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Cohort study
Low-dose aspirin is associated with an increased risk of haemorrhage; but not in people with diabetes who have a high baseline rate of bleeding
  1. Sonia Butalia,
  2. Alexander A Leung
  1. Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to: Sonia Butalia
    Division of Endocrinology and Metabolism, University of Calgary, 1820 Richmond Road SW, Richmond Road Diagnostic and Treatment Center, Calgary, Alberta T2T 5C7, Canada; sbutalia{at}

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Commentary on: De Berardis G, Lucisano G, D'Ettorre A, et al. Association of aspirin use with major bleeding in patients with and without diabetes. JAMA 2012;307:2286–94.

Implications for practice and research

  • Low-dose aspirin (≤300 mg/day) increases the risk of major bleeding.

  • Individuals with diabetes have a higher risk of bleeding independent of aspirin exposure.

  • Future work should include comparative effectiveness studies to help inform treatment strategies based on individual risks, benefits, patient preferences and values.


Aspirin has a proven role in the secondary prevention of cardiovascular disease.1 Further interest has emerged on extending its use for primary prevention. However, the desired benefits of aspirin need to be carefully balanced against the potential harms.1 Although the cardioprotective benefit of aspirin has been well defined, the general risk of haemorrhage remains uncertain as existing data are mostly limited to …

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  • Competing interests None.