Aspirin Given Immediately for a Major Heart Attack (STEMI)
Benefits in NNT
42
1 in 42 were helped (life saved)
Harms in NNT
167
1 in 167 were harmed (non-dangerous bleeding: blood levels showed anemia but not enough to require transfusion)
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Efficacy Endpoints
Death at 1 month following major heart attack (STEMI)Harm Endpoints
Major bleeding (brain bleeding or bleeding requiring transfusion) and minor bleeding.Narrative
The lone high quality trial addressing this question was multi-institutional across the U.S and Western Europe and was a randomized controlled trial of over 17000 subjects. Subjects were believed to be suffering acute MI by treating physicians and were randomized to aspirin, a thrombolytic (‘clot-busting’ medication), both, or neither. The groups were similar. There was increased death in the first month among those assigned to placebo 1016/8600 (11.8%) versus those assigned to aspirin 811/8587 (9.4%) with no significant increase in transfusion or intracerebral hemorrhage. There was a 0.6% increase in minor bleeding.Aspirin provides among the best mortality benefits of any intervention for MI, with minimal downside. The anti-platelet mechanism seems sensible and the data is strong. Aspirin should be given to all cases of confirmed or suspected STEMI unless a significant contraindication exists.