Aspirin has long been used in the prevention of recurrent disease in people with symptomatic coronary artery disease and cerebrovascular disease and has been recommended in those with peripheral artery disease (PAD). But evidence to support its use in people with PAD hasn't been established. In a metaanalysis to investigate this, the authors identified 18 trials (N = 5,269) of patients with PAD who were randomized to aspirin treatment or placebo or a control group, and which included data on mortality, myocardial infarction, stroke, and major bleeding.

The results show that aspirin therapy alone or in combination with dipyridamole did not significantly reduce cardiovascular events in patients with PAD, however it did reduce the risk of nonfatal stroke. The authors suggest that these findings could be related to an underrepresentation of patients with PAD in clinical trials.

The crux of the matter. The metaanalysis found a small but not significant benefit of aspirin therapy in patients with coronary artery disease and an association between aspirin therapy and a significant reduction in nonfatal stroke in patients with PAD. Until large prospective studies are undertaken, the benefits and risks of aspirin therapy can neither be confirmed nor denied in patients with PAD.