclusión La valoración global de riesgo-beneficio de la profilaxis con AAS en prevención primaria sugiere que esta no se debería aplicar en personas con DM.

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