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To the Editor: Dr Berger and colleagues¹ conducted a meta-analysis investigating aspirin for prevention of cardiovascular events in patients with peripheral arterial disease (PAD). They found that treatment with aspirin alone or with dipyridamole in patients with PAD resulted in a statistically nonsignificant decrease in cardiovascular events and a statistically significant reduction in nonfatal stroke. Although funnel plots were reportedly generated for cardiovascular events, the authors did not assess publication bias for nonfatal stroke.

In the subset of 6 randomized controlled trials of aspirin alone (including trials in which either the treatment or control group did not have any events, but excluding trials in which both groups had no events), aspirin was associated with a significant reduction in nonfatal stroke (pooled relative risk [RR], 0.64; 95% confidence interval [CI], 0.42-0.99). To assess the effect of possible publication bias, we recommend using a trim and fill adjustment.² This is an iterative . . . [Full Text of this Article]

Hisato Takagi, MD, PhD
kfgth973@ybb.ne.jp

Takuya Umemoto, MD, PhD
Department of Cardiovascular Surgery
Shizuoka Medical Center
Shizuoka, Japan

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